Is New York's Education Department Making the State's Doctors Shortage Worse?

Recently, the New York State Education Department (NYSED), the state agency responsible for regulating medical schools, adopted a policy prohibiting hospitals in New York from offering clerkships to many international medical students. By doing so, the department made it more difficult for hospitals to tap into the growing population of foreign medical students who want to come to New York to train and ultimately to practice medicine here.

Why is this important? In today's rapidly changing field of medicine, there's a doctors shortage that threatens to become an all-out crisis. The situation is so troubling even The New York Times, which has downplayed the issue in the past, seemed to sound an alarm in mid-2013 when it ran a front-page article entitled "Doctors Shortage Likely to Worsen With Health Law."

For sure, Obamacare has contributed to the problem, as it allowed 16.4 million new enrollees to acquire health insurance since the law was passed five years ago. But there are other factors as well. "Americans are living longer, with many needing to manage a host of chronic diseases," U.S. News and World Report observed. "One in five Americans will be eligible for Medicare by 2030." In addition, doctors themselves are retiring because they too are reaching retirement age.

Indeed, the Association of American Medical Colleges predicts a shortfall of 90,000 doctors nationwide within a decade. Many states, however, are experiencing serious shortages already, New York among them. A survey performed by one healthcare organization found that, outside of New York City where there is a saturation of doctors, the state could use 942 additional doctors right now, particularly primary care physicians.

One region that's hard hit is Upstate New York where, according to the study, 615 doctors are needed. "Seventy four percent of hospitals surveyed," reported, "indicated there are times when they have to transfer emergency room patients to other hospitals because specialists such as neurologists and neurosurgeons are not available."

Western New York is also struggling. "[T]he national average for the number of family medicine about 80 per 100,000 patients," one source noted. "Western New York has only 60. In general surgery, the national average is about 8 per 100,000 patients, and Western New York has only five."

Rochester is short doctors, as is Buffalo. "[W]hen it comes to recruiting doctors, Buffalo can be a tough sell," The Buffalo News wrote, "so much so that the community faces a shortage of primary care doctors, as well as gastroenterologists and psychiatrists.... Compared to 305 regions in the United States, the Buffalo area lands near the bottom for the number of family practice physicians [22 for every 100,000 residents as of 2011]. Buffalo places in the bottom half of the nation's regions for the overall number of physicians; 192 for every 100,000 residents in 2011."

To be sure, efforts are being made to address the shortage. After graduating from medical school, a doctor must complete a residency before he can go into practice -- so the more residencies there are the more doctors there will be. Most residencies are funded through Medicare. Because they are so vital, the U.S. Congress has increased spending for residency slots to more than $10 billion a year, meaning the number of residencies has increased from 96,000 in 2001 to 113,000 in 2011.

To feed these residencies, new medical schools are opening up, and current medical schools are enlarging their enrollments. "That's in addition, mind you," The New York Times wrote, "to the swelling number of medical students studying abroad, with the goal of eventually practicing in the United States."

But, thanks to the Education Department, if those international students are thinking about coming to New York to serve in a clerkship -- hospital clerkships focusing on a range of medical areas comprise the latter part of a student's medical school training -- they can think again. They are not welcome in New York.

"Most medical student clinical clerkships are authorized and administered by the medical schools and the hospitals wherein the schools place their students," a NYSED spokesman said. "NYSED is not a party to these arrangements." Not so with foreign medical students. "[For them,] the NYSED provides letters of eligibility for students, which authorize their participation in clerkships. Students from foreign medical schools...must be matriculated in an international medical school approved by the department for this purpose."

Most impacted by the decision are U.S. citizens attending medical schools abroad. Many of these schools have agreements with hospitals in New York that won't be renewed because of the policy.

It is not clear why the Education Department has taken this new position. But the end results are indisputable. The policy discriminates against foreign trained medical doctors, even though 40 percent of physicians now practicing in New York studied abroad. More troubling, it's going to make the state's doctors shortage worse, not better.