Op-Ed: Addressing rural physician shortages – the urgent need for licensing reform

Think the federal government’s plan to add extra residency slots for health professional shortage areas will alleviate the growing rural physician shortage? Think again. The Journal of the American Medical Association recently published research showing that of the 400 newly federally funded residency slots, a mere 20 residents spend more than half their time in rural shortage areas.

Physician shortages are expanding around the country and are even more severe in certain urban areas and most rural areas. Nationally, the United States will be short 124,000 physicians by 2035. Some 80% of rural areas in the United States are medically underserved, and the government projects a continued decline in the number of doctors practicing in rural areas. And the exodus of healthcare workers away from the profession over the last few years only exacerbates the problem.

To help solve this issue, Missouri created a pathway to limited practice for medical school graduates who don’t complete residency training after school. Idaho is funding additional residency slots on its own. And Tennessee is opening the door to doctors licensed outside the United States. Other states can and should work to address these shortages, too.

While Missouri’s and Idaho’s pathways can help to alleviate the physician shortage over the long run, only Tennessee’s, Colorado’s, and Illinois’ approach of licensing ready-trained, practicing physicians offers immediate relief to the patients who need care today. Licensing doctors who already have all the necessary training means immediate opportunities to treat patients without extra hurdles.

Doctors licensed abroad often attend the same medical schools as doctors licensed in the United States. The main difference in training for foreign doctors is that they usually do not complete their post-graduate training or “residency” in the United States or Canada. If you graduate from medical school abroad and complete a U.S.-based residency, you are eligible for a license in every state. But if you attend medical school in the United States and residency abroad, you have to repeat residency in the United States unless you qualify for a special pathway to licensure.

So this isn’t a question of whether doctors born and raised outside the United States can provide high-quality medical treatments; it isn’t even a question of whether doctors with some training outside the United States can provide good care. In fact, some studies show that foreign-trained doctors provide better quality care in the United States. Instead, it’s a question of whether you need the last phase of your medical training to occur in the United States or Canada.

This wouldn’t be a big deal if America had an overabundance of doctors and patients in rural areas had ready access to healthcare. But unfortunately, that’s not the case. As our population has grown, the number of newly minted doctors who complete residency has remained relatively flat. And as an aging population has increased the demand for medical professionals, many physicians are readying to retire—further exacerbating the shortages.

This means pregnant women must drive hundreds of miles to deliver their babies, and primary care visits have 6-month wait lists. These challenges are more than a mere inconvenience; they are harmful to those who need medical care the most, and it’s only getting worse.

Congress recognized the problem and tried to add more residency slots for underserved populations, but those residents primarily serve urban areas, not rural communities. Innovative states such as Tennessee, Colorado, Illinois, and Idaho are trying to smooth the licensing path for international physicians, especially since foreign-trained doctors are more likely to practice in underserved communities.

These states are increasing access to doctors without sacrificing high-quality care. To obtain a license, these states require international doctors to be fully licensed abroad, have years of demonstrated practice, pass the same tests as current licensees, and show proficiency in English. As a further layer of protection, Tennessee requires the doctors to have a job offer from a licensed healthcare provider.

International physicians stand ready and willing to serve American patients. As the rural healthcare shortages grow, states must do more than wait for the federal government to solve their problems and should find ways to increase the number of doctors and other healthcare professionals. International doctors must be part of the immediate solution to this long-standing problem.

By Jonathan Wolfson | Cicero Institute
Jonathan Wolfson is chief legal officer and policy director for the Cicero Institute