as a recent eight-nation bracket tournament in the new york times showed
and i've discussed that a lot many people think the united states
healthcare system has a lot of problems so it seems reasonable to think of
policy changes that make things better not worse making it harder for
immigrants to come here to practice medicine would fail that test that's the
topic of this week's healthcare triage
by any objective standard the United States trains far too few physicians to
care for all the patients who need them we rank towards the bottom of developed
nations with respect to medical graduates per population when physicians
graduate from medical school they spend a number of years in a residency program
I did not enjoy mine although they have their degrees we still require them to
train further in the clinical environment to hone their skills
residents are more than learners though they're doctors they fill a vital role
in caring for patients in many hospitals across the country we don't have enough
graduates even to fill residency slots this means that we're reliant on
physicians trained outside the country to fill the gap a 2015 study found that
almost a quarter of residents across all fields were foreign medical graduates
and more than a third of residents and sub specialist programs were even
training aside foreign medical graduates are also responsible for a considerable
share of physicians practicing independently today about a quarter of
all doctors in the United States are foreign medical graduates as in many
other fields foreign medical graduates work in many of the areas that other
doctors find less appealing more than 40% of the American primary care
workforce is made up of people who trained in other countries and moved
here more than half of all the people who focus on caring for older people or
geriatricians are foreign medical graduates as well as if this weren't
enough foreign medical graduates are more likely to practice in geographic
areas of the country where there are physician shortages like non urban areas
and they're more likely to treat Medicaid patients - as a physician who
graduated from a domestic medical school I've often heard others disparaging
doctors who went to medical school outside this country as if they were
inferior those complaints are not supported by data study from health
Fair's in 2010 found that patients with congestive heart failure or myocardial
infarction had lower mortality rates when treated by doctors who were foreign
medical graduates another from earlier this year in the BMJ found that older
patients who were treated by foreign medical graduates had lower mortality as
well even though they seemed to be in general in other words foreign
medical graduates take care of patients who appear to be more ill but seem to
achieve better outcomes a recent study in annals of internal medicine shows
that these graduates are also responsible for a significant amount of
teaching of the 80,000 or so academic physicians in this country more than 18%
were foreign medical graduates more than 15% of full professors and medical
schools in the u.s. were educated elsewhere most often in Asia Western
Europe the Middle East Latin America and the Caribbean foreign medical graduates
also do a lot of research although they are ineligible for some NIH funding
which is granted only to citizens of this country they still manage through
collaboration to be primary investigators on 12 and 1/2 percent of
grants they led more than 18% of clinical trials in the US and were
responsible for about 18% of publications in the medical literature I
spoke to the lead author of the study Dhruv cooler who's a physician at New
York Presbyterian Hospital and a researcher at Weill Cornell he said and
I'm quoting our findings suggest that by some metrics these doctors account for
almost one-fifth of academic scholarship in the United States the diversity of
American medicine and the conversations ideas and breakthroughs this diversity
sparks may be one reason for our competitiveness as a global leader in
biomedical research and innovation the United States is not the only country
that relies on doctors trained or educated in other countries we're not
even the country with the highest percentage of such physician according
to data from the OECD almost 58 percent of physicians practicing in Israel are
foreign medical graduates about 40 percent of doctors in New Zealand and
Ireland we're also trained outside those country
because of the sizes of those nations even though the percentages of foreign
medical graduates are higher there the total numbers aren't as high as in the
u.s. though in 2015 the OECD estimated that the United States had more than two
hundred and thirteen thousand foreign trained doctors and no other country
comes close Britain had about 48,000 Germany about thirty-five thousand and
Australia France and Canada had between 22 and 27 thousand I've listened to
people tell me stories of physicians who leave Canada because they were
dissatisfied about working in a single-payer health care system that
might have been true debt to go but in the last 10 years that
number has dropped precipitously the number of Canadians returning to their
country to practice may actually be higher than the number leaving and
although many feared the coverage expansions from the Affordable Care Act
might lead to an overwhelmed physician workforce that didn't happen that
doesn't mean that America doesn't have a shortage of physician services as we've
discussed in previous episodes especially when it comes to the care of
the oldest the poorest and the most geographically isolated among us even
though we know foreign medical graduates care for these patients just
proportionally we make it very difficult for many born and trained elsewhere to
practice here some Americans need those doctors desperately all the evidence
seems to suggest that policies should be made to attract them not deter them
sometimes talking about drugs and sex education and health insurance aren't
advertising friendly and making those important videos could actually hurt our
bottom line healthcare triage is made possible in part therefore by our
supporters at patreon the support we receive from our patrons at patreon
allows us to keep making those kinds of videos without worrying about ad revenue
so thanks to all of them and particularly thanks to our surgeon
Admiral Sam and Research Associates Joe sevens and Joshua Crowe if you'd like to
support the show we'd really appreciate it you can go to patreon.com/scishow
there tree up while we're asking you to do stuff please consider subscribing to
the show consider buying some healthcare triage
merch as the holidays come up at HCT merch calm and I've got a book coming
out in November 7th the bad food Bible available anywhere you'd buy books and
I'd really appreciate your picking up a copy
you
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