About 25% of U.S. physicians got their medical education abroad… and they’re providing an important public health service especially in rural and underserved areas.
Doctors educated abroad are more likely than U.S.-educated physicians to practice in communities with primary care shortages. Physicians working here through the H-1B visa program are also more likely to serve high-poverty communities.
But the Trump administration’s immigration policies are making these doctors harder and more expensive to recruit. The $100K fee on H-1B petitions imposed by Rubio and Mullen, now facing legal challenges, adds to those recruitment barriers.
In addition, Rubio has imposed travel restrictions affecting 39 countries and is even scrutinizing visa applicants’ Instagram & Facebook to stop certain visa applicants.
But there’s another public health question that I’ve been wrestling with: Is it ethical for us to solve our physician shortage by poaching doctors from countries that have even greater physician shortages?
Whose Shortage Are We Solving?
From a strictly US point of view, recruiting another physician can mean better care for patients and more efficient operation of medical facilities.
But public health ethics asks us to consider who benefits and who bears the cost.
When a physician leaves a country with scarce medical resources, the community they leave loses access to care. If public funds financed that doctor’s education, the country also loses the benefits of an investment in medical training.
Indeed, the WHO warns that poorly managed health worker migration is weakening health systems in the global south and widening inequities in countries already facing shortages.
In other words, our gain often comes at someone else’s expense.
Doctors Have Rights, Too
That doesn’t mean physicians should have to stay where they were born or trained. They have legitimate reasons to look for better pay, safer working conditions, professional opportunities or a more secure future for their families.
Nor does every foreign-trained physician’s arrival mean there’s a loss to an underserved community. Countries differ in their training capacity, employment opportunities and ability to keep clinicians (and some foreign medical graduates are legal US residents who studied overseas).
There’s an ethical distinction between a doctor independently seeking a job and a hospital system actively poaching from a country with an already inadequate workforce.
What Would a More Ethical Approach Look Like?
My view is that we should take greater responsibility for producing and keeping the healthcare workforce we need by expanding medical education and most especially residency opportunities, as well as supporting rural practice.
When we take the path of least resistance and actively recruit from developing nations, we’re not being ethical in my view. We’re being selfish.
I’m not 100% sure what the answers are. My purpose here is to highlight that it’s important for us to look at the full picture when it comes to recruiting physicians trained overseas. I don’t have a problem with recruiting from Australia, Canada, Western Europe etc.
But it strikes me as wrong when we actively recruit from places like India, Pakistan, Jordan, Lebanon and Nepal (the top 5 from developing countries).
On the other hand – making that distinction also looks like racial discrimination – which also bothers me.
Like I said – I don’t have the answer – but I also know it’s not a simple question. Like a lot of things in life – it’s a shade of gray.