Coming to America ... to Practice Medicine

Two UA surgeons are examining issues and misperceptions about foreign-trained physicians practicing in the U.S.
Jan. 4, 2008
Dr. Luis Leon along with treatment and care of his patients and teaching responsibilities, studies the impact of foreign trained physicians in the United States.
Dr. Luis Leon along with treatment and care of his patients and teaching responsibilities, studies the impact of foreign trained physicians in the United States.

Foreign-trained doctors have long filled the needs of rural and underserved populations in the United States, but their role in American medicine is often under fire.

There is much discussion but very little research in understanding what it takes for these physicians to come and practice in the U.S., including the sacrifices they make by not practicing in their country of origin.

Their migration into the U.S. also brings with it controversy over the quality of their skills.

Dr. Luis R. Leon Jr., assistant professor of clinical surgery in The University of Arizona College of Medicine and chief of vascular surgery at the Southern Arizona Veterans Affairs Health Care System, says that medical care to underserved populations would suffer “if it were not for physicians trained abroad who are willing to practice in these areas. Many of these positions would go unfilled.”

The critical need for these doctors has led Leon to conduct two studies – and begin work on a third – to investigate the issues and controversies related to foreign-trained doctors working in the U.S. and to raise awareness of their role in the U.S. health care system.

Foreign-trained doctors account for one quarter of all active U.S. physicians.

In articles published in the Journal of the American College of Surgeons, Leon outlines the arduous process these doctors overcome to obtain a certificate from the Educational Commission for Foreign Medical Graduates after passing several exams, including the U.S. Medical Licensure Examination and a spoken English proficiency assessment.

The first article explores the academic rigor as well as the financial costs associated with the exams and preparation courses, and administrative fees for submitting credential information, including legal and translation fees that create a huge barrier for many.

Leon, who received his medical degree in Peru, has his own experience to draw from. "In Peru, the average minimum yearly wage is about $1,440 U.S. The testing costs to gain the right to practice here alone are equivalent to the average annual gross incomes in many countries," he said.

Once these doctors are matched with residency programs, complications and more financial strain follow, with immigration requirements sometimes keeping them from beginning their programs on time, Leon said.

The second part of Leon’s study, “Controversies Surrounding the Impact of this Migration to the United States,” also was published in the Journal of the American College of Surgeons.

The article identified several additional issues that impact these foreign-trained doctors who complete U.S. residencies and stay here for clinical practice. Among these is the “brain drain” phenomenon that occurs in their countries of origin, particularly in poor nations that are unable to compete with the higher salaries provided by developed nations.

Another controversy that Leon addresses is the perception that foreign-trained doctors are inferior. He cites several studies showing that physicians trained abroad achieve less satisfactory outcomes when treating patients than their U.S. counterparts.

Leon argues that this is simply not the case.

“Most of these studies suffer from serious flaws,” he says. “To measure the quality of care, many variables have to be considered, such as the time of medical training, quality and location of residency training and post-residency opportunities. After controlling for these variables, most reports have identified no differences in quality of care rendered by the two groups.”

Leon has taken his analysis of foreign-trained doctors further by comparing them with medical doctors and surgeons who stay in their country of origin.

“We evaluate and compare job satisfaction and perceived quality of life,” he said, “as well as the quality of life for their families in the U.S. and whether this differs greatly from those from their home countries.”

Leon, who hopes to have the results of the analysis published soon, is the first to examine the impact of cultural changes due to doctors' migratory status and their perceived quality of life.

Dr. Hugo Villar, chief of surgical oncology at the UA College of Medicine and one of the study’s co-investigators, says the research will bring to light important controversies concerning the migration of foreign-trained physicians to U.S. residencies.

“Understanding the obstacles and the quality-of-life issues once the foreign-trained physicians are here can help us identify means of helping qualified foreign-physicians stay in the U.S. and provide care, especially in the specialty areas that are in need of medical personnel,” Villar says.