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FOREIGN DOCTORS
MAY 20, 1996
TRANSCRIPT
Fred De Sam Lazaro of KCTA-St. Paul-Minneapolis reports on the place, or lack thereof, for foreign doctors in the American health care system.
FRED DE SAM LAZARO: At 9 sharp every morning in the heart of one of Chicago's poorest neighborhoods what looks like an international medical conference is convened.
DOCTOR: (talking group of doctors) 55 year old female with history of chest pain for the last four days.
FRED DE SAM LAZARO: Actually, it's the daily meeting in which doctors go over the status of patients admitted to Cook County Hospital. Of some 250 doctors in the hospital's department of medicine, 90 percent are newly arrived in the U.S.. Most are recent graduates here for their residency, usually three years of intense "hands on" experience that's required for a license to practice on their own.
DOCTOR: 51 year old Hispanic female who's got arthritis--
FRED DE SAM LAZARO: Cook County is the middle of a physician pipeline that begins in countries like India, the Philippines, or Poland, and for man ends all across the U.S. in remote, rural areas like Oaks, North Dakota. Foreign physicians have long been a fixture here. Several years ago, the NewsHour profiled Dr. Rup Nagala who has served folks now for nearly two decades.
DR. RUP NAGALA: (1986) I think the thing that brought me here is the fact that the other doctor was here and he was also from India.
DR. RUP NAGALA: When I first came here in '78, like I said, I wasn't sure what I was going to do, you know, really how long I was going to stay, whether I would like it or not, but it seems like the more you stay, the more you get rooted in a place.
FRED DE SAM LAZARO: Medically under-served areas like North Dakota and urban centers like Chicago have become something of a niche for foreign-born physicians over the years. They are areas shunned by most U.S. graduates for perceived lack of cultural amenities, also because they involve general or primary care medicine in an age when U.S. graduates have been attracted by the high technology and higher salaries of specialties like surgery or radiology. Dr. Terry Conway is among the few U.S. graduates who trained and stayed on at Cook County Hospital.
DR. TERRY CONWAY, Cook County Hospital: When I was in medical school, the professors in medical school would say, well, I trained at County Hospital, and I had a great experience, but don't you go, you know, you're--it isn't what you want to do now. You want to go into a university program, go into a specialty. I was interested 20 years ago in going into a primary care field, and that wasn't popular.
FRED DE SAM LAZARO: However, for newcomers like Nigeria native Dr. Peter Hart, Cook County Hospital is a prized opportunity.
DR. PETER HART, Resident, Cook County Hospital: My exposure to primary care medicine in this condition has really been very widely varied with a lot of sophisticated equipment to learn with and really good teachers, and my long-term plan is to provide the same kind of care for the medically under-served.
FRED DE SAM LAZARO: And that would be somewhere here in Chicago?
DR. PETER HART: Well, somewhere around Chicago in part in the Appalachian regions or other areas where I think I will provide excellent care, and that will be appreciated by the population.
DR. RAJUL MALIK, Resident, Cook County Hospital: (talking to patient) I'm just going to check your heart and then your abdomen.
FRED DE SAM LAZARO: Dr. Rajul Malik isn't sure if she'll stay in the U.S. or return. Either way, she says, her training here is far better than anything available in her native India.
DR. RAJUL MALIK: Back home we would read books and we would have management--I mean, there were lack of resources and because of that trouble, we couldn't manage the way we wanted to, probably the way the book described, and I guess that's what you can do over here, umm, get down to bottom of the problem, and, and have resources available to you.
FRED DE SAM LAZARO: Dr. Malik's stint here, like almost all graduate medical education, is funded by the federal Medicare program. Republican leaders in Congress say that's a bad deal for the taxpayer. Last year, as part of a Medicare reform package, they moved to phase out all government payments to hospitals for residents who are not U.S. citizens or permanent residents. Congressman Bill Thomas chairs the House Subcommittee on Health.
REP. BILL THOMAS, Chairman, Subcommittee on Health: I think most Americans are not aware that taxpayer dollars train after medical school doctors that are not citizens of the United States, have not signed an obligation to spend some time in the United States, and could essentially finish their residencies, and go back to another country, having that residency paid for by taxpayers.
FRED DE SAM LAZARO: The Republican proposal on foreign doctors failed to pass despite the support of physician groups like the American Academy of Family Physicians. The AAFP's Dr. Douglas Henley says the problem is foreign doctors who stay in the country compete with U.S. graduates for fewer and fewer jobs.
DR. DOUGLAS HENLEY, American Academy of Family Physicians: We need to begin to address the aggregate over supply of physicians because of the excess supply in aggregate of total number of physicians, particularly sub-specialists and because the majority of them go into sub-specialty training after their residency program. Then we may be training them for future unemployment. We're graduating about 16,000, 17,000 medical students a year, but yet we have 24,000 residency positions in this country. That's an excess over what we graduate of about 7,000 positions per year.
FRED DE SAM LAZARO: Cook County officials say the problem is a lop-sided distribution of physicians, too many in specialties like surgery, not enough in primary care, and they say there's no over-supply in places like Cook County, which rely on foreign medical graduates. These graduates do much of the grunt work in patient care, according to Dr. Brendan Reilly, who chairs Cook County's Department of Medicine.
DR. BRENDAN REILLY, Cook County Hospital: Residents are cheap labor. That's true. There's no getting around that. In order to replace residents who get paid on an average of $30,000 a year for at least an 80-hour week, estimates have been made you have to pay at least $80,000 per year to replace each resident. That's an enormous increase in labor costs to hospitals.
FRED DE SAM LAZARO: Reilly adds that foreign medical graduates are far more likely than their U.S. counterparts to fill the persistent shortage of primary care doctors, especially in under-served areas. But Dr. Henley at the Family Physicians Group argues the solution lies in training the ample supply of U.S. graduates in primary care. Those of hospital programs like Cook County, he adds, are not the answer.
DR. DOUGLAS HENLEY: If all of their training is within the towers of the hospital, which it tends to be, particularly for internal medicine, then when they go out into the community even in Chicago, they probably are not going to be as adequately prepared as they should be, and, and I do not think that those people would be adequately prepared or trained to provide care in a rural area, much less the socioeconomics of living in these areas.
FRED DE SAM LAZARO: Cook County officials agree foreign MD's may not be the perfect fit for medically under-served areas, but until more Americans move into them, Dr. Maurice Lemon says there's no alternative.
DR. MAURICE LEMON, Cook County Hospital: There has been a slight increase, uh, in those American graduates who are interested in, in training in primary care specialties. It's a relatively small increase. My feeling is that unless there are dramatic market changes to reinforce those who are interested in primary care, we're not going to see much of a change or a very speedy change over the next decade.
ELIZABETH FARNSWORTH: Indeed, even congressional Republicans who pushed for dramatic market changes appear to have no plans to reintroduce the measure on foreign doctors this year. They and several physician groups, however, remain committed to changing the supply of physicians to 50 percent primary care, 50 percent specialists, and, if possible, 100 percent American.
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