Correspondence

The Oversupply of Specialists and Graduates of Foreign Medical Schools

N Engl J Med 1995; 333:1781-1782December 28, 1995

Article

To the Editor:

Whitcomb (Aug. 17 issue)1 proposes correcting the oversupply of specialists by limiting residencies for graduates of foreign medical schools. The health system in the United States exists not to ensure employment for physicians but to provide medical care. It follows that residency programs should accept the best applicants for available positions in order to supply the public with the best physicians possible. To select the best applicants, all qualified graduates should be permitted to apply. If the result is the displacement of graduates of U.S. medical schools from residency positions, the correct response would be to train fewer (or better) students, not to limit artificially the choices of residency-program directors.

Dana Kellis, M.D.
Memorial Medical Center, Johnstown, PA 15905

1 References

1
Whitcomb ME. Correcting the oversupply of specialists by limiting residencies for graduates of foreign medical schools. N Engl J Med 1995;333:454-456
Full Text | Web of Science | Medline

To the Editor:

Limiting training for graduates of foreign medical schools cannot create new jobs; it can only preserve the few remaining specialty jobs for Americans. Thus, it may avert large-scale unemployment among U.S. physicians, decreases in compensation, or both. These may be important goals, but we should be honest about them as such.

Many of us hold a fundamental belief that medicine should, to the greatest extent possible, be a meritocracy. All appropriately trained physicians should be able to compete on an equal footing for advanced training and jobs. To a degree, therefore, graduates of medical schools in the United States are currently in competition with graduates of foreign medical schools. Ironically, Whitcomb's proposal to subvert this system is profoundly anti–free market. As imperfectly as the ideal of advancement by merit alone is upheld today, I prefer this to its open dismissal.

Matthew K. Wynia, M.D.
New England Medical Center, Boston, MA 02111

To the Editor:

America is a nation of immigrants, yet Americans of every generation are frightened of newcomers. Whitcomb cites anecdotal reports that American physicians in some specialties are having difficulty finding suitable practice opportunities. The real reason is an overabundance of graduates of U.S. medical schools in a few financially rewarding specialties such as cardiology and gastroenterology and in desirable areas such as California, not the graduates of foreign medical schools.

Tanveer A. Sheikh, M.D.
American College of International Physicians, Washington, DC 20002

To the Editor:

Graduates of foreign medical schools are easy to target because they lack clout in physicians' organizations, despite their substantial numbers.

Whitcomb gracefully acknowledges services of graduates of foreign medical schools to poor people but at the same time recommends that the government allocate funds to replace such physicians with nonphysician providers in the hospitals caring for the poor. This approach not only equates graduates of foreign medical schools with middle-level practitioners but also implies that indigent people deserve no better. This is tantamount to the implicit promotion of a two-tier system of medicine.

We are saddened that our peers cast us as scapegoats in a chaotic health care system that often alternates between bashing graduates of foreign medical schools and banishing them.

Srinivas S. Vasireddi, M.D.
Jayadeva Chowdappa, M.D.
24550 76th Ave., Bellerose, NY 11426

To the Editor:

It would be dangerous for the medical profession to promote a proposal that strives solely to decrease the number of foreign students entering U.S. residency programs. This stance would perpetuate the notion that domestic problems can be adequately addressed simply by denying immigrants access to certain services or positions and could thus contribute to attitudes of exclusion both inside and outside the profession. Such a position would also undermine our ability to be effective advocates for immigrants and their right of access to health care services.

Brett W. Robinson, M.D.
Clackamas County Department of Human Services, Sandy, OR 97055

To the Editor:

I believe that the federal government is restrained from taking the actions proposed by Whitcomb by virtue of the Fifth Amendment to the U.S. Constitution. Under the equal-protection doctrine, governmental classifications on the basis of alienage, race, or national ancestry or origin are inherently suspect.1-3

To survive a challenge under equal protection, the policies excluding foreign medical graduates would have to advance a compelling governmental interest and be narrowly tailored to effect that interest.4 Although the need to increase the number of primary care physicians and decrease the number of specialists may be important, it is far from compelling. More important, there are better ways to accomplish this than by restricting residencies for foreign medical graduates. The government can provide financial incentives to ease the initial costs of starting a primary care practice or ease regulatory controls that make it difficult for hospitals or health care organizations to assist physicians in relocating.

A.L. DeWitt, R.R.T., C.R.T.T., J.D.
Shamberg, Johnson and Bergman, Overland Park, KS 66207

4 References