We Need Free Trade in Health Care – WSJ.com

I have said this privately for a while, and now it’s being said openly: one way to drive down costs is to open the US to non-US trained physicians.  I have no doubt that will work and is being advocated in a WSJ Editorial today: We Need Free Trade in Health Care – WSJ.com


Yes, I read it, and all those non-US trained docs will be restricted to ‘underserved and rural areas’.  Riiight.  My legs’ wet, is it raining?

We Need Free Trade in Health Care

May 27, 2008; Page A19

Health-care reform is a major election issue. Yet while Democrats Hillary Clinton and Barack Obama offer comprehensive plans, important gaps remain. Neither plan addresses the need for more doctors, a problem that Gov. Mitt Romney ran into when he introduced comprehensive medical coverage in Massachusetts in 2006.

Comprehensive coverage of the over 45 million uninsured today will require that they can access doctors and related medical personnel. An IOU that cannot be cashed in is worthless.

Massachusetts ran into this problem: Few doctors wanted (or were able, given widespread shortages in many specialties) to treat many of the patients qualifying under the program. The solution lies in allowing imports of medical personnel tied into tending to the newly insured.

This is what the Great Society program did in the 1960s, with imports of doctors whose visas tied them, for specific periods, to serving remote, rural areas. U.S.-trained physicians practicing for a specified period in an “underserved” area were not required to return home.

It is time to expand such programs – for instance, by making physicians trained at accredited foreign institutions eligible for such entry into the U.S. But in order to do this, both Democratic candidates will first need to abandon their party’s antipathy to foreign trade.

It could easily happen.


  1. Sandhya Rani says:

    You Are Correct and I Definitely Agree WIth You.

  2. If we open the US to foreign trained grads, then it really isn’t “free” trade.
    How are American-trained docs with $250,000 in student loans supposed to compete with foreign grads who generally don’t owe a penny in student loans?
    What US student will want to pay a quarter million dollars for a medical education only to be offered a pittance when they graduate? Drive prices down to the point where being a doctor is no longer worth the lawsuits plus bureaucracy plus low earnings and medical school enrollment will drop precipitously. Then the problem will only be compounded. Less new docs for the baby boomer generation when many older docs are getting fed up with the system and retiring.
    I think this is a bad idea.
    Perhaps if foreign grads had to pay a licensing fee in the US equivalent to the median cost of a US medical education (or take out a loan for the same) – then everyone would be on an even playing field.
    Otherwise, it will just cause more apathy in an already apathetic system.
    In fact, I’m going over to the WSJ blog to post this same comment.

  3. Derrick says:

    As a current medical student (who will have $250K in debt soon), I think this is a TERRIBLE idea.

    1. A scant percentage of the people who start undergrad off with the intention of going to medical school actually do so. The solution must involve creating more spots for these people before we look abroad for more physicians.

    2. The entire healthcare industry must shift towards prevention of illness, and not simply response to illness. It would be far cheaper if as a society we taught nutrition in our schools – and had an emphasis on maintaining a healthy weight instead of treating all of the comorbidities associated with obesity.

    3. The foreign physicians that you are bringing in are often leaving countries that desperately need them there. Contributing to brain-drain is not a globally conscious attitude when we have motivated and intelligent students here clamoring for the limited slots we have available to train physicians.

    4. Driving down wages further when reimbursement is already moving in the negative direction will only drive more US physicians out of the field. Coupled with the staggering increases in tuition, eventually only people completely incapable of doing simple arithmetic will enter medical school.

  4. So tell me: how does this help to fix the huge divot in our international image the Lefties claim our Mideast activities have produced?

  5. Free trade my butt. Foreign grads are trained by hard earned money of their countrymen and they just take off to the US for greener pastures leaving the original tax payers with nothing. I agree, let them take out a loan for 250K from a US institution at the same interest rates and then we will see.

  6. patient says:

    I check on where each of my providers are trained & I won’t go to a foreign trained physician – even if he/she has done a US residency (particularly the ones that aren’t so “picky” – yep….I’m the father of a physician, so I know of a few…).

    I’m also a pharmacist and I steer my patients away from these people as well. Its not just about the money – its about the kind of treatment they deliver. Some are just AWFUL and don’t keep up with current changes in medicine.

  7. Great idea…lets just turn medicine into the Dell Support-line, out-source all of our medical education, and import our doctors from the third world. Importing everything at a reduced price has done wonders for the US Economy, hasn’t it?

    Beyond the money issue, there are substantial differences in medical training between the US and the rest of the world: most of what we learn is geared to the medical issues relevant to this country. Tossing someone whose primary care training is centered around staving off malnutrition/infectious disease/hygiene into a practice where they’re dealing with my 300 lb Aunt Sue and her Diabetes/Hypertension/Depression/Arthritis and you’re going to end up with mis-managed illnesses.

    We have fifth pathway programs to educate foreign trained physician to conform to the same licensing standards of every other physician in the US…if they want to work here they need to do the time.

  8. hospitaladmin says:

    The issue is not free trade….foreign subsidization of their medical schools is common and the debt burden to an FMG is not comparable to our medical graduates. Yep… the playing field is not level.

    The real issue, however, is access. We have a overall shortage of physicians today that is exacerbated in many markets by a maldistribution of physicians across the country. Two looming environmental events – one political and one demographic – potentially will make today seem like the “good ole days” in 4 to 5 yrs.

    First, whoever gets in the White House – the Dems or the Reps – there will be pressure to address the uninsured. As the original posters point out, the Mass experience highlights the unintended consequences of providing financial access to the Mass unisured to that state’s delivery sytem. On a nat’l scale, especially in states that don’t enjoy the md/1000 population Mass does, this benefits expansion will in reality address nothing.

    The second looming factor is the aging baby boomers. Enough said on that.

    What does it mean? There are not enough, nor will there be enough, physicians to deal with inevitable increase in demand. So the question really isn’t about free trade, but rather do we want access to medical professional for all who call the US home? Allowing more FMGs (and yes quality concerns should be taken into consideration) into the country for a limited time while concurrently retooling how our medical schools and the policy wonks determine the US’ MD supply (which will take 6 – 10 yrs to yield a material result) might be a solution.

    Regardless, we are in a crisis and unless public policy changes and reimbursement trends for both doctors and hospitals are reversed, it won’t necessarily be about affording care, but finding it.

  9. And meanwhile, the hospital construction boom continues with Starbucks and waterfalls and marble floors overlooking scenic expanses…

  10. Lady Doc says:

    I have concerns about “stealing” medical personel whose training has been subsidized by their own underserved nations. A country that funds medical training expects those physicians to remain and take care of their own population. I am not aware of any nation that is suffering from a surplus of physicians or nurses that would be excited about sharing them with us.

    We do have a serious physician shortage problem developing here. Primary care is particularly underserved, and is getting worse. Medical students don’t want to go into primary care because it does not pay as much, and many of them have very large educational debts. (That is another issue, though.) Part of this shortage is our own fault because medical school enrollment was limited seconday to the fear of “too many doctors will reduce pay for us all.” Enrollments that were recently increased will take years to impact the market.

    I don’t know what the answer is to this problem, but I do not think taking physicians away from other nations where they are already needed is going to solve our dilemma. The up side of all of this is that we do indeed have assured employment. I am such a pollyanna that I can find the positive side in almost anything.

    This is only one of many problems on our current horizon. I do believe that it is time for physicians to stand up and work together to try to solve the myriad of issues confronting us. Trying to get physicians to work together, though, is like trying to herd cats. Every one is out for themselves and there is way too much finger pointing. It would be nice if we could earn a report card that says “plays well with others.”

  11. From an Australian perspective, use of overseas trained doctors is by no means a perfect solution. Cultural issues and quality assurance are some things, there is also the ethical issue of “poaching” the workforce of a less well of country. Many OTDs are fantastic and contribute enormously to the health system of Australia, and to the communities in which they live. Others (Jayant Patel for example, Bundabergs Dr Death) give the others a bad name and do not always provide an acceptable standard of care.