COVID-19 is disproportionately impacting low-income and minority communities across the United States. In New York City, the epicenter of the pandemic, the poorest quarter of zip codes account for 36 percent of coronavirus cases. The wealthiest quarter, by contrast, account for less than 10 percent. African-Americans and Latinos are more likely to call these hardest-hit zip codes home. 

This phenomenon isn't unique to New York City. In Illinois, African-Americans comprise 15 percent of the population but 30 percent of confirmed coronavirus cases. In Michigan, they represent 14 percent of the population but 30 percent of cases and 40 percent of deaths. And in Louisiana, African-Americans comprise one-third of the population but a staggering 70 percent of deaths.  

Of course, the virus isn't deliberately targeting minority neighborhoods. But minorities often live in higher-density housing and suffer from diabetes, heart disease, and other chronic conditions at far higher rates than white Americans. And COVID-19 is particularly deadly for anyone with underlying health conditions.

To combat this pandemic -- and the next one -- we'll need to do more to fight chronic disease. That starts by improving access to primary care in at-risk neighborhoods, which suffer from severe shortages of medical personnel. Graduates of international medical schools have long been the physicians to fill these gaps. And many of these physicians aren't foreign at all -- they're U.S. citizens who simply chose to attend medical school abroad. Our leaders must welcome and train more of them in the United States.

The United States already faces a shortage of up to 43,000 physicians.  That figure may increase to 122,000 -- including 55,000 primary care doctors -- by 2032, according to the Association of American Medical Colleges. These shortages are particularly severe in low-income and minority neighborhoods, according to a recent analysis conducted by the Pittsburgh Post-Gazette and Milwaukee Journal Sentinel.

International medical graduates (IMGs) are well-positioned to address these shortages. They're already more likely than their U.S.-educated peers to practice in low-income areas. About 25 percent of all doctors in the United States attended medical school outside the country. But in neighborhoods where per-capita income is below $15,000 per year, IMGs account for 43 percent of doctors.  

Physicians who received their training abroad deliver top-notch care. According to a 2017 study published in The BMJ, patients who received treatment from international medical graduates had lower mortality rates than those treated by U.S. graduates.  

IMGs are also disproportionately likely to serve in disciplines experiencing the most acute doctor shortages. In 2019, nearly 70 percent of international medical graduates went into primary care --- including specialties like internal medicine, family medicine, and pediatrics.

International medical graduates are already on the front lines fighting COVID-19. More than 750 graduates of St. George's University School of Medicine, the international medical school I lead, have begun residencies in New York City over the past four years. The vast majority of them are U.S. citizens who returned home to practice.  

In some parts of the Bronx, nearly 80 percent of doctors are international medical graduates. Almost four of every ten doctors in New York are IMGs. They also make up nearly 40 percent of the physician workforce in New Jersey, and 31 percent in Illinois.  

But given the depth of the doctor shortage, especially in minority communities, we clearly need more. Congress can now act to combat these physician shortages by enacting the Resident Physician Shortage Reduction Act, which would increase the number of residencies funded by Medicare by 15,000 between 2021 and 2025. The measure would "emphasize training in community-based settings" so that all populations have better access to quality primary care.



COVID-19 has been so destructive in part because millions of Americans struggle with chronic conditions that have left them susceptible to the coronavirus's ravages. To reduce the threat posed by COVID-19 -- and other infectious diseases like it -- our healthcare system must do a better job managing, treating, and preventing chronic disease, especially in vulnerable populations.



Primary care physicians can do that job. And there's no better source of primary care physicians than international medical schools. It's time to bring more of their graduates in -- and expand post-graduate training capacity to allow them to further their careers as U.S. doctors.

 

Dr. Richard Liebowitz is vice chancellor of St. George's University (www.sgu.edu). Previously, he was president of New York-Presbyterian Brooklyn Methodist Hospital