How to help end rural America’s physician shortage

By | June 1, 2021

Physician shortages in rural America are sustaining. To help fix this, states should remove some barriers to entry for foreign physicians.

Access to rural hospitals has been deteriorating for years. Low patient volumes and substantial reliance on government payers have made rural hospitals increasingly susceptible to pandemic-induced financial pressures. It all came to a head in 2020, when a record high of 20 rural hospitals closed in a single year — that’s 14% of all hospital closures in the last decade.

The loss of so many healthcare facilities has unleashed a cascade of repercussions, one of them being an acute physician shortage. This has led to higher prices, increased disparities in health outcomes, and reduced access to specialty care for vulnerable populations. Rural Medicare beneficiaries are 18% less likely to receive appropriate medications after hospitalizations, and fewer doctors mean outrageous commute times for rural residents. No one should have to travel 45 minutes to get to their mother who’s having a stroke in the nearest emergency room.

Luckily, there’s a ready supply of doctors that states could tap into. State legislators should consider removing the requirement of repeating a residency program for foreign doctors to practice in the states.

The push is already happening. In Missouri, Rep. Derek Grier is attempting to empower foreign physicians by allowing regulatory state boards to waive residency requirements for international applicants who meet the state’s safety, competency, and conduct standards. It makes sense that this would happen in Missouri. Forty-four of the state’s 114 counties are without a single hospital. To ignore this problem would be irresponsible. Other states should follow suit.

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The national doctor shortage is projected to reach 159,000 by 2033. That’s ridiculous, especially given the 263,000 medically trained immigrants in America who are stuck in positions beneath their skill levels. We have more than enough supply to address this growing crisis. So, why are we refusing to use these workers?

Unfortunately, to a certain degree, this crisis is being self-inflicted by rigid review processes influenced by American doctor associations. It seems wrong that the American Medical Association mandates foreign physicians repeat steps in their training when these doctors often come from countries with better healthcare outcomes than ours.

For a physician who completed a decade of training in Australia, Switzerland, or the United Kingdom, the prospect of repeating a residency for another three years is completely unnecessary. Additionally, there are simply not enough U.S. residency programs to support the influx of foreign physicians in a reliable way. In 2020, nearly 45,000 qualified medical school graduates applied for only 37,000 residency positions. Those who completed their educational training abroad faced the harshest odds.

Rural healthcare systems are either fragile or nonexistent. The road to recovery for rural communities in post-pandemic America is steep. It’s thus far past time for state legislators to reevaluate the metric of accreditation.

Tanner Aliff is a Young Voices associate contributor and healthcare policy research fellow.