Bombay to Bentleyville
The American Medical Association estimates that a quarter of practicing physicians in the United States received their medical training outside of the country’s borders. Some in the industry contend that maintaining America’s healthcare system will be impossible without a continuing influx of international medical graduates.
The increase in internationally trained physicians has gradually improved perceptions of such physicians over time, says Phillip Miller, vice president of communications for Merritt, Hawkins & Associates, a national physician search and consulting firm in Irving, Texas. “In the past there was a pronounced bias against internationally trained doctors,” he says. “It was thought that even though they did U.S. residencies, their training was not comparable.”
That opinion, still held by some, can put a healthcare administrator in a precarious position, says Miller, considering the looming shortage of U.S.-trained physicians that by some accounts is projected to reach 200,000 by 2020. “In some cases, you’re talking about excluding 35 percent to 40 percent of your potential candidates,” he says.Moving on up
Educated in India, Kamlesh B. Gosai, M.D., was a green card holder when he completed the Eastman Kodak Occupational Medical Residency Program in Rochester, N.Y. On the East Coast, he gained additional medical experience and U.S. citizenship before he established a primary-care practice in rural Bentleyville, Pa., in 1988.
Today, Gosai’s Southwest Medical Center has eight physicians who serve nearly 19,000 patients. In addition, he has developed a medical laboratory and MRI facility in the region.
With all that Gosai has accomplished—he was honored in 2001 as Country Doctor of the Year by Irving-based Staff Care, a national physician-staffing firm—he still recalls his first meetings with two large hospitals. “One was very welcoming and had a good attitude toward international physicians,” he says. “They recognized my value. At the other hospital I went to, I felt most unwelcome there.”Realizing a need
Based on his initial impression, Gosai’s choice was a no-brainer. Patrick Alberts, senior vice president and chief operating officer for 210-staffed-bed Monongahela Valley (Pa.) Hospital, says Gosai’s decision has helped the hospital seize an opportunity in Bentleyville.
“Bentleyville is interesting because depending on which physicians transitioned in and out of the community, the market would swing between our hospital and Washington Hospital,” says Alberts. “When Gosai came into practice, with many privileges at our hospital, his patients would come here.”
Almost two decades later, Alberts says Monongahela Valley Hospital’s approach to assessing physicians hasn’t changed. “We don’t focus on whether a physician is internationally trained. We look at the quality of training and require board certification within five years of training,” he says.
The key to finding the right physician, says Phillip Miller, is to get decision-makers in agreement about the physician criteria on the front end—and this should not include requiring the candidate to be U.S.-trained. These long-held concerns about internationally trained physicians are becoming outdated:
- Assumption: Language and cultural barriers will make for bad patient-physician interactions. Reality: Internationally trained physicians are required to pass a Clinical Skills Assessment test, which ensures that they have the necessary communication skills to treat patients in the United States.
- Assumption: Patients won’t want to see a foreign doctor. Reality: Negative perceptions toward foreign doctors are fading as more succeed in underserved and rural communities, says Miller. In addition, the demographics of many communities are becoming more diverse.
- Assumption: International physicians will leave after completing their visa obligation. Reality: Physicians on special temporary-worker visas could be required to practice in a federally designated underserved community for up to five years, says Los Angeles-based immigration lawyer Carl Shusterman. Some of these physicians will move on when they receive permanent residence status, acknowledges Miller, but he adds that U.S.-trained physicians are more mobile than in years past, as well.