State's Bias Against Foreign Medical Schools Worsening New York's Doctors Shortage

The current doctors shortage in the United States is so dire a recent report from the Association of American Medical Colleges suggests that within ten years there will be a nationwide shortfall of 90,000 doctors. Even though New York has more medical schools than any other state, it is not immune to the shortage.

Most affected are areas outside of New York City. Last year, the Healthcare Association of New York State (HANYS) reported there was an immediate need across the state of 942 additional doctors, particularly primary care physicians. According to HANYS, Western New York was hard hit. On a national basis, there are 80 doctors per 100,000 patients, but in Buffalo only 60 doctors were practicing per 100,000 patients.

Upstate New York had a shortage of 615 doctors, meaning that cities like Syracuse were already citing an inability to deal with patient demand. The situation in Rochester was so bad Governor Andrew Cuomo asked the federal government to declare the city a Health Professional Shortage Area. "The City of Rochester leads the nation in infant mortality and hospitalizations per capita," Senator Chuck Schumer said, "but with one of the lowest doctor-to-patient ratios in any major city many residents are not getting the access to proper care they need."

In this time of crisis, a debate has erupted at the New York State Education Department over hospital clerkships. During medical school, a student spends his first two years in coursework, but his final two years are made up of clerkships that normally occur in a clinical setting. Several years back, international medical schools, many of them located in the Caribbean, started paying hospitals in New York as much as $400 per week per student for clerkship positions. Since 2007, for instance, St. George University School of Medicine in Grenada has paid New York City Health + Hospitals $100 million for clerkships for its students.

Because hospitals are constantly in need of increased revenue to remain open, it was not long before half of the clerkships in New York were held by foreign medical students whose schools were paying for them. Officials at some of the state's 16 medical schools began to complain about the paid clerkships so bitterly that, two years ago, the Education Department's Board of Regents formed a committee to evaluate them, effectively establishing a moratorium on paid clerkships. Now the domestic medical schools want the moratorium turned into an outright ban, while international medical schools hope the moratorium will be lifted.

Ironically, though domestic medical schools "do not provide a per-student-per-week reimbursement to the hospitals," to quote one medical school representative, they do pay hospitals. Besides supplying funds "to upgrade their medical libraries," they have affiliation agreements whereby "attending [physicians] at the hospitals are faculty at the medical schools."

Over the last decade, enrollment in New York's medical schools has grown by more than 20 percent, making the clerkships even more valuable. Administrators at international medical schools argue many of their students who come to New York to hold these clerkships remain in the state to practice. These students are more likely to enter primary care, an area many domestic medical students avoid in order to pursue more lucrative specialty fields.

In addition, foreign-educated doctors often end up practicing in underserved areas, in particular poor urban neighborhoods, because the student bodies at international medical schools tend to be more diverse. Lack of diversity is a problem at a number of domestic medical schools. For while 13 percent of the population in the U.S. is African-American, African-Americans make up only 5 percent of the number of doctors in the country. Conversely, the American University of Antigua College of Medicine boasts a student population in which 20 percent are African-American.

New York's doctors shortage is not helped by the fact that 55 percent of doctors trained in the state leave to practice elsewhere once their training is complete, leading one industry leader to declare, "New York exports physicians." Indeed, so many doctors depart the state after training that New York accounts for 11 percent of the nation's doctors.

Since that's the case, some observers believe New York should continue to welcome foreign medical students, many of whom want nothing more than to stay in the state and practice, frequently in areas where doctors are desperately needed, and the Board of Regents should lift the de facto moratorium on paid clerkships.