Doctors Trained Abroad Will Save Rural Health Care


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By G. Richard Olds | St George University

Health care is growing hard to come by in rural America.

Three-quarters of rural counties suffer from doctor shortages. Hundreds of rural hospitals are at risk of closing due to financial hardship. And while 20% of the U.S. population lives in a rural region, just 10% of physicians practice in these communities.

Fortunately, there’s a group of doctors uniquely suited to fill these gaps — graduates of international medical schools. These physicians have a history of working in our country’s neediest communities. Many are U.S. citizens who simply chose to go abroad for their education.

COVID-19 took advantage of rural America’s shortage of care. Patients in rural areas were 54% more likely than others to contract the virus, according to a September 2021 analysis from the Rural Policy Research Institute. Tragically, those infected people were also twice as likely to die as their urban counterparts.

Lower vaccine rates in rural areas certainly contributed to those disparities. But so did staffing shortages and limited access to care, the analysis found.

Boosting numbers of primary care physicians in shortage areas could save over 7,000 lives every single year, according to a March 2021 study published in the Annals of Internal Medicine.

That’s easier said than done. The United States is predicted to face a nationwide shortage of up to 48,000 primary care physicians over the next decade.

One of the key drivers of these shortages is our aging physician workforce. Approximately 40% of doctors will reach retirement age over the next 10 years.

There are three key ways to combat the coming wave of retirements and strengthen the pipeline of rural doctors.

First, we can increase the number of rural Americans who pursue careers in medicine. Students from rural communities accounted for just 4.3% of new medical students in 2017. That’s the result of a 15-year decline. The share of rural medical students dropped by a staggering 30% between 2002 and 2017, according to research published in 2019 in Health Affairs.

Medical graduates from rural communities are far more likely to practice in places like their hometowns than those from more populated areas.

The second is to look beyond U.S. borders — to international medical schools — for the next generation of rural physicians.

International medical graduates, or IMGs, account for about 25% of physicians currently practicing in the United States. The share is higher in particularly needy communities. In low-income areas, many of which are rural, more than 42% of doctors are international grads.

The U.S. healthcare system’s top source of new doctors over the last eight years is actually outside the United States — St. George’s University in Grenada, of which I’m the president. Many of our graduates practice in rural and other medically underserved areas.

In addition, graduates of international medical schools enter primary care specialties at disproportionately high rates. In the 2022 residency match cycle, about 70% of IMGs matched into a primary care residency.

The third is to expand residency training opportunities in rural America. Where physicians complete their residencies plays a big role in where they ultimately practice. One analysis found that over half of family physicians go on to practice within 100 miles of where they do their residency.

The lack of access to care in rural America has devastating consequences. International medical graduates can help fix this problem — and make America a healthier place.

Dr. G. Richard Olds is president of St George’s University (