Original URL: http://www.jsonline.com/alive/news/feb05/305401.asp


Foreign doctors may decide to stay home
Economic, cultural forces could keep physicians in their native countries, worsening the U.S. doctor
By SHEILA B. LALWANI
slalwani@journalsentinel.com
Posted: Feb. 27, 2005
When Bharathi Pulla, a bright, young doctor from Bangalore, had the chance to practice in the United States, she seized the opportunity.

Now, after watching India's economic growth, Pulla, a family doctor with the Kenosha Community Health Center, wonders whether she made the right decision.

"Given the situation now, I'm happy here," she said. "If I could do it over, yeah, probably, I would have stayed back."

For years, developing countries - particularly India, Pakistan and the Philippines - have sent their best and brightest medical graduates to places in the United States that need qualified physicians through the federal J-1 visa, which allows immigrants to live here to teach, study, research, consult, demonstrate special skills or receive training.

Now that the economies of some developing countries are growing, medical experts fear that foreign medical graduates will find the U.S. less attractive. In addition, more foreign doctors may feel compelled to return for family and cultural reasons. If that happens, the American physician shortage could worsen.

Some say the signs are showing in India, which has supplied the most foreign medical school graduates since the 1950s. In a 2004 survey by a Wisconsin researcher, more Indian students said they are hopeful for opportunities in India than those who were part of a similar 1998 survey.

Thousands of doctors have come to the U.S. through the J-1 visa and finished their residency.

As part of the visa requirements, doctors must return to their native countries and practice there before applying to return to the U.S. and practice as doctors.

If doctors want to stay in the U.S. instead of going back to their countries, they can enter the Conrad-30 Program in which they agree to work for several years in a medically underserved area.

Thousands took advantage of this exception to reach for the American dream, and the U.S. had more physicians to work in inner cities and rural areas.

Wisconsin was among the first beneficiaries of the Conrad-30 Program. Doctors in the state practiced in clinics in urban and rural areas that didn't attract or retain American physicians, in cities such as Milwaukee, Kenosha, Beloit, Madison and rural areas such as Wautoma.

"These are clinics that have not been able to recruit an American-born doctor in four or five years," said Randy Munson, outreach specialist with the state Office of Rural Health.

Potential brain drain
Richard Cooper, a physician and director of the Health Policy Institute at the Medical College of Wisconsin and a national expert on physician shortages, recently surveyed a group of medical students from India. He found that a surprising number of the 166 students surveyed were optimistic about opportunities in their home country.

The Indian economy grew about 8% in 2004 and has grown between 5% and 7% over the past several years. Pakistan and the Philippines have showed much slower progress.

Because India has provided the most graduates, Cooper says that alone is something to cause concern. Plus, many foreign medical graduates have deep cultural and family ties that may draw them back.

"There is a tremendous optimism within India that opportunities will exist there. That clearly is something," Cooper said.

Cooper plans to address the recruitment of foreign doctors by the U.S. and its effect on foreign countries at a conference in Europe this year.

He said Wisconsin and the U.S. are nearing a physician shortage crisis.

Neither the state nor the country trains enough doctors domestically and can't keep relying on foreign doctors, he said.

Wisconsin has two medical schools, one public and one private.

Roughly 500 graduates are doing their residencies at the University of Wisconsin Medical School in Madison. Fewer than two dozen residents hold the J-1 visa, which is much lower than in previous years, school officials say. The majority graduated from schools in foreign countries.

Of the 693 medical residents at the Medical College of Wisconsin, 183 are graduates of foreign medical schools, and 35 of those students hold J-1 visas. The others may be American citizens or here on other visas.

Mahendr Kochar, senior associate dean for graduate medical education and a former J-1 visa holder, said the volume of applications from foreign doctors has remained steady.

Despite that, Cooper thinks Wisconsin needs to train as many as 100 more doctors a year.

The way to do that is to build another medical school in the state, he said.

Training another crop of medical professionals here takes time, he said, and the state needs to make more such facilities available.

The two medical schools in the state now produce about 350 doctors annually, he said.

Jagan Ailinani, president of the American Association of Physicians of Indian Origin, isn't as worried about the state's physician shortage because he thinks the country will continue to be attractive to foreign doctors.

"There's as much interest as there has ever been," he said.

In 2002 - the most recent year available - J-1 visa holders accounted for 24.7%, or 210,355, of practicing physicians in the U.S., according to a 2004 Congressional Research Service report titled "Immigration: Foreign Physicians and the J-1 Visa Waiver Program."

Wisconsin communities that showed they needed a foreign medical graduate could recruit doctors and secure them for years.

As an example, the village of La Farge in Vernon County has one foreign doctor who served 800 people for several years.

Desperate for doctors
The Memorial Medical Center in Neillsville had difficulty finding American-born doctors who were willing to move, center spokesman Glen Grady said. The center eventually hired a physician from the Philippines.

Without the foreign doctor program, he said, "We would have a hard time maintaining our little facility." The facility employs 10 doctors, and being short a physician makes a difference because the next nearest hospital is a 30-minute drive away. At the Beloit Area Community Health Center, executive director Richard Perry said his clinic also has benefited from foreign medical graduates.

He's hired one doctor, Nadeem Siddiqui from Pakistan, who joined the facility in 1999.

"Let me tell you, he's a very beloved physician in the area," Perry said.

A new culture
The difficulties of adapting to a new culture contributes to the desire of many foreign doctors to return home, Cooper said.

Pulla, who did her residency in Racine, said she misses her Indian culture and family. Pulla has worked in a Kenosha clinic since 2001.

Siddiqui said he misses Pakistan. He said he feels he hasn't done enough to heal the sick and poor in his homeland.

"I'm thinking this might not have been the right decision," he said of staying in the U.S. "At the end of the day, what have I gained here?" He says he may go back someday.

Srinivas Erragola, a doctor from India who's set to finish his residency at Froedtert Memorial Lutheran Hospital in June, has been in the country for about six years. He would like to stay in Wisconsin, at least for now.

His family lives in the U.S., which lessens the incentive for returning home to Hyderabad.

A taste of America
He said he knows other students who want to go back. But it can be hard for immigrants once they get a taste of a higher standard of living, he said.

"At this time, I want to stay for a few more years, but I am open to going back," he said.

Muhammad K. Ahmed, a physician from Pakistan who participated in the J-1 visa program and has practiced in Wisconsin for a couple of years, believes this was the right program for him.

He is a doctor at Dean Medical Center in Platteville, where the community has welcomed him.

"I wanted to stay in this country, and this program let me do that," Ahmed said.

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Two thumbs up for you....a very good article....and very true.....

Siddman

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