Study shows medical certification standards inhibit international physicians

Politics Profs. David Leblang and Sonal Pandya, along with doctoral student Brenton Peterson, released a study this week that examined the political and economic aspects of different processes for obtaining medical certification in the United States for the international community.

For an international student to be eligible for medical residency in the United States, he must pass three sections of the U.S. Medical Licensing Exam. Medical education standards are highly specific and these qualifications often prevent qualified physicians from practicing in the United States based on technicalities.

“We are by no means proposing a plan for policy change … rather, we are drawing attention to an aspect of immigration and regulatory policy that is interesting from a political economy perspective: the fact that unelected state regulators are deciding the international mobility of critical skills,” Pandya said Tuesday in an email.

These policies exacerbate physician shortages and therefore have an affect on the overall health of a nation, Pandya added.

Only 42.6 percent of international medical graduates in 2008 passed all three components of the test on their first try, and only 73 percent of those who passed all necessary exams eventually found a residency, according to the study. Some of the states with the worst physician shortages in the United States are New Mexico, Louisiana, Mississippi, Missouri and North Dakota. These same states are also some of the most stringent in their policies for allowing international doctors to practice medicine.

Immigration policy debates often center around issues of skilled versus unskilled labor and the competition each group provides to American employees, but the study attempts to take a more nuanced view, Pandya said. “Our innovation is to highlight that ‘skilled’ is not a monolithic category,” she said. “Rather, skills are typically highly specialized to certain professions so the employment threat that skilled migrants pose is limited to those Americans with the same skill sets.”

One of the largest barriers to allowing doctors to practice medicine in the United States was competition for employment, as more doctors means a smaller success rate for American-educated physicians seeking jobs, Pandya said.

According to the study, international students’ qualifications are equivalent to those American medical graduates receive prior to residency training.

Finances also play a role in how strict the stipulations are for international physicians. The study explains how states with a medical board dependent on the state government are likely to require less residency training for the international students, whereas states with self-financing medical boards often require much longer residencies, up to 36 months.

The study’s authors estimate that changing the standards for international doctors would lower health care costs. State-by-state estimates of annual cost reductions range from $615,669 to $1.28 billion.

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