Medical Schools Abroad: Meeting Demands of Physician Shortage in U.S.

The U.S. is expected to face a physician shortage of between 13,500 and 86,000 by 2036, according to a report published a year ago by the Association of American Medical Colleges (AAMC).

Ahead of Match Day later this month, Healthcare Innovation spoke with the dean of the American University of the Caribbean School of Medicine (AUC), Dr. Mark E. Rosenberg, MD, FASN, to find out more about what they are doing to meet the demands of the physician workforce shortage.

Hailing from Canada, Dr. Rosenberg held positions at the University of Minnesota Medical School, including vice dean of education and academic affairs. At the Minneapolis VA Health Care System, he was chief of medicine and director of the Primary and Specialty Medicine service line. He has been with AUC for six months now.

AUC is a two-campus school. One campus is located in St. Martin, and the other is in Preston, England. Students spend about two years of their first phase of medical education on either of those campuses. The clinical training is done in the United States, the UK, or both countries. "It's a standard US medical education program…and the same residency match as US medical students," Rosenberg noted.

Rosenberg explained that students have to select a specialty like pediatrics or surgery after completing their MD degree. "Then they enter this National Match, and on March 21, they will find out where the next phase of their medical education will be."

Could you speak to the bias historically present when students go abroad for their medical education?

A school such as AUC expands access for more students to become physicians. In the United States, a workforce shortage is projected for physicians, but probably for any healthcare worker. International medical graduates, US or non-US citizens, make up about 25 percent of the U.S. workforce.

Medical schools in the U.S. and Canada aren't expanding enough to address this projected workforce challenge. There needs to be more than one pathway into Medical School, and AUC does that. It offers another pathway for qualified students who weren't given an opportunity at a U.S. or a Canadian Medical School.

Many qualified students in our school will make great physicians, but they have been shut out because there are just not enough spots. It's about making doctors who are going to serve future patients and communities.

Taking into account the shortage, has the matching rate improved?

Last year, there were about 40,000 positions offered in the match, and that's across all of the United States. About 98 percent of our students match. In a U.S. school, it's probably very comparable. There is a main residency match. For students who don't match, there's what's called a supplementary match. About 93 percent of positions get filled in the main match, and then through the supplementary match, it gets into the high 90s.

Last year, about 2700 positions went unfilled, so the students have the rest of Monday, Tuesday, and Wednesday to interview at the places that didn't fill. On Thursday, there's this supplementary match for those remaining 2700 positions.

A school like ours has a very comparable match rate compared to U.S. schools, and we, along with our partner school, Ross University School of Medicine, ranked first for all Caribbean schools in terms of the matching rate. (DISCLAIMER: *Based on information available on the schools’ websites as of July 2024. Methodologies vary.)

The rate is much lower if you take all international medical schools into consideration.

Why do you think this school does better than some of the others?

We have great students and a great education program. Our students come in with a lot of different experiences, and in many ways, they have a level of maturity and life skills that not all medical students have. By the time they're done with medical school, they stand out. When they're rotating in hospitals in the U.S. or the UK, I think residency programs recognize that; they see that they're very patient-centered.

What is the percentage of students that go to the U.S. for their residency?

There are a few that go to Canada, but then, and every so often, some stay in the UK for their system of training after medical school. The majority, 99 percent match into a U.S. residency.

Are many students going to rural areas because of the staffing shortage that we see here in the U.S.?

We don't have exact numbers of how many of our students go to rural or underserved areas. In last year's match, about 60 percent of them matched into a primary care specialty, defined as family medicine, internal medicine, or pediatrics. Those physicians are the ones that tend to be more in rural or underserved areas.

What advice do you have for international medical schools?

Having a robust clinical training program and instilling in the students that sense they're here to serve. That's the approach we take at AUC.

Is there less interest in studying medicine?

The number of applicants to medical school each year has been increasing. During COVID, we saw the biggest increase in number of students interested in medicine, to the point that schools in the U.S. have way more applications than they have spots.

At the University of Minnesota, where I was, we would have over 4000 applications of qualified students for 240 spots a year, and we were the seventh-largest medical school.

There's this huge number of students who have applied to medical school who don't have a spot. That's an opportunity for a school such as AUC. The requirements for students are basically the same as for any U.S. school.

There's no shortage of people out there who want to become physicians.