Foreign medical graduates formidable allies when fighting physician shortage

Sometimes serenity is a sinister sensation — bubbling up where and when it shouldn’t, sheathing nerves with a proverbial veil while perils gather at its fringes. It’s this treacherous sense of calm that now cloaks the physician profession even as the furious clouds of occupational shortage cluster ominously above. And with the Affordable Care Act (ACA) charging the air even more, doctors practicing now and those currently being trained are in for a monumental soaker if the climate doesn’t change its course.

Peter J. Landis of the firm Landis Arn & Jaynes, P.A. located in Portland, Maine, hails this atmosphere as “the perfect storm” — a “physician-shortage tsunami” of sorts headed straight for American healthcare as we know it.

“I don’t think I need to preach to the choir to you about the shortage of physicians in this country,” Landis said. “But we have a critical shortage that’s grown increasing over the last ten years and there really is no end in sight, particularly for primary care.”

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” G. Richard Olds, MD, dean of the new medical school at the University of California, Riverside, told the New York Times. Regarding his region, he added: “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

Olds’ last assertion packs a startling accuracy for the entire nation — in the case of the physician’s role especially, the only alleviant to shortage is time, a component few have harnessed. Typically, a decade is needed to train a doctor and since medical schools began capping enrollment in 1980, only a select, small group of candidates have been allowed down that 10-year stretch at a time. Thus, while the number of newly trained physicians entering practices each year has remained fairly constant (around 15,500), other factors, such as ACA and a retiring horde of baby boomer doctors, have increased at a far faster rate than there are new physicians to handle it. Like Olds said, there is little else anyone can do now except wait 10 years until the greater number of doctors now permitted to enter med school exit from the other side of the training tunnel. 

Yet despite this inevitability of shortage — according to the Association of American Medical Colleges, the country will have 62,900 fewer doctors than it will need in 2015, a number that is projected to more than double by 2025 — practice managers and medical staffers are banning together to do whatever they can to make the blow a little less devastating. Physicians in Georgia are employing video dial-a-doc technology to converse with more patients in less time, and more states are starting to fully develop their foreign medical graduate resources to place qualified physicians in areas of need. Within this latter group, Landis finds an abundance of opportunity regarding the preservation of primary care, a vision he discussed during his seminar at the New England Clinical Symposium and Workforce Summit.     

 “Of the more than 100,000 residents and fellows in training here in the U.S., 25 percent of them are foreign medical graduates who come here to obtain graduate medical training — either residency training or voucher training,” Landis said.

As practitioners, these foreign hands are among the best in the world Landis added. “These physicians…generally they come here after practicing in their home countries. They are really highly motivated, highly skilled folks. There’s a recent study that shows that foreign-trained physicians in the U.S. [deliver] better results than U.S.-trained physicians. Which is at first surprising, but then you realize that these are folks have practiced abroad — I’ve seen cardiologists doing transplant surgery come over here and have to redo resident training in internal medicine. I don’t know what drives these folks. They’re the cream of their crop in their own countries, they’re living well, but they still want to come here.”

Regardless of the obvious talent, though, there are still several pitfalls riddling the path to practice that have left such helpers in a bind.

“Congress, years ago, made it more difficult for foreign medical graduates to remain in the U.S.,” Landis noted. “There’s a provision called 212 (e) of the Immigration Nationality Act which basically says that persons who come to the U.S. as an exchange visitor [or] J-1 physician or a J-1 exchange visitor trying to take post-graduate medical training — and that’s the vehicle that most doctors come to the U.S. with and are training on — before you can either change your status in the U.S. to the primary work status or non-immigrant work status, which is an H-1B temporary worker, or acquire permanent residence in the U.S., you have to go home  for two years at the end of your training program.”

Landis mentioned that each state possesses a Conrad 30 waiver program, through the department of public health or equivalent agency, which “provides each state with the ability to sponsor up to 30 waivers a year annually — year-round from October 1 to September 30.”

With shortage demanding all hands and buckets be on deck, Landis encouraged practices looking to add a foreign medical physician to their staff to reference their state’s Conrad 30 roundup and make sure paperwork is in order. After all, the devil with these docs is in the documents.

To avoid the agony, attention to detail is key: “It’s really all logistical — making sure that everything lines up,” Landis said. “You’ve got the waiver, you’ve got the licensing and…are able to file the H1-B petition. Fortunately there is a way to expedite the processing of H1-B petitions. Normally it takes three months for USCIS to process an H1-B, but USCIS has found a way to raise a lot of money by expediting your request and processing the case within 15 days on payment of an additional fee of $1,225. So we can, in essence, get within a couple of weeks an H1-B petition to get processed. Once the H1-B petition gets approved, then the physician can start working.”

In states like Maine and New Hampshire, successfully bringing J-1 physicians on board has resulted in impressive retention rates (72 percent and 80 percent respectively). Officials also noted that in Maine, 28 J-1 physicians have had a powerful economic impact — $22 million worth in rural areas, according to 2007 statistics alone.

At the end of the day and in the eye of the storm, J-1 physicians are worth the paperwork and fees, especially given their immense, ready-to-engage talents.

“It just blows you away, their skill level,” Landis said.