Foreign medical graduates and mid-levels will provide the majority of tomorrow's primary care

The primary care shortage has been extensively chronicled on this blog.

Thomas Chappell writes about what is it like to be in Maryland (via Dr. Wes), where there are 16 percent fewer physicians per capita compared to the rest of the country.

Well, you get a situation where mid-level providers like NPs and PAs see an increasing number of patients.

Currently, 24 percent of mostly primary care training positions are filled with international medical graduates. That number will also likely rise.

Not that there’s anything wrong with NPs, PAs, and IMGs. The majority of them provide exceptional care.

Soon, specialists will uniformly be comprised of American medical graduates, while the majority of generalists will be composed of mid-levels and foreign-trained physicians.

It’s an interesting demographic glimpse of the future American medical workforce.

Comments

Manalive
Just got back from Prime Med in Baltimore. It was jarring how few young men were there.
Anonymous
Maryland, like Connecticut, metro NYC, New Jersey and parts of California has a combination of high living costs, mostly through real estate costs and state income taxes along with a high social services demand. Medicaid pays poorly in Maryland, and managed care entities represent a large segment of the private and public insurance market. Practice operating costs are very high, largely due to the expensive labor market and the expensive commercial real estate market. Local and state governments tax businesses heavily as well. Even though there is an urban and suburban culture that is attractive to educated workers, there has been a net loss of physicians in the area, as many find the costs too high for startup and salaried positions less competitive with many other areas of the country. Using extenders might seem like a good idea, but the prevailing conditions affect them as well.
Anonymous
lumping IMGs with mid-levels is absurd.
IMGs go through the same rigorous training programs (if not more rigorous inner-city understaffed residencies) as american grads.
Oh yeah, and they are DOCTORS.
Mary
What about those of us Americans training abroad? I’m currently doing my MD at Oxford and am disgusted that I might be lumped into the same group as mid-level practitioners. I think the number of Americans choosing to do med school abroad is likely to increase, as many foreign medical schools (Oxford included) end up costing far less to train.
Anonymous
Mary,
As long as you pass your USMLE well, I doubt your having been from Oxford is going to be any problem. Ditto for any other highly-regarded institution, Imperial, Cambs, Wits, etc. But you will have to pass. The only easier integration of extra-territorial medical school education in the USA is with Canadian universities which are treated equivalently to US schools.
Rian
Anon and Mary are both corrent. The constant relegation of FMGs to little more than mid-levels is absolutely ridiculous, and it comes across as a superiority thing that has little basis in reality. If we’re all about evidence in healthcare, where is the evidence that those not trained in medical schools in the US are statistically more likely to be poorer physicians?
Until such a time as there’re studies that show this, it would be nice to stop seeing that kind of built-in class bias. It doesn’t do meaningful, productive discussion about the primary care problem any favors, and quite likely holds back productive dialog on the issue.
And as it happens, Kevin, this foreigners-as-experts phenomenon is hardly unique to medicine. Many people in graduate school and/or doing post-doc work aren’t from the United States, regardless of discipline. I believe that healthcare is an anomaly in this regard where medicals schools in the US still get most of their student body domestically. In that respect, medical schools are very much behind the curve in this trend. If you’re going to take the superiority stance, this is your silver lining.
Personally, I don’t have a problem with experts being foreign. I’d much prefer the brain drain to work in my country’s favor. You’ll need to really worry when practicing medicine in other countries becomes more attractive than the prospect of practicing it here. Until then, long-live the brain drain.

Foreign medical graduates and mid-levels will provide the majority of tomorrow’s primary care

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