Policy

Keeping Foreign Doctors Out, Keeping Health Care Prices High

Protectionism and medicine.

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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 emergency

immigrant 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."