American Culture

Live in a rural area? Can you find a doctor when you really, really need one?

The vascular surgeon who removed my gangrenous gall bladder last month received his early medical training in Lahore, Pakistan. He’s been a member of the medical community in my rural valley for more than three decades.

eimyxgertMy primary-care physician for the past 20 years received his medical training in Taiwan. My urologist for a decade was an Iranian-American. The surgeon who removed a subcutaneous growth from my right elbow is a Pakistani-American. So is the internist who treated a pulmonary issue. He’s been here more than two decades.

Those who live in rural areas likely know, or have, doctors with surnames they might think uncommon. Yet all my foreign-born physicians are American citizens with deep ties to the community in which I live. They’ve taken good care of me.

But why have these wonderful doctors settled here, in rural America?

Rural areas tend to be medically underserved. The federal Health Resources & Services Administration says such areas need more than 15,000 medical professionals, spread across medical, dental, and mental health disciplines. About 50 million Americans, about 20 percent, live in rural areas. But only 9 percent of physicians do, according to the National Center for Biotechnological Information. According to The New York Times, about 25 percent of all physicians practicing or training in the United States — more than 200,000 — are foreign-born, but in most rural areas, that share is significantly higher. The Association of American Medical Colleges predicts the United States will be short between 60,000 and more than 90,000 physicians between now and 2025.

Reasons abound for the shortage. Medical school in America is expensive: Doctors-to-be may choose specialties to be able to afford to pay back a median student loan of $183,000, according to the Association of American Medical Colleges. (They still may have undergraduate loans averaging about $30,000 to pay off, too.) So they tend to gravitate to the highest-paid specialties — orthopedists, cardiologists, dermatologists, gastroenterologists, and radiologists (see the list). Doctors-to-be may prefer an urban (and perhaps more affluent) lifestyle than a rural one.

Rural areas remain underserved despite Affordable Care Act incentives for med school students to entertain a career in primary care, particularly in rural areas. Hence doctors born outside the United States are highly recruited by health-care entities in rural and other underserved areas.

Recruiting foreign-born physicians to these areas has become more difficult. Reports Miriam Jordan of The New York Times:

[A] recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.

While the Trump administration is fighting, in the courts of justice and public opinion, for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.

… The procedural change regards temporary visas for skilled workers, known as H-1B visas. United States Citizenship and Immigration Services recently announced that it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others who did not pay the extra fee.

The H-1B visa is the vehicle many rural areas use to recruit — as quickly as possible after vetting qualifications — foreign-born physicians. The H1-B program has its flaws and could use an overhaul. But if physicians who are born-and-bred American citizens continue to shun underserved areas in their own nation, the H1-B program is needed to bring qualified foreign-born medical personnel to those areas — such as where I live.

It’s not just doctors and nurses who are needed in underserved areas. Consider an accident or a heart attack far from medical help. How does the patient get to that help?

I’ve lived in rural areas most of my life. EMTS are like diamonds — rare and valuable to the community. In my village, there’s a permanent sign asking residents to volunteer to be emergency medical technicians — EMTs.

In Maine, where the rural population is aging, EMTs are in short supply. But the state’s immigrant population, particularly in Portland, houses people who are medically trained — some were even doctors in their homelands. So a program is underway to train many as EMTs.

Reports The Times’ Katharine Q. Seelye:

Thanks mainly to a small influx of immigrants, the state’s population inched up last year by about 2,000 people over 2015, despite the anti-immigrant sentiments expressed by Gov. Paul R. LePage. But the state recorded 1,300 more deaths than births, a downward trend in which Maine and West Virginia lead the nation. Like other graying states in New England, Maine is struggling to keep its young people living and working here.

This is where the E.M.T. program comes in.

“This program is a win-win-win,” said David Zahn, chairman of the global languages department at the community college, which started the program.

He said he basically put two and two together. Surveys showed that employers, especially municipal and private ambulance services, needed more E.M.T.s; other surveys showed that many immigrants in the Portland area are underemployed and have medical backgrounds.

Maine’s program may not fit in other states. But the value inherent in its immigration population ought to be obvious, even to ideological troglodytes.

A rural ambulance has taken me to my local hospital a dozen times in the last 14 years. Medical practitioners born elsewhere but now American citizens have kept me alive and well.

More federal attention needs to be paid to the health-care and medical needs of rural and underserved communities. Those potential immigrant physicians President Donald does not wish to welcome should continue to be part of the solution as their predecessors have for decades.

3 replies »

  1. I have a government doctor, because I am of an age and demographic that are assigned “government doctors.” White girl, typical ‘Muircan: weighs about three hundred pounds, smells bad and doesn’t seem to understand the combination of simple English words “no, thank you, I don’t use drugs.” Utterly baffled at my good health.

    As one who does more than just “practice” a more traditional means of medicine I find it really rather humorous.

  2. Wow this was a very interesting read. I think it’s great that these doctors with diverse cultures are settling in rural areas. I used to live out west in a small town and there were doctors with uncommon last names like you mentioned. I think it’s good that they don’t choose to live in a big city just because of the pay.