Study: foreign-trained physicians vital to poor, under-served patients

September 30, 1999

CHAPEL HILL -- A significant minority of community health centers need foreign-trained physicians on staff to provide care to poor and medically under-served people, according to a new University of North Carolina at Chapel Hill study.

A report on the UNC-CH Cecil G. Sheps Center for Health Services Research Center study appears in the October issue of the American Journal of Public Health.

"Many of these centers would have difficulty remaining open without international medical graduates," said Leonard D. Baer, a National Service Research Award fellow at the Sheps Center who wrote the paper with Dr. Thomas R. Konrad and undergraduate Jeremy S. Miller.

Community health centers are private, non-profit organizations that receive federal funding to serve poor people and others with little access to private doctors, particularly in rural areas and inner cities. They receive funding through the Public Health Services Act and receive other public grants, including enhanced Medicare and Medicaid reimbursement. As of 1996, community health centers served more than 8 million patients at more than 3,000 U.S. sites.

Researchers surveyed 100 community health center administrators and found that about a quarter of centers depended on foreign-trained physicians. Of those, most administrators foresaw unfilled positions should foreign-trained physicians no longer be available.

Findings also suggest that administrators believe that foreign-trained physicians are more willing to take lower salaries offered by community health centers.

Twenty-three percent of the community health centers in the sample were dependent on foreign-trained physicians, according to the study. Of those, most planned to increase recruitment of doctors trained outside the United States. More than half of administrators surveyed said that they had employed one or more foreign-trained physicians since 1990.

The new study and previous investigations underscore the role of foreign-trained physicians as health-care safety net providers and may have important policy implications, the authors said.

"Many policy-makers want to reduce the number of foreign-trained physicians coming into the United States," said Baer, a doctoral candidate in geography at UNC-CH. "The question now becomes: what are the consequences of a cutback on access to care for the poor and under-served?"

Fifty-seven percent of positions for foreign-trained doctors and almost 16 percent of staff positions for all doctors at the centers could go unfilled if the number of foreign-trained physicians were cut, the new research showed.

The study was supported in part by the Federal Office of Rural Health Policy and the Health Resources and Services Administration's Bureau of Health Professions.
Note: Baer, Konrad and Miller can be reached at 919-966-5011.
Sheps Center Contact: Carolyn Busse, 919-966-3847.
News Services Contact: David Williamson, 919-962-8596.

University of North Carolina at Chapel Hill

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