From the issue dated August 4, 2000

Should Medical Schools Admit More Applicants?


From the Chronicle of Higher Education issue dated August 4, 2000


Journal article warns against an increased reliance on graduates of foreign institutions




Medical schools in the United States aren't producing nearly enough graduates to fill entry-level residencies, and should consider increasing their enrollments, a health-policy expert argued in July in The New England Journal of Medicine.


For the past two decades, medical schools have graduated about 16,000 aspiring doctors a year. That's 28 percent short of the 22,320 entry-level residencies filled by new physicians last year.


Graduates of foreign medical schools took up most of the slack, filling 25 percent of the new residencies. The remaining 3 percent were filled with graduates of osteopathic schools, which emphasize such nontraditional techniques as manually manipulating the body to fight disease.


The author of the journal article, Fitzhugh Mullan, is a physician and a former director of the Bureau of Health Professions, a federal agency. He thinks it's time the United States reduced its reliance on foreign-trained medical graduates and produced more of its own.


"Teaching hospitals have hired thousands of graduates of medical schools elsewhere in the world, despite the large numbers of competent young people unable to obtain a medical education in this country," wrote Dr. Mullan, who contributes to the journal Health Affairs.


While graduates of foreign schools have made huge contributions to health care in this country, "our continued reliance on medical schools in other countries to train physicians for residency programs and practice in the United States draws talent away from these countries, limits opportunities for young Americans, and ultimately results in a medical work force in the United States that is not well matched to the population in terms of culture and language," he wrote.


Dr. Mullan said that even if medical schools in the United States followed his suggestion and graduated more students, more doctors wouldn't necessarily be hanging their shingles in this country. In order to become doctors, the graduates have to complete residencies, and the number of residencies is likely to remain constant. The only thing that could change is the proportion of those residencies that goes to domestically trained doctors.


The president of the Association of American Medical Colleges, Jordan J. Cohen, called Dr. Mullan's idea "intriguing" but impractical.


The reason? Many medical schools in the United States are struggling financially already, and accepting more students would only exacerbate their problems, Dr. Cohen said.


"The idea of increasing class sizes at a time when resources are severely constrained is very troubling," he added. "It could be difficult to maintain the same quality of education."


Some medical educators argue that there's a danger in reducing the nation's reliance on foreign-trained medical graduates.


Those graduates are more likely, the educators say, to accept jobs in areas of the country that desperately need doctors.

Graduates of foreign medical schools are often permitted to remain in the United States longer if they accept such positions. Dr. Mullan and Dr. Cohen agreed that medical educators should come up with more incentives, such as loan-forgiveness programs, to entice homegrown physicians to serve in rural or inner-city areas.


Many medical schools have restricted their enrollments because of concerns that the United States would have a glut of physicians. The Association of American Medical Colleges has stated in recent years that the current number of practicing physicians is sufficient.


"For 20 years, we've believed we shouldn't expand enrollment," Dr. Mullan said. "It's become a kind of mantra." What many educators don't realize, he argues, is that a quarter of those practicing physicians come from overseas, and that it's possible to open up more opportunities for students to study here without creating a physician surplus.



Copyright 2000 by The Chronicle of Higher Education