Plight of Foreign Doctors

A 31-year-old Philippine doctor sat grimly in a Bronx hospital one day last week, hands clenched, anger and sadness on her face. In 1958 she had paid her own fare to New York, happy at the opportunity to work and study in the U.S. Now a senior resident at the hospital (salary: $3,180), she had earned the full respect of her colleagues. Said the medical superintendent: '"Outstanding--a record such as you have never seen."

Yet last week, like 2,000 other foreign interns and resident physicians at about 900 hospitals across the nation, she faced the loss of her job and possible deportation. She had flunked the qualifying examination that would have enabled her to stay in the U.S. and complete her training. "I am humiliated. I will carry this with me when I go back to Manila," she said.

The powerful American Medical Association makes passing the test the qualification for internships and residencies in accredited U.S. hospitals--therefore foreign doctors lose their jobs upon failing the test. They lose their right to stay in the U.S. because the State Department makes holding such a hospital job the qualification for keeping a visa.

Many U.S. hospitals are understaffed, and U.S. medical schools cannot turn out graduates quickly enough to fill the internships and residencies open (TIME, June 20). Moreover, some of the 9,500 foreign physicians now in U.S. hospitals came here on Government-sponsored cultural-exchange programs from strategically sensitive areas like Southeast Asia and the Middle East. The State Department warned last week that packing them home "could present us with an embarrassing foreign-policy problem."

Medical Mecca. The qualifying examinations had their origin in the postwar emergence of the U.S. as the world's medical mecca. Foreign physicians wanted to study in the U.S.--just as U.S. doctors, before World War II, wanted to study in Germany. In theory, hiring foreign doctors for U.S. hospitals is mutually advantageous: the hospitals flesh out their staffs to adequate size; foreign physicians add to their medical skills and go back to improve medical care in their native lands. The program won the support of both the U.S. and foreign governments.

But there have been many difficulties. Some of the poorer hospitals exploit the visiting doctors as semi-slave labor, e.g., to replace orderlies; and they offer the foreigners little professional training. Thus treated, the foreign doctor is often a liability to patients in his care.

In 1957, the A.M.A., together with the American Hospital Association, Association of American Medical Colleges and Federation of State Medical Boards, created the Educational Council for Foreign Medical Graduates. Its job: to set standards for foreign-trained doctors, administer qualifying tests. To win permission to work in a U.S. hospital, a candidate must score 75% or better on the Educational Council exam. If he scores 70% to 74%, he can stay in the U.S., bone up to take the exams again.

Many foreign students argue that the exams are unfair, claim they include subtly worded, semantic-trap questions that would be tricky even for a native-born American. Critics also insist that the A.M.A. purposely makes the exams tough to maintain a monopoly for U.S. doctors --a charge the A.M.A. hotly denies.

Softened Attitude. Top hospitals like New York's Bellevue which has about 100 foreign physicians, can choose the most promising foreign medical school graduates, who have less difficulty getting past the examination hurdle. The pinch comes in hospitals that have no affiliation with a medical school, need A.M.A.A.H.A. accreditation to attract good U.S. graduates. Six of the twelve foreign-trained doctors in Rhode Island's State Hospital for Mental Diseases flunked the exams, and one New York City hospital faces loss of a quarter of its house staff.

Last week, under pressure from Congress and the State Department, the A.M.A. relented a bit on its pass-the-test-or-get-out policy. Foreign doctors who flunked the September exam may remain with their hospitals until next July 1 can take another crack at the qualifying test in April. But they will not be permitted to treat patients until they pass the exam. The A.M.A. and the State Department also agreed that in the future, foreign doctors who want to work in the U.S. must pass the qualifying examinations in their own countries before even applying for exchange-visitor visas.

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