The involved testing process and often duplicative training these doctors must go through are intended to make sure they meet this country’s high quality standards, which American medical industry groups say are unmatched elsewhere in the world. Some development experts are also loath to make it too easy for foreign doctors to practice here because of the risk of a “brain drain” abroad.

But many foreign physicians and their advocates argue that the process is unnecessarily restrictive and time-consuming, particularly since America’s need for doctors will expand sharply in a few short months under President Obama’s health care law. They point out that medical services cost far more in the United States than elsewhere in the world, in part because of such restrictions.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage is going to get exponentially worse, studies predict, when the health care law insures millions more Americans starting in 2014.

The new health care law only modestly increases the supply of homegrown primary care doctors, not nearly enough to account for the shortfall, and even that tiny bump is still a few years away because it takes so long to train new doctors. Immigrant advocates and some economists point out that the medical labor force could grow much faster if the country tapped the underused skills of the foreign-trained physicians who are already here but are not allowed to practice. Canada, by contrast, has made efforts to recognize more high-quality training programs done abroad.

“It doesn’t cost the taxpayers a penny because these doctors come fully trained,” said Nyapati Raghu Rao, the Indian-born chairman of psychiatry at Nassau University Medical Center and a past chairman of the American Medical Association’s international medical graduates governing council. “It is doubtful that the U.S. can respond to the massive shortages without the participation of international medical graduates. But we’re basically ignoring them in this discussion and I don’t know why that is.”

Consider Sajith Abeyawickrama, 37, who was a celebrated anesthesiologist in his native Sri Lanka. But here in the United States, where he came in 2010 to marry, he cannot practice medicine.

Instead of working as a doctor himself, he has held a series of jobs in the medical industry, including an unpaid position where he entered patient data into a hospital’s electronic medical records system, and, more recently, a paid position teaching a test prep course for students trying to become licensed doctors themselves.

For years the United States has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today about one in four physicians practicing in the United States were trained abroad, a figure that includes a substantial number of American citizens who could not get into medical school at home and studied in places like the Caribbean.

But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.

The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.

That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

The whole process can consume upward of a decade — for those lucky few who make it through.

Article source: http://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html?partner=rss&emc=rss