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11 Feb

Looming shortage of residency positions in the United States is worrisome for international medical students

A resident reviews an X-ray

If you are attending an international medical school, there is some rather startling news regarding residency positions in the United States of America (USA).

According to a recent article in the Journal of the American Medical Association (JAMA) in December 2012, the number of graduates of medical programs in the United States alone will surpass the number of residency positions in that country by the year 2015. It appears that the primary reason for this is that in the recent past, the United States has expanded its existing medical schools and even created new ones, without planning for an increase in residency positions. Interestingly, throughout the world, the number of medical schools has increased from 800 to 2,300 in less than 20 years. Perhaps a concurrent increase in hospital training positions has lagged behind this trend.

While there has been an increase in the United States of post-graduate year 1 (PGY-1) positions from 20,192 in 1991 to 23,421 in 2011, it is projected that the enrollment at American medical schools alone will increase to as much 26,709 by the year 2016-2017.

International medical students typically take on more debt that American medical students and indeed they rely on residency positions in the United States where they can qualify as physicians and earn the money required to pay off their student loans. The outcome for these international medical students remains unclear as competition from medical students in American medical schools heats up as a result of dwindling residency positions. Typically, graduates of American medical schools fare better than international medical graduates (IMGs) anyway, so landing a residency position as an IMG will become even more difficult if indeed the number of residency positions is only sufficient for American medical graduates.

It would appear then that international medical graduates may have to look at countries other than the United States to find a residency position. This is a major departure from the trends seen over the past two decades and it is unclear as to whether such IMGs would be able to eventually practice in the United States. Interestingly, the USA has served as the West’s primary trainer of international medical graduates in recent times. Other countries in the West, including many European nations as well as Australia and Canada, have policies that restrict access to most of their residency positions to local residents. Often this is related to the fact that local governments subsidize the positions.

With this said, some international medical schools have agreements with hospitals in the United States to provide residency positions. If pursuing medical training outside of the United States with intent to practice in that country, it may be prudent to study at such schools. The result of the current situation is that America is likely to prove challenging for future graduates of international medical schools.