US call to deter foreign medics

December 25, 1998

An influential committee chaired by former senator George Mitchell has recommended ending government subsidies to medical students in the United States who are not American citizens.

But the proposal was immediately criticised by health-care activists and a union representing medical residents, who said it would reduce services in inner-city and poor communities where foreign medical students are more willing to practise than Americans. The report was sent to Congress for deliberation.

The influential Pew Health Professions Commission called for a cut of 25 per cent in the number of first-year medical residency positions supported by government subsidies. The goal is to curb the surplus of physicians and change the system under which most doctors are trained in hospitals so that they receive more training in emergency treatment than in general medicine. Many are "ill-prepared to serve the public in the emerging wellness-oriented, ambulatory-based environment," the commission found.

The government spends $7 billion a year subsidising medical training by making direct payments to hospitals, which use the money to pay and equip medical residents. The commission also recommended shifting the financial burden from the government to private insurance companies and the hospitals themselves.

There are about 98,000 medical residents in the US, of whom about 12,000 are foreign citizens certified by the Educational Commission on Foreign Medical Graduates, which tests candidates to be sure they have completed a US or US-equivalent medical school education and have English-language competence.

Under the proposal, medical residents who are foreign nationals would be allowed to complete their training in the US so long as it was paid for by their home governments or from private sources.

At least two members of the commission joined health-care activists and student organisations in condemning the idea of cutting off the non-American trainees, who, they said, were more likely to practise in poor communities where medical care was in high demand but in short supply.

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