States are beginning to utilize an untapped resource to ease the widespread physician shortage, which has been made worse by the COVID-19 pandemic: foreign doctors.
New Jersey and New York have temporarily eased some of the licensing requirements to allow physicians who were trained in other countries to practice in their states at a time when the medical profession is particularly strained.
It’s a smart move, says Sally Pipes, president and CEO of the Pacific Research Institute.
“Welcoming more immigrant doctors to the United States is one way we can begin to narrow [the physician] shortage,” Pipes said. “While it’s important to maintain high-quality standards when determining who should be able to practice in the United States, we shouldn’t prevent competent physicians from coming here to supply the labor that the market is clearly demanding.”
One Physician’s Experience
Maqbool Halepota, M.D., an Arizona-based oncologist who trained abroad, says he had to go through enormous hoops to practice in the United States.
Halepota graduated medical school in his native country, Pakistan, and completed a residency at the Jinnah Postgraduate Medical Centre, becoming a specialist in physical medicine and rehabilitation. Halepota supervised the only artificial limb-fitting institute serving Pakistan and neighboring countries in addition to teaching at his alma mater. But when Halepota came to the United States for greater opportunity in the field, he faced a host of roadblocks.
“In order to pass the exams and get into the system in the U.S., I had to take so many steps back,” Halepota said in a Cato Institute webinar on August 5. “I feel on the average, I lost maybe half a decade of my life.”
Five Years – No Exaggeration
Foreign physicians who seek to practice in America must wade through a bureaucratic approval process dating back to the 1950s.
Graduates of international medical schools are required to submit paper copies of their application for an H-1B visa for individuals in highly skilled professions, but these forms can be hundreds of pages in length.
The H-1B visa also bars doctors from changing employers, providing care in other states, or practicing medicine that doesn’t fall under their approved specialty. Furthermore, the United States punishes foreign medical students doing their residencies stateside.
Similarly, those on a J-1 visa must return to their home countries for at least two years before being able to apply to return to the United States, with limited exceptions.
“State licensing boards require international medical school graduates who have completed post-graduate specialty training and are licensed to practice in other countries to repeat their entire post-graduate training in an accredited U.S. institution before receiving a state medical license,” wrote Jeff Singer of the Cato Institute in an op-ed for the Detroit News. “As a result, many experienced foreign-trained doctors take positions in ancillary medical fields such as nursing, lab technicians, and radiology technicians instead of starting all over again. Some even work as waiters or taxi drivers.”
The Doctor Shortage
The nation’s medical licensing laws for qualified foreign doctors are now under scrutiny, given an impending doctor shortage.
According to a June study published by the Association of American Medical Colleges, the United States is on track for an estimated shortage of between 54,100 and 139,000 in primary and specialty care physicians by 2033. Already, 80 million Americans live in an area with a designated health-professional shortage.
Congress has wide influence over the number of practicing physicians because it funds all medical residencies in the country under Medicare. Lawmakers have the authority to increase the number of slots, but in its last opportunity, the COVID-19 relief package passed in December, Congress failed to do so in a significant way. Lawmakers approved only 1,000 additional residencies over the next five years (see related article, page 3).
Some states are temporarily lifting occupational licensing laws barring doctors and other medical professionals from practicing medicine across state borders without paying fees and passing examinations.
Singer says a lift of all restrictions is needed—and that change should be codified and made permanent.
“This pandemic has taught us that state occupational licensing laws, particularly as pertains to medical licensing, have been particularly restrictive, as governors realized when they relaxed them,” Singer told Health Care News. “By suspending a lot of these regulatory obstructions, they’ve tacitly admitted that these regulations only serve to protect special interests. We should learn from this and not go back to the status quo.”
The States Could Lead
State legislatures have the authority to amend their medical licensing laws. One concern is whether foreign doctors would take jobs away from doctors in the United States, Pipes says. Physicians devote years of their lives and spend tens of thousands of dollars on clinical training.
“The United States needs many more doctors than its medical schools are producing,” Pipes said.
Singer concurs, noting that restricting trained, quality medical professionals hurts not only the medical consumer but also the medical industry because it insulates it from competition, which can improve the quality and cost of care.
“I think we should be less concerned with what hurts American doctors and more about what hurts American patients,” Singer said. “American patients are helped by quality medical care and doctors – not just in all 50 states but in other countries.”
Madeline Peltzer (mpeltzer@hillsdale.edu) writes from Hillsdale, Michigan.