Every year, more than 4,000 foreign graduates of international medical schools come to the United States for a residency program. They rarely return home to serve the countries that raised and educated them. Meanwhile, more than 2,000 graduates from U.S. medical schools each year are blocked from becoming doctors because there are not enough residency programs for them to enter, and they cannot practice medicine without this training experience. A further 2,000 American graduates of international medical schools are also denied the opportunity to practice medicine in the U.S. for the same reason.
As COVID-19 has inevitably spread to developing countries, this policy will come to be seen for what it is: robbing developing countries of their desperately needed medical professionals. This must stop, even though American medical care benefits from being able to take the best doctors for ourselves.
In the U.S., there is one doctor per every 385 individuals. In South Asia, there is one physician for every 1,250 individuals. But in Sub-Saharan Africa, on average there is one doctor per 5,000 people with some countries faring far worse. For example, Tanzania has 1 doctor per 71,000 individuals. Roughly half of Sub-Saharan African countries suffer a loss of more than 30 percent of the doctors they train. This equates to tens of thousands of doctors. Roughly equal numbers of nurses from such countries also immigrate to developed countries.
To be clear, while the U.S. accepts a significant number of doctors from developing countries, some come to the U.S. from other advanced economies, which is much less concerning, given that many European countries have a significantly higher number of doctor per capita than the U.S. Yet the number from developed countries is small; for example, 21 percent of foreign-trained doctors in the U.S. come from India, while only 3 percent come from Canada.
We also need more U.S. medical students each year, more residency programs for them to enter and more clinical opportunities for them during medical school. While medical school and residency spots are expanding, neither are growing quickly enough. Research by the Association of American Medical Colleges (AAMC) indicates the U.S. will face a doctor shortage of up to 122,000 in 12 years. Recent draft legislation, the Resident Physician Shortage Reduction Act, has proposed increased funding for residency programs, which is a start. But we must accept that it is unethical to steal doctors from countries with greater need, especially given our vast financial resources and capable student pool.
In 2010, the World Health Organization adopted a Global Code of Practice on the International Recruitment of Health Personnel to discourage the recruitment of practitioners from developing countries with shortages. Yet its voluntary principles have largely been ignored. As the worst offender, the U.S. should take the lead in reversing this practice. Of the nearly 650,000 foreign-born doctors in developed countries that are members of the Organization for Economic Co-operation and Development (OECD), 42 percent reside in the U.S., compared to 13 percent in the United Kingdom, the second highest destination (this figure also captures some children who immigrated at an early age to OECD countries and individuals who migrated to an OECD country to study medicine).
Of course, even if we stop taking doctors from countries that need them more, it will not prevent all physicians from poor countries from immigrating to the U.S. to take up another profession—either working as nurses or outside the medical field. Yet such limitations should not stop the U.S. from showing solidarity with the more than 170 countries battling the disease by acknowledging that we have many more doctors than most.
This argument is not an attempt at isolationism; it is about stemming global suffering. We can be advocates for allowing the world’s best scientists and medical researchers to immigrate, just not practicing physicians. Immigrant medical researchers in the U.S. can leverage the resources we have to discover treatments to help the world, yet patients must often be seen locally. As a nation we can be pro-immigration while acknowledging this critical exception. Ideally, the number of residency programs would grow sufficiently to include spots for all U.S. students and some international students who would return home to serve. This would not only halt a medical brain drain in developing countries but allow the U.S. to help spread our cutting-edge knowledge of medicine.