The COVID-19 pandemic has stressed the New York State and New York City health care systems to their breaking points. Pushed beyond our physical limits, it has become a daily occurrence to be thinking outside of the box.

Telemedicine, expedited FDA drug review, and off-label use of medications are all examples of such creativity.

Recruiting large numbers of foreign-trained doctors and medical students, however, is not as such a reasonable solution. While their willingness to work is a sincere and noble gesture, such a proposal comes with a host of worrisome problems.

In the past, New York has utilized temporary physicians in times of national disasters, but in those cases, the practitioners have come from different parts of the United States. There is a reasonable assumption that those practitioners have received their education and training in medical school and residency under our national system. They will have all passed a battery of standardized tests, have been fully licensed to practice their specialty in another state, and will have documentation of adequate malpractice coverage. All that is necessary in this scenario would be an executive order from the governor directing the State Education Department to grant them temporary licensing in New York State.

The process to recruit such physicians who are foreign-trained is not nearly as clear. It would be a long and time-consuming process and would still require us to make uncomfortable assumptions as to their ultimate clinical value and abilities.

The public and the government have made it a priority in recent years to have a sizable reduction of medical errors. Multiple safety policies and procedures and quality initiatives are in place to avoid serious medical errors. This well-intentioned recruiting effort to utilize foreign-trained practitioners, however, would run contrary to this initiative.

More granular questions arise in terms of how these physicians would be licensed and indemnified. Their educational backgrounds can vary greatly, as will the quality of their medical training, due to the vast disparity in standards among the various countries.

There are also many individual unknowns. No one would come for an interview or with letters of recommendation. There will very likely be challenges due to a lack of language proficiency and an unfamiliarity with the electronic medical record systems of the varying institutions. How quickly and completely can these practitioners be vetted, with regard to routine governmental background checks?

Engaging in a medical career has a steep learning curve. As July 1 comes upon us, the new class of physicians to be trained will arrive at hospitals around the country. At this time, the existing medical and surgical staff, already stretched thin, will not likely have much extra time to supervise an additional group of new caregivers.

The use of foreign-trained physicians is not like the NYU medical students, for instance, who have expedited their internships a few months early! Those students have spent the past years preparing to work in hospitals across the nation upon their graduation.

Another problem becomes determining what licensed medical doctors will be willing to assume the added liability of foreign-trained physicians? Now does not appear to be the time for a baptism by fire. Also, many of these doctors may have been out of clinical practice for any number of years. Utilizing this labor force in a hospital systemwhere supervising physicians are responsible for those practicing under their guidanceraises serious concerns that these foreign-trained physicians may not be able to discern when significant clinical decisions must be discussed with supervising physicians.

In a post-COVID-19 world, a great deal of retrospective analysis will be given as to how this pandemic occurred and how we responded to it at every level. Why we had a shortage of qualified physicians is a fair question. In this discussion, there are two main reasons why foreign-trained physicians are not practicing in United States:

1) They were unable to meet the minimum standard of passing the national board examinations. These examinations are difficult for a reason. That is to ensure that there is a minimum standard requirement to be a physician. No one should believe that these tests are arbitrary or capricious.

The problems are that residencies look for physicians who are out of medical school less than five years, candidates who have had at least one year of clinical experience in a US institution and those who apply have had to obtain high grades on the United States Medical Licensing Examinations. As someone who has been involved in selection and training of surgical residents for over twenty years, there are often reasons why foreign-trained medical students are not selected to residency programs. There is a strong correlation between poor USMLE board scores and failure to pass specialty board certification examinations.

2) Even if they have reasonable scores, the federal government, as part of the Balanced Budget Act in 1997, mandated caps on funding additional residency positions in the United States, in a sense, producing workforce reductions. The United States is projected to have a shortage of primary care physicians in this country of between 21,000 to 55,000 by 2023, and between 47,000 to 122,000 by 2032. There lies the key to having adequate numbers of physicians in the future. The amount of governmental funding to support residency education must be increased, as it is clear from this analysis that we STARTED OFF with a physician shortage before this pandemic even unfolded.

The questions should be asked: will this plan really help our current situation? In this instance, if we listen to the voice of reason, I think not.

Be safe.

Dr. Reilly is an orthopaedic surgeon who has practiced on Staten Island for 35 years. He is Director of Orthopaedics at Staten Island University Hospital and is an Assistant Professor of Orthopaedic Surgery at SUNY Downstate in Brooklyn.

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