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By any objective measure, the United States doesn't train enough medical doctors to meet the nation's needs. That means graduates from other countries are needed. Aaron takes a look at foreign medical graduates, an essential element of America's health care system.

This episode was adapted from a column Aaron wrote for the Upshot. Links to further reading and sources can be found there:

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as a recent eight-nation bracket tournament in the new York times showed and i've discussed that a lot many people think the united states healthcare system has a lot of problems so it seems reasonable to think of policy changes that make things better not worse making it harder for immigrants to come here to practice medicine would fail that test that's the topic of this week's healthcare triage by any objective standard the United States trains far too few physicians to care for all the patients who need them we rank towards the bottom of developed nations with respect to medical graduates per population when physicians graduate from medical school they spend a number of years in a residency program I did not enjoy mine although they have their degrees we still require them to train further in the clinical environment to hone their skills residents are more than learners though they're doctors they fill a vital role in caring for patients in many hospitals across the country we don't have enough graduates even to fill residency slots this means that we're reliant on physicians trained outside the country to fill the gap a 2015 study found that almost a quarter of residents across all fields were foreign medical graduates and more than a third of residents and sub specialist programs were even training aside foreign medical graduates are also responsible for a considerable share of physicians practicing independently today about a quarter of all doctors in the United States are foreign medical graduates as in many other fields foreign medical graduates work in many of the areas that other doctors find less appealing more than 40% of the American primary care workforce is made up of people who trained in other countries and moved here more than half of all the people who focus on caring for older people or geriatricians are foreign medical graduates as well as if this weren't enough foreign medical graduates are more likely to practice in geographic areas of the country where there are physician shortages like non urban areas and they're more likely to treat Medicaid patients - as a physician who graduated from a domestic medical school I've often heard others disparaging doctors who went to medical school outside this country as if they were inferior those complaints are not supported by data study from health Fair's in 2010 found that patients with congestive heart failure or myocardial infarction had lower mortality rates when treated by doctors who were foreign medical graduates another from earlier this year in the BMJ found that older patients who were treated by foreign medical graduates had lower mortality as well even though they seemed to be in general in other words foreign medical graduates take care of patients who appear to be more ill but seem to achieve better outcomes a recent study in annals of internal medicine shows that these graduates are also responsible for a significant amount of teaching of the 80,000 or so academic physicians in this country more than 18% were foreign medical graduates more than 15% of full professors and medical schools in the u.s. were educated elsewhere most often in Asia Western Europe the Middle East Latin America and the Caribbean foreign medical graduates also do a lot of research although they are ineligible for some NIH funding which is granted only to citizens of this country they still manage through collaboration to be primary investigators on 12 and 1/2 percent of grants they led more than 18% of clinical trials in the US and were responsible for about 18% of publications in the medical literature I spoke to the lead author of the study Dhruv cooler who's a physician at New York Presbyterian Hospital and a researcher at Weill Cornell he said and I'm quoting our findings suggest that by some metrics these doctors account for almost one-fifth of academic scholarship in the United States the diversity of American medicine and the conversations ideas and breakthroughs this diversity sparks may be one reason for our competitiveness as a global leader in biomedical research and innovation the United States is not the only country that relies on doctors trained or educated in other countries we're not even the country with the highest percentage of such physician according to data from the OECD almost 58 percent of physicians practicing in Israel are foreign medical graduates about 40 percent of doctors in New Zealand and Ireland we're also trained outside those country because of the sizes of those nations even though the percentages of foreign medical graduates are higher there the total numbers aren't as high as in the u.s. though in 2015 the OECD estimated that the United States had more than two hundred and thirteen thousand foreign trained doctors and no other country comes close Britain had about 48,000 Germany about thirty-five thousand and Australia France and Canada had between 22 and 27 thousand I've listened to people tell me stories of physicians who leave Canada because they were dissatisfied about working in a single-payer health care system that might have been true debt to go but in the last 10 years that number has dropped precipitously the number of Canadians returning to their country to practice may actually be higher than the number leaving and although many feared the coverage expansions from the Affordable Care Act might lead to an overwhelmed physician workforce that didn't happen that doesn't mean that America doesn't have a shortage of physician services as we've discussed in previous episodes especially when it comes to the care of the oldest the poorest and the most geographically isolated among us even though we know foreign medical graduates care for these patients just proportionally we make it very difficult for many born and trained elsewhere to practice here some Americans need those doctors desperately all the evidence seems to suggest that policies should be made to attract them not deter them sometimes talking about drugs and sex education and health insurance aren't advertising friendly and making those important videos could actually hurt our bottom line healthcare triage is made possible in part therefore by our supporters at patreon the support we receive from our patrons at patreon allows us to keep making those kinds of videos without worrying about ad revenue so thanks to all of them and particularly thanks to our surgeon Admiral Sam and Research Associates Joe sevens and Joshua Crowe if you'd like to support the show we'd really appreciate it you can go to there tree up while we're asking you to do stuff please consider subscribing to the show consider buying some healthcare triage merch as the holidays come up at HCT merch calm and I've got a book coming out in November 7th the bad food Bible available anywhere you'd buy books and I'd really appreciate your picking up a copy you