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Forbes
a day ago
- Business
- Forbes
Visa Pause Could Leave U.S. With Fewer New Doctors Amid Shortage
About a quarter of doctors currently in practice were educated in foreign medical schools and the United States faces a growing physician shortage. Newly-minted M.D.s are among the thousands of students, trainees, teachers and exchange visitors put in limbo after the Trump State department hit pause on new visa appointments last week, as it develops a plan to vet visa candidates' social media. For foreign-born and educated doctors who haven't snagged an appointment yet, the timing couldn't be worse—most medical residencies officially begin July 1, with orientations for the newest M.D.s (known as interns or P.G. 1s) starting some time in June. International medical graduates without visas could miss their start date, putting their positions at risk and leaving hospitals in the lurch, since interns provide hands-on medical care under the supervision of more experienced doctors. According to the American Medical Association, about a quarter of doctors currently in practice in the U.S. were educated in foreign medical schools and the nation faces a growing physician shortage. But before a foreign-educated doctor can be licensed to practice medicine in the United States, they must complete a U.S. residency, making these programs crucial to keeping the needed supply of foreign doctors flowing. In March, in what's known as the 'main residency match,' 37,677 graduates of medical schools and schools of osteopathy were placed into first year jobs. Of those, 6,653 were foreign-born students who graduated from a non-U.S. medical school per data from the National Resident Matching Program. (Another 3,108 were U.S. citizen graduates of foreign medical schools.) These figures don't include the 2,374 positions that were initially unfilled in the March match; 300 of those jobs later went to foreign-born and educated students. 'Some people are saying, 'Oh, maybe [foreign doctors] are taking all the spots,' says Sebastian Arruarana, a resident physician at the Brookdale University Hospital and Medical Center in Brooklyn, New York. 'But no, they're not taking the spots—there's a bigger number of positions to be filled than the number of medical students graduating here.' Most international medical graduates (who aren't U.S. citizens) come to the United States on J-1 visas, which are reserved for exchange visitors participating in teaching, research and other training. Many of this year's incoming interns have already made their visa appointments, but about 5%—or more than 300 doctors—have not, estimates Zain Abdin, a Chicago-based physician and founder of the international medical graduate support organization IMG Helping Hands. Arruarana, who is also a social media influencer focused on international medical graduate issues, has been hearing from some of those doctors stuck in limbo. 'We are stuck and we are helpless,' one international medical graduate who matched at a Texas medical center said in a message to Arruarana. The new resident's orientation program began on June 3, which is on the early side. 'I don't know what to do in this position.' 'I just got matched on May 23 after so many challenges and against all odds,' another messaged Arruarana. 'My program just started the J1 visa sponsorship process, so I don't have an interview slot.' Some residencies start later in the year, explains Abdin, primarily in September. Those residents, on the whole, are more likely to be impacted by this visa hold. Big states like New York and Florida—where 1,592 and 698 foreign-born international medical graduates matched this March, respectively—are home to the most foreign medical residents, according to NRMP data. But they represent only 24% and 19% of residents. Less populous states like North Dakota, Wyoming and Arkansas—all of which supported Trump in the last election—rely more on foreign medical residents, with foreign-born and educated medical graduates making up 38%, 33% and 32% of their incoming residents, NRMP data shows. The ongoing appointments pause affects all student visa types, including F-1 visas, primarily issued to foreign undergraduates and graduates at colleges and universities, and M-1 visas, issued most often to foreign students studying at trade schools or in non-academic programs like flight school. State department correspondence said the scheduling pause would stay in place until further guidance is issued 'in the coming days,' Politico reported last week. In the meantime, leadership from the Educational Commission for Foreign Medical Graduates (ECFMG), which essentially serves as a gatekeeper for foreign medical graduates entering the U.S., is attempting to gain an exception for physicians, according to Arruarana, who says he spoke with a staffer there. An email from the ECFMG warned current residents who need to renew their visas not to travel outside the U.S. until the pause is ended. The ECFMG did not return Forbes' request for comment. More From Forbes
Medscape
a day ago
- Business
- Medscape
‘Kind of a Shock': Welcome to the Bureaucracy as a New Doc
When Jeremy Lipman, MD, first started working as an attending colorectal surgeon, he knew very little about how to code and bill. He would receive weekly emails from medical coders and billers about how he wasn't doing it right. If he excised a lesion or debrided a wound, the billing team would want to know what kind of debridement he performed and how big the wound was, 'which just never crossed my mind to put into a note but were important for them for billing,' he said. Lipman finally set up a meeting with the key players on those teams, and they went through charts and showed him what he was doing wrong and what he needed to fix. 'And that was very helpful,' said Lipman, who now works at the Cleveland Clinic, Cleveland. How prepared a resident is for the bureaucratic tasks required of an attending doctor today — including billing and responding to patient messages in a timely fashion — is 'highly variable,' said John Andrews, MD, vice president of graduate medical education innovations at the American Medical Association. If a new attending doctor starts at a practice setting that is closely aligned with where they received training, that doctor may learn these skills more quickly, Andrews said. However, if a physician moves from one city to another — or to a different healthcare system — 'the challenges can be greater because you may have a different EHR [electronic health record]. You may have different supports to the team that provides care to your patients,' he told Medscape Medical News . Also, 'within a large health system, it may be a more seamless path than if you're going into solo practice or joining a small group,' Andrews added. Time spent navigating bureaucratic challenges may be harder at first because 'you haven't developed the reflexes to do it quickly,' Andrews said. 'And so it takes some time for that to get better.' Here are tips for new attending physicians as they navigate the great bureaucracy of the American healthcare system. Learn the Practical Side of Medicine As a Resident Once a resident becomes an attending doctor, all of a sudden the buck stops with them and that person must navigate tasks such as billing and Medicare and Medicaid reimbursement, Andrews said. '…For some people it's kind of a shock,' he said. The biggest change moving from being a resident or fellow to an attending physician 'is that you suddenly have independent responsibility for navigating these systems whereas in a training program there's backup or there is an attending physician who is ultimately responsible,' he said. To help ease this transition, Andrews said medical residents in their final months of training should 'really consciously pay attention to some of the issues that you're going to need to surmount' in your practice as an attending. For example, after seeing a patient, ask the attending doctor how they coded the visit. Also learn from the attending physician how to work within and coordinate interprofessional teams. 'I think there's an old school model of the physician doing everything,' Andrews said. 'And the truth of the matter is in the current healthcare system; it's a multidisciplinary activity.' 'And being sort of at the head of that team and coordinating the input of people like pharmacists and physician's assistants and physical therapists and occupational therapists and whomever you may have to work with, that's an important skill that people have to learn,' he said. Meet the Teams When you're a resident, there is a program director who is responsible for your daily workflow, said Lipman, who serves as the director of Graduate Medical Education at the Cleveland Clinic. However, 'Once you become an attending, you often have many people that are responsible for different areas of your work.' That can create confusion about what you're supposed to be doing day to day, he explained. After accepting an attending position, consider setting up a meeting with the key players to ask about documentation standards and billing. 'If you have the opportunity to meet with the biller or coder from your institution to get some tips and tricks, that's great,' Lipman said. There are also billing courses available online. It is also important to learn how to manage patient communications outside of direct clinical encounters. Find out what other team members, such as nurses and office staff, can manage. Also, ask new colleagues when they answer emails, calls, and MyChart messages, Andrews said. Find out how your new team keeps up with communication and paperwork in a timely manner, Lipman said. Such paperwork includes insurance pre-authorizations, work release letters, Family and Medical Leave Act paperwork, and disability forms. 'If they're not submitted in the right time, patients are going to lose out on disability benefits which can be their financial lifeline if they lose their employment,' Lipman said. Figure Out What's Important Once a new attending arrives at their position, 'figure out what the coin of the realm is,' Lipman advised. 'What is the thing that that institution is most focused on as far as a metric for your success?' 'Certainly, we all want to provide excellent patient care,' he said. '…But then there are things like research and committee involvement and education and documentation… What are the other things that become meaningful to your institution and to your leadership so you can focus your efforts in the right places?' If different people want different things from you, try to figure out who is responsible for what you want, Lipman said adding: Do you want more time for your clinical work? Better operating room times? More leadership opportunities? Find out who can offer you those things, Lipman said 'and that's probably the person that I would defer to.' It's also important to learn the practice's protocols and regulations and understand how they may differ by setting. Lipman sees patients in a variety of practice settings including the endoscopy suite. 'And each of those settings has a different level of rules and regulations and how things are done and it's important to understand what those are,' he said. 'What works in one setting doesn't work in another even though it's in the same hospital and so understanding those different rules and regulations is key.' Also, talk with your new partners to find out what's really important. 'You might be told that there are sort of 10 things that you have to do, but you can talk to your partners and they say: 'Well you know in reality it's just these three things that are super important and the other seven are not', so you have to prioritize,' Lipman said. 'They can help.' Note that doctors who go into private practice have 'a whole separate' layer of things they must deal with compared with doctors working for larger systems, Lipman said, including making sure they are running their private practice. Finally, new attendings may want to consider writing down the things that are important in their job currently and what they would like to see in their job 5 years from now, Lipman said. Then when they are given opportunities or things they're being asked to do, they can reflect on whether those things align with what they have written down that are either currently or in the future going to be important to them, Lipman said. 'And if not, then trying to find ways to either say no or delegate to somebody else.'
Forbes
3 days ago
- Business
- Forbes
As Trump Cuts Healthcare, Private Equity Gains Hold At Doctor's Office
Just two in five U.S. physicians are in doctor-owned private practice as hospitals and private equity firms gobble up physician groups thanks in part to cuts in insurance payments to medical care providers that are about to get even worse. The American Medical Association, the nation's largest physician group, says in a new report that the share of physicians working in private practice was 42.2% last year, which is a sharp decline from more than a decade ago when more than 60% -- or three in five doctors – were in private practice, which the AMA defines as a 'practice wholly owned by physicians.' The AMA's analysis blames flat to falling payments from health insurance companies and government health programs like Medicare coverage for the elderly and Medicaid coverage for low-income Americans among the reasons physicians are selling to hospitals, health systems and private equity. In addition, AMA says its data cites 'costly resources, and burdensome regulatory and administrative requirements' as 'longstanding and important drivers of this change.' 'The share of doctors working in practices wholly owned by physicians is unraveling under compounding pressures,' said AMA President Dr. Bruce A. Scott said. 'The cumulative impact of burdensome regulations, rising financial strain, and relentless cuts in payment poses a dire threat to the sustainability of private practices," Scott said. "After adjusting for inflation in practice costs, Medicare physician payment has fallen 33 percent over the past quarter century, which has severely destabilized private practices and jeopardized patients' access to care. Payment updates are necessary for physicians to continue to practice independently.' But there appears to be little interest by the Republican-controlled Congress to boost payments to physicians. The AMA report comes as Republicans in Congress and the Donald Trump White push for more cuts in federal health insurance programs, including Medicaid and Medicare, which would most certainly spill over onto doctor practices as more Americans lose health insurance. Last week, a new analysis published by the Robert Wood Johnson Foundation of the budget reconciliation bill passed by the U.S. House of Representatives shows physicians and other healthcare providers 'could lose more than $770 billion in revenue over the next decade as a result of more than 11 million people losing health coverage through Medicaid and the Affordable Care Act marketplaces.' The budget still faces approval by the U.S. Senate and would need to be signed into law by Trump. Meanwhile, more and more physicians are working for hospitals or companies owned by private equity no matter their medical discipline. 'Private practices now account for less than half of physicians in most medical specialties, ranging from 30.7 percent in cardiology to 46.9 percent in radiology,' the AMA said of its report. 'Exceptions included orthopedic surgery (54 percent), ophthalmology (70.4 percent), and other surgical subspecialties (51.2 percent).' The share of physicians working in hospital-owned practices increased to more than one-third, or 34.5 percent last year. 'Twelve percent of physicians were employed directly by a hospital (or contracted directly with a hospital), double the share (5.6 percent) in 2012,' the AMA said. 'In 2024, 6.5 percent of physicians characterized their practice as private equity-owned, higher than the shares in 2020 and 2022, which were both around 4.5 percent, the report noted.'
CBS News
6 days ago
- General
- CBS News
Penn Medicine to stop providing gender-affirming surgeries for patients 18 and under, official says
Penn Medicine will no longer provide gender-affirming surgery to patients under 19 years old Penn Medicine will no longer provide gender-affirming surgery to patients under 19 years old Penn Medicine will no longer provide gender-affirming surgery to patients under 19 years old Penn Medicine will stop providing gender-affirming surgeries for patients under 19 years old, the Philadelphia-based system said Thursday. Penn Medicine will no longer perform gender-affirming surgical procedures in plastic surgery, obstetrics and gynecology, and urology, as well as head and neck surgeries, PJ Brennan, Penn Medicine's chief medical officer, said in a statement. The change comes "as a result of current guidance established by the federal government," the statement says. The news comes after President Trump signed an executive order restricting gender-affirming care for people under 19. The order, which threatens federal grants awarded to institutions that provide gender-affirming care to people 18 and under, has been challenged in court. Major medical groups, including the American Medical Association and the American Academy of Pediatrics, support access to care, and surgery for minors is extremely rare. "We remain deeply committed to ensuring a respectful and welcoming environment for all members of the communities we serve and providing comprehensive medical and behavioral health care and psychosocial support for LGBTQ+ individuals while complying with federal government requirements," Brennan said in the statement. The University of Pennsylvania previously came under fire from the Trump administration, which claims the school violated laws guaranteeing women equal opportunities in athletics by letting a transgender swimmer compete on the school's women's team and into team facilities in 2022. Penn has said that it always followed NCAA and Ivy League policies regarding student participation on athletic teams. The Trump administration said in March it would cut $175 million in grants for the university over the issue.
Yahoo
6 days ago
- Business
- Yahoo
7 Best Countries for Cheap Healthcare — and How Much It Costs To Live There
Americans thinking about moving abroad are likely to spend less money on healthcare no matter where they end up. The United States ranks as the most expensive country in the world for healthcare, according to a new analysis from Outcomes Rocket, a healthcare marketing company. Check Out: Read More: Below are details from the study about the cost of healthcare in America, as well as the seven best countries for cheap healthcare, based on the Outcomes Rocket analysis. Also see four ways Mark Cuban is lowering healthcare costs. Outcomes Rocket estimated that Americans face an average annual healthcare expenditure of $12,555 per person. That's well above Switzerland, which ranks as the second-most-expensive country at an average of $8,049. The cheapest country surveyed, Mexico, has an average healthcare expenditure of $1,181 a year. Data from the American Medical Association found that U.S. health spending saw one of the highest growth rates in two decades in 2023, and, for the first time since the COVID-19 pandemic, healthcare spending growth outpaced GDP growth. But while you're just about guaranteed to find lower healthcare costs outside of the U.S., you're not guaranteed to get better healthcare. As part of its research, Outcomes Rocket analyzed 167 countries and then identified and ranked the best ones for U.S. expats in terms of both cost and quality of healthcare. Here are the best countries for cheap healthcare from the study, as well as how much it costs to live in each, per Numbeo. Each of the countries had to rank in the top 15 for healthcare affordability. In terms of overall healthcare score, the scores ranged from a high of 80.2 (Estonia) to a low of 10.0 (Lesotho). Learn More: Overall healthcare score: 80.2 (out of 100) Healthcare affordability ranking: No. 10 Monthly cost of living: $1,007.90 per person (excluding rent) Overall healthcare score: 65.39 Healthcare affordability ranking: No. 15 Monthly cost of living: $770.70 per person (excluding rent) Overall healthcare score: 63.33 Healthcare affordability ranking: No. 4 Monthly cost of living: $674.30 per person (excluding rent) Overall healthcare score: 60.06 Healthcare affordability ranking: No. 6 Monthly cost of living: $678.60 per person (excluding rent) Overall healthcare score: 58.54 Healthcare affordability ranking: No. 7 Monthly cost of living: $720.00 per person (excluding rent) Overall healthcare score: 58.43 Healthcare affordability ranking: No. 3 Monthly cost of living: $902.00 per person (excluding rent) Overall healthcare score: 57.99 Healthcare affordability ranking: No. 12 Monthly cost of living: $912.50 per person (excluding rent) More From GOBankingRates 6 Big Shakeups Coming to Social Security in 2025 This article originally appeared on 7 Best Countries for Cheap Healthcare — and How Much It Costs To Live There
