Let's Hope That Match Day Brings Us Lots Of Foreign-Born Doctors
This Friday is Match Day, an annual rite of passage for seniors in medical school, when they find out at noon if they've "matched" with a residency in the specialty and location of their choice.
But many of those being matched will be happy to go pretty much anywhere. They are international medical graduates — either U.S citizens who've attended school out of the country (think the Caribbean or Mexico) or doctors who are citizens of other countries and want to train here.
Though getting into medical school in the U.S. is highly competitive, the simple fact of the matter is that there aren't enough graduates of those medical schools to fill all of the residency training slots, especially in the less-desired primary care fields. It's been this way for decades, and we've depended on foreign-born doctors to fill out our training cohorts.
Nationwide, 24 percent of medical residents are graduates of foreign medical schools, many of them at urban hospitals that serve low-income patients or hospitals in rural areas.
Throughout my medical career, I've benefited greatly from working with doctors from other nations. Regardless of their country of origin, doctors who come to the U.S. to train and work are ambassadors of humane values, learning the mores of American culture while sharing their skills and knowledge. A recent study even suggests that patients do slightly better when treated by doctors born and educated outside of the United States.
In my days as a medical student in Cleveland, my favorite rotations were at our county hospital. There the mission was clear: Treat any patient who walked through the door. There were no insurance requirements or other barriers to patients seeking help. Another benefit was that as a student, I could get the most hands-on experience.
As a third-year medical student, I had to learn to draw blood from patients, usually the ones with the hardest-to-find veins that the regular lab techs and nurses couldn't get. I was blessed to work with a resident named Ahmad who was originally from Pakistan, where he'd trained as a surgeon.
Ahmad gave up his dreams of performing surgery when he obtained a student visa and matched in internal medicine in Cleveland. He moved his family to Ohio, where they shivered through their first experience of real winter.
Ahmad's dexterity skills were in high demand among his American-born fellow residents, who were happy to learn procedures like intubation and inserting central lines from him.
One night on call, a patient with an IV drug habit had a fever, which made us worry that he had a bloodstream infection. The problem was that his veins were so scarred that drawing blood to verify our hunch was a real challenge.
It was no problem for Ahmad. He coached me through a couple of tricks like obtaining blood from a leg vein and the external jugular vein in the neck. And he did all of this while talking the patient through it to distract him from the unpleasantness. Ahmad's skill made it easier for both of us — the patient, who didn't even flinch, and me, a wet-behind-the-ears student.
Residents like Ahmad who train in the U.S. often decide to stay here, where physician incomes are higher and educational opportunities for their children are more abundant. Because of their visa requirements, doctors like Ahmad often move to locales that find it hard to attract health care professionals, including rural and low-income areas.
I see this as a win-win: highly skilled foreigners move along the pathway to becoming permanent residents or U.S. citizens, and areas with a shortage of health professionals get doctors willing to ply their trade and become members of the community.
Such is the American melting pot in the medical profession. However, the recent rise in anti-immigration sentiment in our country threatens to undermine this balance — which leaves us vulnerable to worsening doctor shortages in smaller cities and community health centers.
The president's revised immigration executive order, which was slated to go into effect Wednesday, would cloud the picture for those who would come here to train. Foremost are those from the six countries that are temporarily banned. But other visa holders, while still allowed to travel to the U.S., may find a less welcoming environment, too.
Foreign medical graduates already undergo rigorous screening as part of the visa process, notes Darrell Kirch, CEO of the Association of American Medical Colleges. He said of the executive order in a statement: "This order will not only have short-term negative implications, but will have a lasting impact on our nation's patients, particularly those in rural and urban underserved areas."
Here's hoping that brings more Ahmads to our country's training programs. The medical profession could sure use more of that skill, worldliness and wisdom.
John Henning Schumann is an internal medicine doctor and serves as president of the University of Oklahoma's Tulsa campus. He also hosts Studio Tulsa: Medical Monday on KWGS Public Radio Tulsa. You can follow him on Twitter: @GlassHospital.
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