Domestic and International Medical School Education for Physicians in Massachusetts – A Perspective

Source: FolioMed Provider Data Management Statistical Data

One of the issues facing the new changes in healthcare is the ability of Physicians to respond to the increase in uninsured patients who would be eligible for insured and routine medical services.  By one count if there are roughly 300,000+ actively practicing Primary Care Physicians (PCP)* in the country and 30 million newly insured, that implies a net gain of 100 patients per PCP.  Using an average multiple of 4 visits a year, there could be up to 400 additional patient visits per PCP.  And, assuming a 20 patient day, approximately one additional month of patient care per year per PCP.

Numbers can be disputed but whatever the result there will no doubt be an increase in the demand for PCP services.  One of the solutions to solving this capacity ‘problem’ would be to allow less than fully licensed Physicians, such as Physician Assistants and Nurse Practitioners, to screen and treat patients and assume some of the traditional functions normally reserved for Physicians.  Another solution would be to increase the available ‘supply’ of Physicians by either increasing the number of US medical schools (a very long term approach) or encouraging the entry of more Physicians educated in foreign medical schools.

Of course foreign educated Physicians does not mean foreign nationals as Physicians.  It does mean both American citizens and others who were educated in Medical Schools abroad.

Anecdotally it appears that the number of Massachusetts physicians educated in foreign medical schools has increased, but is that true?

In analyzing FolioMed data for active practicing Physicians in Massachusetts there are a couple of interesting statistics.

First the overall percentage of active Physicians practicing in Massachusetts and graduating from a foreign medical school has indeed increased gradually over the last 10 years from about 17.3% in 2003 to 20.0% currently.

% of physicians
Domestic Medical School Foreign Medical School
March, 2003 82.7% 17.3%
March, 2013 80.0% 20.0%

 

This rather modest overall change does not really describe what the ‘incremental’ change has been during this period.  As an example, there were a total of 12,870 physicians in the 2013 census that were not practicing medicine in Massachusetts in 2003.  If we look at only those Physicians, we get a greater sense of the foreign educated medical school changes.

% of ‘new’ physicians in 2013 vs.
2003 census
Domestic Medical School Foreign Medical School
71.7% 28.3%

In this view, one can see a greater impact of foreign medical school education based on ‘new’ physicians practicing in the state compared to a decade before.

Does the picture look different when contrasting Specialists with Primary Care Physicians (PCP)?

In short, it does.  Looking at PCPs as a group over the last 10 years:

% of PCP physicians
Domestic Medical School Foreign Medical School
March, 2003 82.5% 17.5%
March, 2013 75.5% 24.5%

 

The distribution of PCPs between Domestic and Foreign Medical Schools in 2003 mirrored the overall population of Physicians.  However there was greater divergence 10 years later in 2013.  And this divergence is captured in looking at the increase in PCPs in Massachusetts in that ten year period.

% of ‘new’ PCP physicians in 2013
vs. 2003 census
Domestic Medical School Foreign Medical School
63.5% 36.5%

From this analysis over 1/3 of all new PCPs currently practicing in Massachusetts over the last 10 years were educated in a foreign medical school.  Although only a picture of the Massachusetts physician population this would appear to support the conclusion that demands for primary care medical services have exceeded the ability of domestic medical schools to meet those needs and increasingly the US will need to turn to foreign, medical schooled, physicians as a solution.

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