I was catching up on reading a stack of newspapers that had piled up while pondering what to write for this week’s blog when the answer leapt out at me from the front page of the Sunday local Lancaster, Pennsylvania, newspaper. Front and center was an article about more than 240 Cuban doctors who have resettled in Lancaster, with more to come.
Since 2006, 7,000 Cuban doctors and other healthcare professionals have been admitted to the United States under a special government program. The article detailed how Church World Services (CWS), a volunteer agency (VOLAG) that specializes in refugee relocation services and garnering large federal government grants in the process, helped to relocate these Cuban healthcare workers here and in 11 other cities.
The article profiled Cuban defector, Dr. Maily Betancourt, who currently works as a caregiver and studies in her spare time to pass U.S. medical licensing exams, so she can practice as a doctor once again. For decades, Cuba has been renting out its doctors and nurses to foreign countries as a way to earn cash and valuable commodities such as oil. In the exchange, Cuba makes billions of dollars a year, and its doctors earn what can be considered subsistence pay. Dr. Betancourt exemplifies the thousands of Cuban doctors who have “made their way” to the U.S. to find a better life.
I was intrigued to read the article because last summer when I was attending Politicon in Pasadena, California, I had the opportunity to interview Dr. Doug Medina, a graduate of Georgetown University School of Medicine. Despite never having failed any clinical course work, and having passed all three licensing exams, Medina was unable to matriculate into a residency training program.
For those unfamiliar with medical career paths, following graduation, if a doctor cannot be matched with a U.S. residency program at a teaching hospital, he cannot be licensed to practice medicine in the U.S. It is pretty brutal when you consider a student, upon completing medical school, may be hamstrung with anywhere from $130,000 to $250,000 in student loan debt (and quite possibly more if you factor in four to five years of pre-med education). Then to add insult to injury, there is the ever-accruing interest at 6.7 percent which could raise a student’s total liability to more than $400,000 over the term of the loan.
According to data from the National Resident Matching Program (NRMP), a program that was established in 1952 to assist medical school graduates with finding residency programs, in 2016, of 19,692 graduates from U.S. medical schools, 1,900 were not matched with a residency program. Currently, it is believed that there are some 9,000 graduates of U.S. medical schools who were not matched with a residency program and for all intents and purposes will never be able to practice as doctors.
It would be one thing if, as in the case of Cuba, education was government funded. Here in the U.S., it is not. And the onus is on students and their families to come up with ways to finance the long-term educational commitment. The question then becomes: How are medical school graduates to service the debt on their loans if they cannot command doctors’ salaries?
If Plan B is to become a high school biology teacher or a research assistant, then good luck servicing the tremendous debt, buying a house and car, and starting a family.
Although in 2016 there were 1,900 graduates of U.S. medical schools who were not matched with a residency program, in the same year, 3,769 foreign trained physicians (FTPs) were matched with residency programs here in the U.S. At first glance this may sound absurd. Sadly, the more one delves into it, it only seems to become even more absurd.
Without a doubt there are many areas across this country that are underserved when it comes to physicians. This is why there is a clamor to admit more FTPs. There are solutions. But we must be prepared to bridle the special interests that have helped to create a situation where, on one hand, there are patients who cannot get adequate healthcare, and on the other we have medical school graduates who are not allowed to practice because they cannot get into residency programs.
One solution could be to increase the federal healthcare budget and create more resident positions at teaching hospitals. You see, residency training in the U.S. is funded in part by Medicare. The salary of about $50,000 per year a resident receives is paid out of Medicare.
Another solution would be to cut down on the number of resident positions given to FTPs. For instance, if the number of FTPs matched with a residency program had been dropped from 3,769 to 1,896 in 2016, every graduate of a U.S. medical school would have been admitted to a residency program.
Another thing to consider would be to reign in the VOLAGs such as CWS which has actively lobbied lawmakers to admit more refugees. These VOLAGs are given federal grants based on the number of refugees (or doctors from Cuba) they work to resettle in the U.S. This is big money. In the case of CWS, 70.8 percent or $68,448,159 of last year’s income came directly in the form of grants from the federal government. Another solution might be to take a chunk of the $68 million given to CWS and allocate to fund more resident programs. At $50,000 a resident position, the money reallocated from CWS to Medicare could create roughly 1,368 new positions.
In addition, the topic of FTPs must also be viewed holistically. The article referred to the arrival of Cuban doctors as an “unprecedented influx of talent.” That may very well be, as for very little investment, the U.S. reaps the benefit of a person’s education and experience. In the case of Dr. Betancourt, that is schooling from elementary through medical school, residency/internship and 15 years of practicing as a physician.
However, our gain is the sending country’s loss. These sending countries need doctors, nurses, technologists, engineers, mathematicians and scientists also. In fact, their needs may be greater than ours. This brain drain is a double-edged sword that is hurting the citizens in this country, as well as countries of origin.
A version of this post first ran in the Institute for Sound Public Policy blog on 17 November 2017.
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