International medical graduates expected to fill gap in U.S. health care

From the Chattanooga Times Free Press,

By Elizabeth Fite

The United States will need up to 120,000 additional doctors, including a minimum of 42,600 primary care physicians, by 2030, and international medical graduates play an important role in helping alleviate the crisis.

Students who attend medical schools outside the U.S. are more likely to go into primary care, particularly in rural areas where need is greatest, said Dr. Richard Olds, president of St. George's University in Grenada, West Indies.

"We often talk about the physician shortage, which is true, but a far greater problem is now distribution of doctors geographically," Olds said.

There are many reasons for the nationwide provider shortage: The limited number of slots in residency training programs, the time it takes to train medical professionals and increased health care utilization as more people gain health insurance. However, demographics are the biggest driver, according to a report from the Association of American Medical Colleges.

Over the next 12 years, the 65 and older population is projected to grow by 50 percent, while it's estimated the population under age 18 will grow by only 3 percent. At the same time, older adults utilize health care at much higher rates than young people, further increasing demand, and many longtime physicians are opting to retire.

The crisis is greatest in rural and underserved urban areas, which struggle to attract young doctors.

Olds said some medical students are averse to primary care fields, like family medicine, pediatrics or internal medicine, in part because those jobs pay less than other specialties, but medical school training is also to blame.

"Most U.S. medical schools train their physicians in big university hospitals so many people who might otherwise go into primary care are dissuaded largely by the facility of their own medical school," he said. "If you want doctors to go into primary care fields, you need to train them in areas where primary care is featured."

St. George's supplies more medical school graduates to the U.S. than any university in the world and places a particular emphasis on primary care by exposing students to more community health centers and outpatient environments.

Most of its students are U.S. citizens, like Dr. Meg Armour-Jones, who will start her pediatrics residency at the University of Tennessee College of Medicine Chattanooga this summer. Armour-Jones is from Sewanee, Tennessee, and completed her undergraduate degree at the University of Memphis.

Like many international med students, Armour-Jones took a "nontraditional" path to becoming a doctor.

"From fifth grade until probably through freshman year of college, it wasn't even on my radar — I was totally sure I was going to do marine biology," she said, but after she took an EMT certification class, she was hooked on medicine.

Knowing that her test scores meant getting into a U.S. medical school would be a challenge, Armour-Jones took the leap and applied to St. George. She is now one of 12 international graduates who will begin residency training in Chattanooga in July 2018. Of those 12 residents, nine are going into primary care.

The number of international graduates entering training in Chattanooga varies from year to year, said Pam Scott, director of graduate and medical student education at UTCOMC. Currently, 37 international graduates are in Chattanooga's residency and fellowship programs. In 2016-2017, the school had 48 international graduates in its programs.

Armour-Jones said college students who want to pursue medicine should keep an open mind about medical school and future careers, because there's a lot opportunities and options that aren't always obvious in the beginning. Her main advice is to "be hungry."

"Because it's really hard, and no matter if you go to an American med school or an international med school, it's going to be really difficult," she said. "I had a lot of people, especially in undergrad, telling me that it's not going to work out for me ... but I was really hungry for it, and I worked hard and I'm about to start residency."

Contact staff writer Elizabeth Fite at or 423-757-6673.