Commentary: The fix to Texas’s doctor shortage lies abroad


The Lone Star State is suffering a severe shortage of doctors. On a per-capita basis, Texas has fewer primary care physicians than all but three states. About 20,000 primary care doctors currently practice in Texas — but the state will need 6,000 more by 2030 to meet the needs of its growing population.

Texas medical schools won’t be able to satisfy this demand on their own — even if every one of their graduates sticks around to practice.

The only way to solve Texas’s doctor shortage is to look abroad — to graduates of international medical schools.

Across Texas, there are 475 federally designated “health care professional shortage areas,” or regions with too few primary care health care providers. Over 6 million people reside in these regions. Thirty-five counties lack a single doctor.

Many current physicians will soon leave the profession, further exacerbating the shortage. Nearly three in 10 Texas doctors are 60 or older, so they’re likely to retire within the next decade.

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Meanwhile, demand for care is soaring. Texas’s population is growing rapidly. New and longtime residents alike face serious chronic diseases. More than one in 10 Texans suffers from diabetes. More than one-third are obese, which increases their risk of chronic conditions such as heart disease and hypertension.

Texas medical schools are graduating about 1,400 new doctors each year — but more than 40 percent of them leave the state after graduating.

Doctors trained abroad can help fill the gap. They already treat millions of patients across the Lone Star State. And many of them are actually U.S. citizens who chose to study overseas — and then return home to practice.

More than a quarter of Texas’s doctors are international medical graduates. Thirty-four graduates from the school I lead, St. George’s University in Grenada, will begin residencies in Texas this year — 85 percent of them in primary care.

And the pipeline remains strong. Dozens of Texans will begin their medical studies at our school this month. Seven incoming Texans earned scholarships to underwrite their education at St. George’s.

Importantly, international medical graduates (IMGs) are more likely to serve in primary care, where the doctor shortage is most acute. In the 2018 residency match cycle, 70 percent of IMGs chose primary care residencies, compared to just 40 percent of U.S. grads.

Fortunately, some doctor groups and state officials are working to bring more international medical graduates to the Lone Star State.

The Texas Medical Association has a program that connects IMGs with mentors known as “physician leaders.” These leaders help international graduates understand medical licensing rules and acclimate to Texas culture.

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The state has also ramped up funding for residency programs, which all medical school graduates must complete before they can practice. In 2014, the state legislature began a Graduate Medical Education Expansion program to train more doctors. In January, program officials announced they were awarding $97 million to support nearly 1,300 residencies for fiscal years 2018 and 2019.

But state leaders are by no means as welcoming of international medical students as they should be. Texas is one of only two states that prohibits students from international medical schools from participating in clinical rotations at state hospitals — even if they’re natives of the Lone Star State. These rotations, which students must complete during their last two years of med school to graduate, enable students to gain hands-on medical experience and learn from established health practitioners.

California, New York, New Jersey, Georgia and Florida require international medical schools to meet national training standards before they allow their students to perform clinical rotations at hospitals within their borders. Texas should do the same — rather than simply banning international medical students altogether.

Texas can’t solve its doctor shortage by relying solely on physicians educated within its borders. Recruiting more graduates from international medical schools is the only way to stave off a healthcare crisis.

Olds is President of St. George’s University.



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