Who should get to be a doctor?
By Joseph Flaherty, dean and chancellor of Ross University School of Medicine, and Heidi Chumley, executive dean and chief academic officer of American University of the Caribbean School of Medicine
Healthcare in America for many patients is an obstacle course of access: finding ways to pay for it, then finding a doctor within network who you can trust and reach, and in the right specialty. The Affordable Care Act made the first point easier for millions of people, but the other barriers remain and in fact are growing as our population increases and ages simultaneously. The Association of American Medical Colleges projects a shortage of physicians of 46,000–90,000 by 2025. And specialties are clustered unevenly, often skipping lower income, diverse, or rural areas. Even at the level of primary care — the kind of doctor we all need at some point — more than 61 million Americans live in thousands of primary health care shortage areas.
Clearly we need more doctors
Every year, U.S. medical schools reject qualified applicants because they simply don’t have seats for them. New schools have opened and existing ones have expanded but the physician shortage still looms and far outpaces this growth in enrollment.
It’s worth stepping back and asking how we can include more of these dedicated, qualified students in the physician pipeline. Who should get to be one of the thousands of additional doctors we need as a society?
Both of us moved from U.S. medical schools — at the University of Illinois and University of Kansas, respectively — to lead our two international medical schools in order to help answer that question. Our schools are based overseas, but train primarily U.S. physicians to go back home to practice. We act as a kind of pressure valve for the medical education system, graduating qualified, successful doctors who are needed and valued in the US.
Where do they come from?
Let’s start with the fact that our graduates and their internationally trained peers are already a significant part of American healthcare. In 2012, nearly one-fourth of U.S. doctors came from international medical schools, a rate that rose to more than one-third in New York, New Jersey, and Florida. And in 2015, international medical graduates who are U.S. citizens filled about 10 percent of all first-year residency positions, and 14 percent of positions in primary care.
How do we continue to cultivate this substantial pipeline of physicians? By providing opportunities to those committed and deserving aspiring physicians who are shut out of U.S.-based medical schools because of limited seats. And each year hundreds of our students prove their merit by passing the same standardized exams taken by U.S. students, gaining competitive residency positions, and ultimately excelling as a physician.
We find these qualified students by taking a holistic approach to admissions that looks at grade performance and testing, but also life experience, social maturity, and other factors. While U.S. medical schools are starting to move in this direction, many admissions decisions are still over-dependent on one-time test scores.
Diversity, experience, quality
We believe that our approach to selecting students helps result in a student body that in many ways is well-matched to the real world waiting for their care.
· While U.S. medical schools are being called on to diversify, we are already there. Last year 16 percent of the graduating class at Ross University School of Medicine (RUSM) was either African-American or Hispanic, compared to the U.S. medical school figure of about 10 percent.
· Our students often have more life experience. We enroll people who are changing careers and tell us of rejection by U.S. medical schools for being away from academia too long. RUSM grad Dr. Amy Jarvis, for example, was a commodities broker who dreamed of following her father into medicine and is now a vascular neurologist at the Miami-Dade Neuroscience Institute and medical director of the Primary Stroke Center at North Shore Medical Center in Miami. Dr. Steven Brooks, who played in the NFL and worked as an actor before deciding to attend American University of the Caribbean School of Medicine (AUC), is now a surgeon at Texas Tech after completing fellowships in surgical critical care and trauma/acute care.
None of this sacrifices quality. International medical schools are all different, but we know our students achieve competitive results on the two key metrics that arguably measure the outcome of medical education: performance on the United States Medical Licensing Examination® (USMLE) Step 1 test of medical science, and attainment of a residency position in the U.S., where medical school graduates finish their clinical training and launch their careers. Not only do our students compete against U.S. medical school graduates for those residencies and obtain them, we have many success stories of alumni becoming chief residents. The latest lists of recently named chief residents from AUC and RUSM include specialties from anesthesiology and family medicine to pediatrics, surgery, and psychiatry.
Other needs
As a side benefit, our institutions also contribute significantly to meeting the need for primary care physicians. At RUSM, for example, more than two-thirds of graduates placed into primary care residencies in 2015. On average, only 35 percent of practicing doctors in the U.S. work in primary care.
We also help expand capacity in the medical education system by increasing the number of clerkships, where students typically spend the second half of medical school. Clerkships in hospitals and other clinical centers provide students with hands-on experience in patient care in a variety of specialties.
Clerkships are resource-intensive because students must be supervised by doctors and need a training infrastructure. Hospitals systems are increasingly resource-strapped, so we have created several long-term programs that provide the funds to train more students. While there are critics who claim this amounts to buying access, we stand by the programs because they do good. It’s a benefit for all when we help healthcare centers train more doctors.
More, not less
So who should get to be a doctor? We want more opportunity, not less, for dedicated, qualified individuals to achieve that goal. International medical schools like ours help rather than hurt any and all efforts to reduce the access obstacle course that too many patients have to run. These are the doctors you may be seeing tomorrow.
