Texas must go beyond borders for doctors

The Texas Department of State Health Services recently released startling new data on the future of the physician workforce. By 2030, there won’t be enough doctors in many medical specialties — including psychiatry, family medicine, and obstetrics and gynecology — to meet patient demand.

Medical schools in the Lone Star State won’t be able to produce enough graduates to fill these shortages. Texas will need physicians educated beyond its borders — at international medical schools. Many of these doctors are native Texans who pursued their degrees abroad and want to return home to practice.

Many parts of Texas are already doctor deserts. Consider the gap in mental health professionals. Twelve million Texans live in federally-designated mental health shortage areas, according to the Kaiser Family Foundation. Nearly three-quarters of the state’s counties do not have a single psychiatrist, according to data from 2015.

The shortage of primary care physicians is equally concerning. Texas has enough primary care doctors to meet just half its needs. Dozens of counties have fewer than 10 such physicians. Some have none at all.

The shortage could soon surge. Nearly 30 percent of the state’s active doctors are close to retirement age. Meanwhile, Texas’s population is growing at among the fastest clips in the nation.

Consequently, state officials project that Texas will need thousands more doctors by 2030 — including more than 800 OB/GYNs, 1,000 family medicine physicians, and 1,200 psychiatrists.

These physician gaps threaten Texans’ health. According to a review of the scientific literature conducted by a researcher at the Johns Hopkins University School of Public Health, “Improved access to primary care was associated with reduced mortality rates, better health outcomes, and lower costs.”

Other research shows that an increase of just one primary care physician per 10,000 people is linked to 1.44 fewer deaths, a 2.5 percent decrease in infant mortality, and a 3.2 percent reduction in low birth weight, on average.

Or take the high rates of mental health issues among children and adolescents. More than one-third of Texas high schoolers struggle with symptoms of depression. Nearly 1 in 5 of them have seriously considered suicide, according to the Department of Health and Human Services. The looming physician shortage could prevent these kids from accessing the care they need.

Texas will have to look beyond its borders — even outside the United States — to find the physicians it needs. Four in 10 physicians trained at in-state medical schools leave to practice elsewhere. And less than half of U.S. medical graduates opt for careers in primary care.

Graduates of international medical schools, by contrast, select primary care residencies at nearly double the rate of U.S. graduates. International medical graduates are also more willing than their domestically trained counterparts to practice in rural parts of the country.

International grads have an outsized presence in mental health specialties, too. Roughly three in 10 psychiatrists practicing in the United States were educated abroad. More than 35 percent of active child and adolescent psychiatry residents graduated from an international school, according to the latest data from the Association of American Medical Colleges.

Graduates of the school I lead, St. George’s University in Grenada comprise a significant share of Texas’ — and the nation’s — physician workforce. This year, 30 of our graduates started residencies in the Lone Star State, in cities ranging from Houston and El Paso to San Antonio and Corpus Christi. St. George’s is the secondlargest provider of practicing doctors to the United States.

More graduates will join the state’s workforce in the coming years. More than 300 of our current students hail from Texas. That’s about one-sixth the total number of students that graduated from all medical schools in Texas last year.

Millions of Texans struggle to access care. International medical graduates have proven they can meet their needs. We must allow them to do so.