Soon, medical trainees entering the healthcare field will start their residencies, beginning the final leg of their journey into medicine. Many of these aspiring physicians and clinicians studied internationally at overseas medical schools. While there used to be a negative stigma surrounding such students, that stigma is fading away.
This year's residency match tells the story in stark terms. Each year, healthcare aspirants apply to be placed in residency, in which they practice at a hospital under supervision with the end goal of transitioning into full-fledged doctors. This was a good year for international students seeking matches, with a percentage increase far larger than in previous years.
Dr. Fred Jacobs, executive vice president of St. George's University in True Blue, Grenada, sees the trend continuing as international medical graduates are given footing equal to that of their domestically-trained colleagues.
"The match was better this year," said Jacobs. "First of all, there were more residency slots this year than there had been in previous years -- something like 6 percent, and that's a big number, because some years it's a 1 or 2 percent increase and that's it."
There are a number of reasons for the increase, but the bottom line is that the numbers are good for the healthcare industry. Physician shortages threaten quality and access in many areas, current doctors are feeling the strain, and internationally-trained students could play a big role in filling the void.
THE PHYSICIAN SHORTAGE
Pinning down exact numbers for the physician shortage is a tricky endeavor because, according to Jacobs, it depends on how the calculation is done. A lot of the figures are extrapolated nationwide, but the scenario is different in specific localities.
The generally agreed-upon number is a shortage of between 90 and 100,000 physicians by the year 2030, said Jacobs. Many current physicians are already feeling the squeeze, working upward of 20 hours a day in some cases. Doctors are known for their work ethic, but fewer physicians are willing to work those kinds of hours, meaning productivity is declining and doctors are spending less time with patients.
"If you look at the average age of physicians in states like New Jersey, it's high, and while doctors are working longer, they're looking at retirement," said Jacobs. "They want to stop. It's not as much fun anymore. There's regulations, hospital regulations, the continuing education for licensure maintenance … all of those things become more of a hassle. The physician shortage is real this time."
It isn't a lack of medical students that's contributing to the shortage. There are high numbers of both American and international applicants. Rather, it's the constriction of graduate medical education; there simply aren't enough residency slots.
More residency slots would help to alleviate the problem, but increasing the number of those slots could prove politically complicated. There's a bill currently in Congress, said Jacobs, that would increase residency slots by 5,000 per year over the next several years, but to do that under the conventional funding mechanism would require Medicare funds to be expanded.
Lawmakers on both sides of the aisle have been reticent to increase funding for graduate medical education, and in a fraught political environment, an increase could be a long way off, if it even happens at all.
In the meantime, more of those residency slots are going to students, many of them American, who have studied overseas. The stigma is quickly becoming a thing of the past.
INTERNATIONAL STUDENTS GET THEIR DUE
So why did international medical graduates have such a good year in terms of the residency match? There are few things going on.
"It's a measure of a number of things," said Jacobs. "Medical directors see high-quality international medical students, particularly Americans studying outside the United States. They see them in their medical programs and they like what they see. They work hard, they come early, they stay late.
"Sometimes they didn't get into American medical school, not because of lack of metrics, but lack of space," he said. "For years, that's been a stigma. Some students were substandard, but many students were not. There was just a substandard opportunity for them, and that has changed a little bit now. There's less of a stigma. The ability of hospital program directors to accept international students unashamedly has increased, and this year was a good year for that."
Angus Acton, an international medical school student and aspiring radiologist from St. George's who found placement in this year's match said there were several positive aspects to studying abroad.
"I actually think it was an advantage to be so far removed geographically, but also from the distractions of family, friends, all that other stuff," said Acton. "If I was in the U.S., it would have decreased the amount of time I studied. And going to medical school is a different beast. In medical school, if you're not spending 80 percent of your free time studying, you're not performing well."
Acton said the infrastructure in Grenada lent itself to the kind of focus necessary to do well in his education. There's a KFC and a Subway, and a few sports bars are starting to pop up, perhaps trying to glean business from the medical students studying on the island. There may be the odd rolling blackout or two, but all told the experience is remarkably … American.
Perhaps that's another reason international students are starting to earn more respect.
"In the back of my mind I knew of the stigma, but it didn't factor into my thinking too much," said Acton. "For me it was just an opportunity to learn. I mean, year, they're for-profit colleges, but I would have lost a year of time by not going to the Caribbean. I wanted to be a doctor. I didn't care how I got there."
One the ways in which residencies used to be judged was by how many Americans were in the program. It signified the organization was of a sufficiently high quality to attract a large pool.
While that still holds true in some cases, there's a growing recognition that international schools are high quality, and comparable to the medical schools located in the U.S.
In fact, most of the schools that train Americans in the Caribbean use the American model: two years of science, two years of clinical rotation, and then space in accredited hospitals. The model is basically identical.
Aspiring doctors typically do their electives at a hospital in which they'd like to do their residencies so the organization has a chance to see them perform up close. Some program directors don't accept someone into their program unless they've seen them there; it's an important decision for the directors to make.
In New York and New Jersey, where Jacobs still occasionally practices medicine, the only programs that can send students to residency are the ones approved by the state. The requirement to be approved in New York is lengthy, involving at least a two-year review process.
As a result, the New York medical school establishment has very little problem with the quality of the international medical students who are coming ashore. And by no means are all the schools Caribbean. Schools from Eastern Europe, the Philippines, and the Middle East all have systems that are comparable to the American system. British and South Asian schools have a tougher time matching students because their programs are different, incorporating training that begins in high school -- non-collegiate pre-med, essentially.
"The schools that are doing well academically will continue to have an important role in the U.S. healthcare system because there isn't the ability to expand the number of medical schools in the U.S. sufficiently so that that alone would be the answer," said Jacobs. "Many schools are state schools, so state legislatures would have to approve more funding. That's probably a significant barrier. Private medical schools have a problem doing it because of the money it costs. It can't be supplied on tuition alone."
Until and unless the domestic picture changes, international students will likely continue to play a bigger and bigger role in filling out the U.S. physician workforce. Acton begins his residency this year.
"If it's something you're even considering, I would say don't hesitate," said Acton. "I kind of let time and outside factors determine my trajectory. I wasn't proactive at all, and I was pretty naive at the time. Definitely be proactive about it. Research all the options. Do what makes sense financially and geographically. As students we know we're going into essentially crippling debt, whether it's in the U.S. or otherwise, so try to add value to that time."