PCPs & Foreign Medical Graduates

Though it is nearly impossible to quantify, primary health care should be the dominant form of health care services that a person receives in his lifetime. Primary health care consists of preventive medicine, which leads to overall better health outcomes. Furthermore, I argue that for the average person suffering ailments, care from a general practitioner will more often than not suffice. In other words, during a person’s lifetime, most of his medical needs can be taken care of by a GP, who will be able to refer him to a specialist if need be.

As discussed in the Macinko article, primary care is correlated with better health outcomes. And since American primary care providers are in such short supply, more investment must be put into ensuring adequate supply of doctors for the future. Speaking from personal experience, the medical school admissions process is extremely competitive. And rightly so. I am not suggesting any alteration in medical school admissions criteria. Rather, alterations must be made to allow for more spots for prospective medical students. As Yahaira suggested, many very qualified applicants are rejected from U.S. medical schools. Some go on to study in foreign institutions and eventually return to the U.S. to train and practice.

Given the dearth of doctors graduating from American medical schools, drastic changes in U.S. medical education are called for. A first step would be to expand the class sizes of current medical schools. Another, albeit more long-term, step would be to create more medical schools. This potential endeavor is worthy of public attention—and funding.

The child of foreign-trained medical professionals, I find my global health advocacy side at odds with my I’m-happy-to-be-an-American side. As discussed in the Starfield report, the U.S. relies heavily on foreign medical graduates to fill PCP positions, correlating with poorer health outcomes in these doctors’ home countries. While I do believe it is unethical for the U.S. to continue to rely on foreign medical graduates, much of the solution lies in these doctors’ home countries. Can we really blame a foreign medical graduate from a developing country for wishing to greatly improve his/her lot in life and that of family by moving to a developed nation? On an individual level, most people would say no. Unfortunately, on a broader level, the mass migration of medical professionals away from developing countries wreaks havoc on already-fragile health systems.

There are few personal incentives to keep medical professionals of developing countries at home. This is no secret within these countries. Take, for example, what I saw when I lived in the Philippines for one year (2005-2006). I worked in rural villages and urban shantytowns in great need of medical services. Now juxtapose this with all too prevalent nursing school advertisements, boasting their ability to place graduates in foreign (first-world) hospitals. And even more egregious—accelerated nursing programs specifically designed for MDs who wish to immigrate to developed countries where nurses are in high demand.

Clearly, the need for PCPs in the U.S. is a problem that must be addressed immediately—not only for the people of this country, but also for people all over the world, particularly in countries from which our foreign medical graduates originate.