Physicians, Residents and Foreigners Oh My!

I was catching up on reading a stack of newspapers that had piled up while pondering what to write for this week’s blog when the answer leapt out at me from the front page of the Sunday local Lancaster, Pennsylvania newspaper.  Front and center was an article entitled DOCTORS WITHIN BORDERS.

Since 2006, 7,000 Cuban doctors and other healthcare professionals have been admitted to the US under a special government program. The article went on to detail how Church World Services (CWS), a volunteer agency (VOLAG) that specializes in refugee relocation services and garnering large federal government grants in the process, helped to relocate these Cuban healthcare workers here and in 11 other cities.

The article profiled Cuban defector, Dr. Maily Betancourt who is currently working as a caregiver and studying in her spare time to pass US medical licensing exams so she can practice as a doctor once again.  For decades Cuba has been renting out its doctors and nurses to foreign countries as way to earn cash and valuable commodities such as oil.  In the exchange, Cuba makes billions of dollars a year and its doctors earn what can be considered subsistence pay.  Dr. Betancourt exemplifies the thousands of Cuban doctors who have “made their way” to the United States to find a better life.

I was intrigued to read the article because last summer when I was attending Politicon in Pasadena, CA I had the opportunity to interview Dr. Doug Medina, a graduate of Georgetown University’s medical school who despite his never having failed any clinical course work, and having passed all three licensing exams, was not able to matriculate into a residency training program.  Now for those not familiar with medical career paths, following graduation if a doctor cannot be matched with a US residency program at a teaching hospital, they cannot be licensed to practice medicine in the US.  It is pretty brutal when you consider a student upon completing medical school could be hamstrung with anywhere from $130,000 to $250,000 in student loan debt (and quite possibly more if you factor in 4 to 5 years of pre-med.) Then to add insult to injury, there is the ever accruing interest at 6.7% which could raise a student’s total liability to over $400,000 over the term of the loans.

According to data from the National Resident Matching Program (NRMP), a program that was established in 1952 to assist medical school graduates with finding residency programs in 2016, of 19,692 graduates from US medical schools, 1,900 were not matched with a residency program.  Currently, it is believed that there are some 9,000 graduates of US medical schools who were not matched with a residency program and for all intensive purposes will never be able to practice as doctors.

It would be one thing if as in the case of Cuba, education was government funded.  Here in the US it is not.  And the onus is on the student and their family to come up with ways to finance their education.  The question then becomes how is a medical school graduate going to service the debt on their loans if they cannot command the salary of a doctor?  If plan B is to become a high school biology teacher or a research assistant, then good luck servicing your debt, buying a house, car, and starting a family. . .

Although in 2016 there were 1,900 graduates of US medical schools that were not matched with a residency program, in the same year, 3,769 foreign trained physicians (FTP) were matched with residency programs here in the United States.  At first glance this may sound absurd and sadly, the more one delves into it, it only seems to become more absurd.

Without a doubt there are many areas across this country that are underserved when it comes to physicians.  This is why there is a clamor to admit more FTPs.  There are solutions.   But we must be prepared to bridle the special interests that have helped to create a situation where on one hand, there are patients who cannot get adequate healthcare, and on the other we have medical school graduates that are not allowed to practice because they cannot get into a residency program.

One solution could be to increase the federal healthcare budget and create more resident positions at teaching hospitals.  You see, residency training in the United States is funded in part by Medicare.  The salary of about $50,000 per year a resident receives is paid out of Medicare.  Another solution would be to cut down on the number of resident positions given to FTPs.  For instance, if the number of FTPs matched with a residency program had been dropped from 3,769 to 1,896 in 2016, every graduate of US medical schools would have been admitted to a residency program.

Another thing to consider would be to reign in the VOLAGs such as CWS who have actively lobbied lawmakers to admit more refugees.  These VOLAGs are given federal grants based on the number of refugees (or doctors from Cuba) they work to resettle in the United States.  This is big money.  In the case of CWS, 70.8% or $68,448,159 of last year’s income came directly in the form of grants from the Federal Government.  Another solution might be to take a chunk of the $68 million given to CWS and allocate to fund more resident programs.  At $50,000 a resident position, the money reallocated from CWS to Medicare could create roughly 1,368 new positions.

In addition, the topic of FTPs must also be viewed holistically.  The article referred to the arrival of Cuban doctors as an “unprecedented influx of talent.”  That may very well be as for very little investment, the US gets to reap the benefit of a person’s education and experience. In the case of Dr. Betancourt, that is schooling from elementary through medical school, residency/ internship, and 15 years of practicing as a physician.

However, our gain is the sending country’s loss.  These sending countries need doctors, nurses, technologists, engineers, mathematicians, and scientists also.  In fact, their needs may be greater than ours.  This brain drain is a double edged sword that is hurting the citizens in this country as well as countries of origin.


5 thoughts on “Physicians, Residents and Foreigners Oh My!

  1. Judie Conant says:

    I am extremely sickened to know this is going on. Our government is
    quite lopsided in it’s thinking and handling of funds it distributes for
    the Cuban’s when our natural citizens need the residency positions.
    Trump needs to get his act together and read about this stuff and do
    something about it so our people don’t fall through the cracks. I voted
    for him to Make America Great Again, not to tear it down. What a
    disgusting revelation this is.

  2. Michael McGrath says:

    Another “huge”area that needs investigated on the Physcians from Cuba is the educational equivalent, especially Medical School and residencies. As a licensed and Nationally Certified Physician Assistant (PA-C) for over 40 years now retired a number of the Cuban Physicians I have worked with are overall very compassionate and genuinely nic people. However, their training is paltry compared to U.S., Canadian, British, South African, India, China to cite a few.
    This is my and only my experience.
    Now some years ago a large group of Cuban Doctors who had immigrated from Cuba to Miami could not get licensed so they wanted to challenge to take the P.A. National Certification exam, totally against rules and regulations of rhe Board since these people were not trained as PA’s in the U.S.A. under rigorous specifications in U.S. Finally, I don’t remember how the rules were bent for them and only them, they were allowed to sit and take the exam. All flunked.
    Later they were able to take the exam again and still flunked.
    They were not trained in the many medical areas and the stringent courses in the PA field, not their fault just the way it is, so how are thet ever to practice as qualified, up to date Physicians in this country.
    Now I recognize there may be a miniscule group who may but I believe that is the exception.
    Now, are we opening up the border to less trained individuals to ply their profession pn unsuspecting American public just so the sponsoring agencies can fleece Federal and State governments for $ millions to increase their coffers ?

  3. Bonnie Loranger says:

    I already answered on Anne’s Corcoran’ page. But I will add this:
    First, we must get rid of all the blood sucking immigration agencies They bring these immigrants in so they can fill their own deep pockets. They do not work for the good of this country and its citizens but for THEMSELVES.
    Second, lets petition the White House for their removal aggressively.
    Third: ask for an audience with the President . I do not know how to do that but I am sure some people will know.
    Heck what do we have to loose.

  4. Sandra says:

    I just sent Ann articles on Shortage of qualified American Teachers so we now are importing Teachers from the Philippines
    Why wont colleges just tell American students we are going to put you in debt forever and you won’t get hired in your own country

  5. Carol says:

    About 2005, a caregiver I knew qualified for nursing school, but there were no places. If CA had built another nursing school, thousands of American grads could be nurses now. No, hospitals prefer nurses from the Philippines. They have babies here, instant U.S. citizens due to misinterpret. of the 14th amend. At age 18, former babies sponsor other family members for LIFE here, many with U.S.-tax-paid benefits.

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