by Corrine S Kennedy | photo by Christine Tannous | from The Commercial Appeal, August 23, 2022
Native Memphian Dr. Sammie Gutierrez took a non-traditional path to medicine. She studied biology at Christian Brothers University and originally wanted to become a veterinarian. She joined the Minority Health International Research Training program in part because it afforded a unique research opportunity. “You could go to Brazil and tag jaguars in a rainforest and who doesn’t want to do that?” she said. She didn’t end up going to Brazil but did go to Uganda to participate in a medical work program. That experience, combined with her interactions with other students in the program who were on a medical school track, changed her mind about her career path. Gutierrez, 31, first got a master’s degree in public health and then took the medical school entrance exams. She applied to St. George’s University in Grenada, which has a relationship with CBU. A few days later, she got a call that there was a spot open for her at the medical school.
“It was one of those jump now or maybe never jump situations, so I jumped,” she said.
Now she’s back in Memphis, doing clinical rotations at the VA, Baptist Memorial Hospital-East and Church Health. She’s one of seven SGU students who started rotations in Memphis over the summer. Seven more are at other Tennessee hospitals. As a national shortage of doctors continues to plague healthcare systems across the country — including the Mid-South — Caribbean medical schools are providing increasing numbers of residents to U.S. medical institutions each year. And more people are likely already being treated by international medical school graduates than they realize. About a quarter of all physicians currently practicing in the U.S. are international graduates, according to Dr. G. Richard Olds, dean of the medical school at SGU.
Long-term solutions needed
International medical graduates are a short-term solution to a long-term problem. Eventually, more medical school slots need to open up as well as more residency positions, Olds said.
Over the next five years, 1,000 new residency spaces will open up across the country, according to the Centers for Medicare and Medicaid Services. It marks the largest expansion of residency openings in more than 25 years. There will also be a push to funnel some of these residents into rural areas.
“CMS recognizes the importance of encouraging more health professionals to work in rural and underserved areas, and the need to train and retain physicians to improve access to health care in these communities,” said CMS Administrator Chiquita Brooks-LaSure when the additional spaces were announced last year.
But it won’t make up for the anticipated shortfall of doctors to come. And the Mid-South could be particularly hard hit.
A study from the National Institutes of Health projects Arkansas, Tennessee and Mississippi to be in the top 10 states with the largest shortage of doctors by 2030. The NIH projects only 14 states will have enough — or a surplus of — doctors by that time.
By 2034, the Association of American Medical Colleges projected there could be a shortage of between 17,800 and 48,000 primary care physicians and between 21,000 and 77,100 non-primary care physicians.
“Until the United States builds enough medical schools for its own needs, and probably more important in the short run, builds more graduate medical education slots…we’re going to continue to have a fairly significant shortage,” Olds said. “So this situation is going to get considerably worse. And obviously, international medical graduates are going to have to fill the void.”
‘Medicine is going to be the same’
One thing Olds said many people would likely be surprised to learn is many of those who attend SGU are Americans who pursue medical school abroad because of the dearth of medical school slots domestically.
But the education is no less rigorous than at American institutions and programs must meet strict accreditation requirements. Students from SGU do their clinical rotations either in the U.S. or the U.K.
They have to pass the same board exams as students who go to medical school in the U.S. in able to practice.
“There’s a couple more loopholes we have to jump through,” Gutierrez said. “That only shows, I think, a commitment to want to practice in the U.S., that we’re willing to go through those jump holes. And, quite honestly, pay more money for education to be able to practice in the U.S.”
For a four-year program, including classroom instruction and clinical rotations, attending St. George’s costs about $332,000. That does not include travel and housing expenses for students not from the island.
“It’s really about how much you want it and so if you want to practice medicine, you want to go and study hard, you could do that anywhere,” she said. “Medicine is going to be the same whether you learn it in a textbook in the US or learn in the Caribbean.”
Solving the shortage involves more medical school spots and more residency spots, Olds said. It also requires a change of thinking about who should attend medical school. Students are sometimes discouraged from pursuing medicine if their grades and standardized test scores are not practically immaculate. While students have to be able to handle the academic rigor of medical school, test scores are not the only thing that should matter, Olds said.
There should also be a focus on recruiting doctors who are going to have a good bedside matter and be able to connect with patients, not simply be able to diagnose an illness. He said there also has to be an emphasis on getting people from underserved communities and under-represented populations in medicine to become doctors.
The shortage is most pronounced in rural areas and impoverished urban areas — affluent suburbs have a surplus of doctors — due to the fact that many medical school graduates go on to practice where they grew up. Given the cost of medical school, many of those people come from wealthy, urban areas, which they then return to to practice medicine.
This leaves states with more rural areas, particularly in the south and the west, even more shorthanded.
All but five Tennessee counties were considered to be medically underserved as of 2019. Those five counties — Shelby, Madison, Davidson, Knox and Hamilton — all have pockets of underserved populations, according to the state department of health.
The NIH predicts Tennessee, Mississippi and Arkansas will be short a collective 12,000 doctors by 2030. Currently, there are about 3,000 residents in training in the three states, according to the AAMC.
Primary care shortage
Doctors from Caribbean medical schools are uniquely poised to address the U.S. doctor shortage in another way, Olds said. For a variety of reasons, the overall physician shortage is also particularly severe for primary care physicians. Only about 30% of people who graduate from U.S. medical schools become primary care doctors. However, for graduates of Caribbean medical schools, it’s the opposite — 70% pursue a career in primary care rather than a specialty.
During the pandemic, about 10% of the country’s primary care practices closed permanently and doctors of all kinds have also been part of the “great resignation.”
For Gutierrez, she bounced back and forth about whether to pursue family medicine or internal medicine but landed on family medicine out of a desire to have more training treating women and children, things like routine pelvic exams, rather than more intensive care unit training.
She’s doing some of her rotations in Memphis at Church Health, where she previously interned.
“If you’re trying to look at what Memphis looks like as far as health disparities, looking at (Church Health’s) population is a pretty good summary. It’s the working uninsured,” she said. “Working with these people that don’t have insurance or are underinsured, you see a lot of the health crisis you see around America.”
After her medical education concludes, Gutierrez plans to remain in her hometown.
“When I was thinking, ‘where can you practice and really make an impact?’ Memphis is such a good city for that because we have this wealth gap. And we have such a large population of people that live at or below the poverty level, and they need family care doctors,” she said. “We need specialists as well, but the vast majority of people don’t have insurance and will never see their way to a specialist, unfortunately. And so having good primary care in Memphis is so necessary.”
Corinne S Kennedy covers economic development and healthcare for The Commercial Appeal. She can be reached via email at Corinne.Kennedy@CommercialAppeal.com