To become a board-certified and licensed doctor in the United States, one must complete medical school and then be placed in a residency program for at least one year of clinical training. In 1981, only 9 percent of medical residents came from foreign medical schools.1National Resident Matching Program, “Match Data & Report Archives,” https://www.nrmp.org/match-data-analytics/archives/ (accessed May 4, 2024). In 2024, 25 percent of medical residents came from abroad. That is, a quarter of the people becoming doctors in the U.S. obtained their medical education abroad.
Of course, there are many skilled and caring physicians working in the U.S. who attended medical school in other countries. They are not at fault for wanting to become doctors and serving patients in the United States. But a system for producing doctors that favors foreign-trained doctors while blocking qualified Americans is strange and problematic.
The primary reason for the huge increase in foreign-trained doctors is simply that there are too few U.S. medical schools2Unless otherwise noted, the term “U.S. medical school” includes both those trained in allopathic schools that grant MD degrees and osteopathic schools that grant doctor of osteopathic medicine (DO) degrees. training too few students. There is no shortage of people applying to U.S. medical schools. In fact, it is getting significantly more difficult to get into medical schools. According to the Association of American Medical Colleges, there were 62,443 applicants to allopathic (doctor of medicine (MD)-granting) medical schools in 2021, of whom 23,711 were admitted.3Association of American Medical Colleges, “2021 Fall Applicant, Matriculant, and Enrollment Data Tables,” https://www.aamc.org/media/57761/download?attachment (accessed on May 3, 2024). This acceptance rate of 38 percent is down from 46 percent in 2011 and 52 percent in 2002. If U.S. medical schools had the same acceptance rate in 2024 as they had in 2002, the current percentage of medical residents that would need to be filled by foreign medical students would be 9 percent—the same as it was in 1981.
The reason that the percentage of doctors imported from abroad has skyrocketed from 9 percent to 25 percent between 1981 and 2024 is that U.S. medical schools have simply failed to keep up with the increased demand for medical services by not expanding the number of doctors they train. It was a policy choice to import significantly more foreign-educated doctors rather than train more in the U.S. That policy choice was enforced by monopoly control over the accreditation of U.S. medical schools, which hindered new entrants and forced the U.S. health care system to look abroad for doctors.