Physicians, Residents and Foreigners Oh My!

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 entitled DOCTORS WITHIN BORDERS.

Since 2006, 7,000 Cuban doctors and other healthcare professionals have been admitted to the US under a special government program. The article went on to detail 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 is currently working as a caregiver and studying in her spare time to pass US 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 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 United States to find a better life.

I was intrigued to read the article because last summer when I was attending Politicon in Pasadena, CA I had the opportunity to interview Dr. Doug Medina, a graduate of Georgetown University’s medical school who despite his never having failed any clinical course work, and having passed all three licensing exams, was not able to matriculate into a residency training program. Now for those not familiar with medical career paths, following graduation if a doctor cannot be matched with a US residency program at a teaching hospital, they cannot be licensed to practice medicine in the US. It is pretty brutal when you consider a student upon completing medical school could be hamstrung with anywhere from $130,000 to $250,000 in student loan debt (and quite possibly more if you factor in 4 to 5 years of pre-med.) Then to add insult to injury, there is the ever accruing interest at 6.7% which could raise a student’s total liability to over $400,000 over the term of the loans.

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 US medical schools, 1,900 were not matched with a residency program. Currently, it is believed that there are some 9,000 graduates of US medical schools who were not matched with a residency program and for all intensive 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 US it is not. And the onus is on the student and their family to come up with ways to finance their education. The question then becomes how is a medical school graduate going to service the debt on their loans if they cannot command the salary of a doctor? If plan B is to become a high school biology teacher or a research assistant, then good luck servicing your debt, buying a house, car, and starting a family. . .

Although in 2016 there were 1,900 graduates of US medical schools that were not matched with a residency program, in the same year, 3,769 foreign trained physicians (FTP) were matched with residency programs here in the United States. At first glance this may sound absurd and sadly, the more one delves into it, it only seems to become 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 that are not allowed to practice because they cannot get into a residency program.

One solution could be to increase the federal healthcare budget and create more resident positions at teaching hospitals. You see, residency training in the United States 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 US medical schools would have been admitted to a residency program.

Another thing to consider would be to reign in the VOLAGs such as CWS who have 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 United States. This is big money. In the case of CWS, 70.8% 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 US gets to reap 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.