Since you quoted from my blog, I'd like to note that you left out the part where I mentioned that we should be increasing the number of medical school graduates in the US. But the problem is a lot more complex than just saying we'll produce more medical school graduates.

First, it pays to quantify the problem. The most recent studies are indicating that the physician shortage in the US is severe and growing. By 2020, we’ll face a shortage of approximately 150,000. Remember, this is against a physician population of about 800,000 so the number is pretty scary.

Why is this happening? First, we have not been expanding our medical education infrastructure. The US has opened almost no new medical schools in the last 25 years. So you have a physician population that has remained fairly level with a population that has increased a good 30 million or in the mean time.

You also have important demographic changes in the population and in the physician supply itself. For the physicians, I know it’s not politically correct to talk about it, but the fact that 50% of all medical school graduates are now women is making a difference. Women tend to avoid specialty areas that have bad call hours so certain specialties (like anesthesiology and radiology) suffer more severe shortages as a result. Over a career, women tend to work fewer hours and also are likely to take leaves of absence for childrearing that reduce the overall number of hours physicians churn out each year. And many women leave the profession all together when they start to have families.

Do I advocate training fewer women doctors? Absolutely not. But we should be accounting for the differences in their career paths when we strategize on dealing with the doctor shortage.

Then there are demographic changes in the US population. We all know that the US population is getting older. And as we age, our needs for medical care increase. So this only amplifies the needs of our growing population. And despite what we’re hearing about the crisis in US health care, the percentage of Americans overall with health care coverage is much higher than it was 30 years ago. So as more and more Americans have access to health care coverage, the demand for physician services increases.

Finally, technology plays a factor. As more and more treatment options are available and new and more powerful technology works its way in to our health care system, Americans are more likely to seek out the services of a physician.

In the US, we obviously need to be growing our domestically educated physician population. But it’s going to take many years to dig ourselves out of the hole that we’re in. It takes about 15 years from the point where we decide to build a new medical school (or even expand a medical school) and when the first doctor is out in private practice. You’ve got to build the school, go through an accreditation process, educate the MDs (4 years) and put them through graduate medical training (another three to seven years). And that assumes we can even convince our legislators to cough up the bucks to build the schools.

Considering the shortage we’re facing, foreign doctors are just a drop in the bucket. We bring in approximately 4,000 – 5,000 doctors a year and that number is already accounted for in the 150,000 shortage figure.

By the way, the foreign physician population in the US has actually been shrinking in the last few years, not increasing as one might expect given the shortages. One reason is because the physician shortages are growing in other countries. Australia in particular has a real problem. Their shortage is so severe that they’ve greatly relaxed the requirements for foreign physicians to enter that country. I’m sure they’ll be revisiting that policy, but the choices they’ll be facing are not very palatable.

One final note – be careful what you wish for. One thing you may not know about foreign doctors in the US is how they are chosen to come here. Every American medical school graduate – from the top student all the way down to the person at the bottom of his or her class – gets selected for residency and fellowship training programs in the US. They may not get their first choice, but they all get slots.

After that, we have approximately 6,000 to 8,000 slots to fill in our residency and training programs. About a third of those go to American medical students who went abroad for medical school. The rest are your foreign nationals who have graduated from foreign medical schools. In order to get one of the coveted training slots in the US, you better have finished in the top 5% or so of your medical school and your medical school better be considered one of the more reputable ones internationally.

There’s a reason why the faculties at our top academic medical centers are disproportionately foreign. Many of these doctors are the brightest in the world and they’ve come to the US because we have the best health care system in the world. We do the top research and our hospitals have the budgets to do the most cutting edge, high quality work. CBS’ 60 Minutes recently reported on hospitals in India and Thailand that are like five star resorts and which cater to foreign patients. When they interviewed the American administrator of the Thai hospital, he was bragging that his doctors trained at places like Johns Hopkins and Mayo in the US. Training in the US for a foreign doctor is like getting admitted to Harvard.

American patients benefit every day from this meritocracy and the number of lives these doctors saves every day will far exceed any tradeoff we would get if we suddenly got spooked by an irrational fear of the terrorist doctor. The solution here is not to bar foreign doctors. We already vigorously screen the ones coming here, but if we need to do more, then we certainly should. But, to use a crude medical expression, we should not cut off our nose to spite our face.