Keeping Foreign Doctors Out, Keeping Health Care Prices High

On Friday I mentioned the laws in some states that prevent nurse practitioners from competing with MDs. Catherine Rampell just published a piece in The New York Times exploring another form of medical protectionism: restrictions on foreign doctors. Here's an excerpt:

Medical emergencyimmigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.

The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

The biggest challenge is that an immigrant physician must win one of the coveted slots in America's medical residency system, the step that seems to be the tightest bottleneck.

That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

The whole process can consume upward of a decade — for those lucky few who make it through.

Rampell notes that "medical services cost far more in the United States than elsewhere in the world, in part because of such restrictions." Meanwhile, the U.S. "already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care."

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  • sarcasmic||

    But, but, but I though costs were high because of greedy corporations and their evil corporate bureaucrats profiting off of misery, and that only single payer administered by selfless government bureaucrats could bring them down!

  • Dweebston||

    Greedy corporations lobby evil bureaucrats to enforce these cost-raising measures, and therefore we need more and better bureaucrats to rein in those greedy corporations. Logic!

  • wareagle||

    related to the topic: took a cruise last week and on the flight back from the port to my town, saw numerous articles in a couple of in-flight mags re: lower health care costs in places like Belize and a couple of Carribean nations, along with ads recruiting docs to the Bahamas, etc.

  • Jordan||

    I'm trying to convince my wife to take up practice in the Caribbean. She's resistant, but I'll wear her down eventually.

  • Dweebston||

    Did you try mansplaining and playing up to the male dominance paradigm? I hear those tactics are irresistable/unignorable for women.

  • ||

    You first mistake was trying to convince her. Just tell her what she's going to do. Duh!

    /sarc

  • Jordan||

    Meanwhile, Obamacare punishes non-profit hospitals for providing free care to the poor. Oh, and let's not forget about Certificate of Need laws, the perfect storm of economic illiteracy (too much competition is bad, don't you know?) and good old crony capitalism.

    But let's blame healthcare shortages on the market!

  • Caleb Turberville||

    The privileged economic protections that physicians have makes all the oaths you are required to swear ring somewhat hollow.

    I have a lot of respect for anyone that is able to buck the system and provide quality, affordable health care to their patients at the expense of their economic protections.

  • ||

    well trained ... gantlet

    Heh...

  • SIV||

    Sure, immigrant doctors can step in and fill the gaps and do a perfectly adequate job, if they are allowed to. But don't count on the Tea Party clique in Congress to have the common sense, foresight, and wisdom to allow a smart solution to immigration.

    All teabaggers' fault.

  • ||

    That's not even remotely what he said.

    And if they're going to espouse smaller government and shit like they do, then maybe they should, I don't know, actually try to reduce the size of all government, not just the government they don't like.

  • SIV||

    The "Tea Party clique in Congress" has zilch to do with raising barriers to foreign-born and trained physicians practicing in the US.

  • Zeb||

    Oh, there's plenty of blame to go around.

  • ||

    That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan.

    I don't see why would couldn't reduce the hours to 60 hours a week and increase the number of slots by 30%. Is there some particular reason why residencies need a grueling schedule? What is it like hazing or something?

  • OldMexican||

    Re: HazelMade,

    Is there some particular reason why residencies need a grueling schedule?


    Ok, repeat after me:

    C-A-R-T-E-L-I-Z-A-T-I-O-N

  • Jordan||

    Yes, this is exactly the reason. Residency slots are tightly controlled to restrict the number of physicians.

  • nova3930||

    As my wife informed me when she was in residency, there are federal regulations that govern how many doctors can be in a given residency program. In her case with family practice, they're limited by the size of the outpatient clinic they have. While she was in residency, her program completed a small expansion to the clinic and were able to increase the size of the incoming class from 5 to 6 doctors.

    The other issue is that residency slots tend to be subsidized by Medicare and Medicaid (residents are cheap labor don't you know) and there's a limitation to that funding...

  • Jesse Walker||

    What is it like hazing or something?

    An unnecessary, degrading, and sometimes dangerous ritual you must go through before being initiated into the class of licensed doctors...actually, it's a lot like hazing.

  • nova3930||

    Based on the experience my wife had, it's not so much hazing as it is purely monetary.

    The entire system is set up to get as much work out of the residents as possible with as little monetary expenditure as possible.

    Residency programs treat a lot of patients who are unable to otherwise pay, so they try to keep their costs as low as possible, which typically means ridiculous work hours and low pay.

  • OldMexican||

    The whole process can consume upward of a decade — for those lucky few who make it through


    You have nothing to worry about, not one bit. Once Obamacare kicks in full, things will only get worse from here.

  • ||

    At least my "internship", foisted on me between the profession and the .gov is only two years. After I pay the $350 initiation fee.

  • nova3930||

    4 years of undergrad, 4 years of med school and a minimum of 3 years in residency and that's for people who were born here.

    So foreign docs requiring nearly a decade is unfortunately somewhat typical....

  • Caleb Turberville||

    I'm actually starting medical school as we type. I've heard a lot of physicians express their reticence or outright opposition to the nurse practitioner issue, and most of their arguments boil down to credentialism.

  • Caleb Turberville||

    "The only exception is for doctors who did their residencies in Canada."

    One has to wonder what makes the residencies in Canada more special than the ones in Britain?

  • Anonymous Coward||

    Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

    The biggest challenge is that an immigrant physician must win one of the coveted slots in America's medical residency system, the step that seems to be the tightest bottleneck.


    Barriers to entry is a LIEbertarian myth.

  • Dr Ben||

    Stupidest article in a long time. There is a reason that ever country values graduates of our medical programs more than any other country: because the training is better. I have worked with doctors who trained elsewhere. They are killing patients regularly. The patient population is not the same and the resources are not the same. It actually matters where you trained. Shocking. Yes, we expect those practicing in this country to actually be qualified. If you think other countries' programs are the same you are a fool. If you think nurses' training is the same, you are a fool. Sure, they can cover very basic things, but it is not the same, not even close.

    The reality is that we are spending a lot of tax payer dollars training physicians from other countries who return to those countries. We do this because there are not enough qualified candidates from this country. making it easier for the unqualified to treat patients doesn't exactly help people, does it?

    Get a grip and accept that your solution is one of the worst.

  • Kreel Sarloo||

    Ah yes, a spokesman for the cartel.

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