If I am to pick one low-cost way for ruralia and other places with physician shortages, it would involve waiving residency requirements:

Dr. Faris Alomran, a British-educated vascular surgeon working in France, says, “My first choice after medical school was to practice in the U.S. In fact, for most [English-speaking] people, in terms of language options, they are somewhat limited to Australia, Canada, and the U.S.”

But he didn’t end up crossing the Atlantic. “In the U.S. I would have had to do five years of general surgery and a two-year fellowship in vascular surgery to be a vascular surgeon. Seven years total. I got an offer in Paris to do a five-year vascular surgery program. They also reduced my training by one year since I had done two years in the U.K.”

Juliana, a physician originally trained in Brazil and currently in an American residency program, agrees that migrating to the U.S. could have been easier, especially if redundant training were removed. “Repeating the residency is not an easy thing, and many times it’s very frustrating. I do not think the internship [that I’m in] will add much to my future career. Having trained in America for the last four months has helped me understand cultural differences [between the U.S. and Brazil], but it has also made me wish I were allowed to skip some steps.”

This article seems to focus on attracting the best and the brightest, though that’s less my primary concern. (It’s a heck of a secondary concern, though!)

There is a perception that doctors aren’t going to come here to work in Idaho, and that may be true for the best and brightest. But there are a lot of doctors who would be willing to come here for a paycheck (which, by international standards, are just fine in Idaho). A lot of them wouldn’t stay there, but some would even after released from a 5-10 year requirement. (Yes, even some non-European ones would.)

I’m not optimistic on this happening, though, because while many argue the requirements are self-enriching gatekeeping, in my experience even those places where the doctors are suffering from the shortage (by having to work insane hours, for instance), they are pretty resistant. It’s a matter of professional pride. If another country (besides Canada) aligned their medical training with ours, it would be possible. But… other countries aren’t anxious to bend over backwards to make it easier for their doctors to leave.

That said, people make the AMA the bogeyman for all things gatekeeping-related, but they’re actually open to it. As it happens, and as I will keep saying from now until the end of the time, they don’t weird very much power. The power belongs to the states, and the medical board within the states. The AMA may have some influence with them, but they are extraordinarily conservative and inflexible institutions as far as such things go. They recognize the problem, but don’t see it as their problem.

And from a more cynical standpoint, the looser the restrictions the less important they are. There is a reason that one particular state ran my wife through the ringer over (her own person) medical records that were destroyed in a hurricane, let the process drag on for over a year, and then demanded another application fee (of $1000) because the original one had lapsed. In a state where her skills and professional interests aligned perfectly with a state, and a shortage precisely where she would have gone.

Across the board, the credentialism is just crazy. My wife has delivered over 1,000 babies, and performed more than 300 c-sections, and she could still never be given privileges in county hospitals covering some 70% of the US population. Doctors just out of obstetrical residency, who have delivered far fewer babies, would have no problem at those same hospitals. It’s a long story as to why this is the case, but the long and short of it is that if she wanted privileges at these hospitals, she’d have to go back to residency for three years. All of her experience would only let her skip a single year.

Category: Hospital, Statehouse

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4 Responses to Unmet Demand, Underutilized Supply

  1. Jaybird says:

    So by setting standards so high, we can brag about how high our standards are and thus provide doctors who made it through the most rigorous weeding.

    I’m surprised we haven’t had more black markets show up among All But Residency kinda doctors.

    • SFG says:

      It’s illegal to practice medicine without a license. A prescription that’s not from a licensed doctor is useless. And no surgeon wants to operate without access to sterile conditions.

  2. Michael Cain says:


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