Physician Shortage: Hospital postponing elective surgeries for March break — Rural areas of the U.S. brace for doctor shortage — Foreign Medical Graduates Essential to U.S. Health Care

Maureen Coulter
Charlottetown, Prince Edward Island, Canada
Published on March 17, 2017
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Queen Elizabeth Hospital in Charlottetown.

©Guardian file photo

CHARLOTTETOWN, P.E.I. – The Queen Elizabeth Hospital is postponing all of its elective operative procedures over the March break.

An internal memo was sent out this past week notifying all medical staff and department managers that there is a planned service slowdown.

Twenty-two beds are closing in surgical, rehab and critical care units until March 27, including two beds in ICU, eight beds in Unit 1, eight beds in Unit 2 and four beds in Unit 7.

The memo states “any urgent emergency cases will proceed as usual” but that “no elective operative procedures” will be booked during this time.

A statement from Health P.E.I. says it does plan scheduled slowdowns at two main hospitals during specific times of the year, including March break, summer and Christmas, when the public demand for non-urgent elective services is lower and more people are on vacation.

“A planned slowdown during this time of year is a fairly standard practice across most health-care jurisdictions,” said the statement. “It also ensures that our hard-working staff and physicians have the opportunity to take some well-deserved time off with their families.”

Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.

James Aylward, MLA for Stratford – Kinlock

However, James Aylward, MLA for Stratford – Kinlock, told The Guardian Friday evening that he heard otherwise from an “extremely” reliable source.

“They confirmed to me that the reason for these bed closures had nothing to do with shortage of staff and vacations, but it had more to do with Health P.E.I. trying to reduce costs here coming towards the end of the fiscal year.”

Aylward, who is opposition critic for health and wellness, said he found this news about service slowdown alarming.

“This is the very first time that anyone can remember bed closures during March break.”

Aylward feels this decision did not consider the pain and suffering of Islanders as they could have been having these elective operative procedures over the course of this planned service slowdown.

The other issue he has with this is that this continues the “constant backlog of patients” in the emergency room waiting for acute care beds.

“Rather than closing these beds, we should be helping to free up the ER and moving those patients into these acute care beds.”

The statement from Health P.E.I. noted that during the March break slowdown, emergency services, including emergency surgical services, will remain fully operational.

“Slowdowns at Island hospitals are planned well in advance and we work with our health-care providers to ensure patient safety and patient care standards are never compromised. We always have a contingency plan in place to ensure that we continue to provide high quality care.”

Aylward feels at the very least the public should have been informed of this service disruption.

He adds this planned service slowdown is one of many things he plans on bringing forward during the spring session of the legislature.

http://www.theguardian.pe.ca/news/local/2017/3/17/queen-elizabeth-hospital-postponing-elective-surgeries-for-march.html

maureen.coulter@tc.tc

Twitter.com/MaureenElizaC

Health PEI is responsible for the operation and delivery of publicly funded health services in Prince Edward Island. … Health PEI is governed by a Board of Directors, which ensures that approved programs are delivered in accordance with the direction from the Minister of Health and Wellness.

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Rural areas of the U.S. brace for doctor shortage

Posted: Saturday, March 18, 2017 11:00 pm

In Coudersport, Pa., a town in a mountainous region an hour’s drive from the nearest WalMart, Cole Memorial Hospital counts on two Jordanian physicians to keep its obstetrics unit open and is actively recruiting foreign specialists.

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Charles Cole Memorial Hospital, Coudersport, Pa.

In Fargo, N.D., a gastroenterologist from Lebanon — who is among thousands of foreign physicians in the state — has risen to become vice president of the North Dakota Medical Association.

In Great Falls, Mont., 60 percent of the doctors who specialize in hospital care at Benefis Health System, which serves about 230,000 people in 15 counties, are foreign doctors on work visas.

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Small-town America relies on a steady flow of doctors from around the world to deliver babies, treat heart ailments and address its residents’ medical needs. But a recent, little-publicized decision by the government to alter the timetable for some visa applications is likely to delay the arrival of new foreign doctors, and is causing concern in the places that depend on them.

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While the Trump administration is fighting for its temporary travel ban affecting six countries, the slowdown in the rural doctor pipeline shows how even a small, relatively uncontroversial change can ripple throughout the country.

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In Montana where nine counties do not have a single physician, it means Benefis Health does not know when a Romanian doctor trained in kidney transplants will arrive. The health care company spent months recruiting the doctor and had been expecting her in July.

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“Our health system already has nine months invested in her, and now we have no idea when she can start,” said Erica Martin, who recruits doctors for the company.

The doctor, Silviana Marineci, who is completing a fellowship at the University of Minnesota, said she was frazzled by being in limbo.

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“I won’t have an income, I don’t know if I will afford rent, I don’t know where I will be,” she said. “It’s insane.”

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The procedural change regards temporary visas for skilled workers, known as H-1B visas. U.S. Citizenship and Immigration Services recently announced that it would temporarily suspend a “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months.

Companies using that option, the government said, have effectively delayed visas for others that did not pay the extra fee.

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A spokeswoman for the immigration agency, Arwen Consaul, said in a statement that the measure was necessary to “work down the existing backlogs due to the high volume of incoming petitions.”

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The H-1B program has raised questions about whether it displaces American workers, particularly in computer programming and engineering jobs, for which most of the visas are issued.

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H-1B recipients also include foreign physicians who practice in places shunned by American doctors for personal and professional reasons.

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About 25 percent of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher.

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There were 211,460 international medical graduates practicing in the United States in December 2015, according to the latest data available from the Educational Commission for Foreign Medical Graduates.

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Sens. Amy Klobuchar, D-Minn.; Susan M. Collins, R-Maine; and Heidi Heitkamp, D-N.D., have urged the agency to continue premium processing.

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“Slowing down this successful two-decade-old program and the doctors it brings to rural areas will hurt families across North Dakota and rural America,” Heitkamp wrote in an email.

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The delay also could affect the roughly 400 foreign medical graduates who come each year to participate in residency programs at teaching hospitals. The doctors were matched Friday for residencies starting July 1 across the country.

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“Everyone around the country will be in a mad scramble to figure out this visa situation,” said Michelle Larson-Krieg, director of international student and scholar services at the University of Colorado in Denver, which usually takes 10 or 12 residents on H-1Bs each year at its Anschutz Medical Campus.

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The immigration agency said in a statement that applicants could still request an H-1B approval on an “expedited basis,” if they could prove there was an emergency or humanitarian justification.

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Immigration lawyers said that it was extremely difficult to meet that standard, and that they doubted whether the agency could handle a flood of such requests.

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“If they don’t have the manpower to do premium processing, I don’t see how they are going to do special requests,” said Andrea Szew, a lawyer in Los Angeles.

http://www.santafenewmexican.com/news/rural-areas-brace-for-doctor-shortage/article_61a71b8d-7fd0-5c21-a7d9-094e692e3e9d.html

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Foreign Doctors Assist With Physician Shortage

The challenge in Iowa, where the shortage of physicians is more pronounced, is finding qualified doctors that will stay in the area.

| March 18, 2017, at 1:02 a.m.

By DEVAN PATEL, Quad-City Times

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DAVENPORT, Iowa (AP) — Dr. Nazir Kayali settled into his chair, deep in thought.

His hand stroked his chin and a smile grew into a laugh as he considered his circuitous path to the Quad-Cities.

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The Syrian-born pediatrician’s first trip outside his native country was to Ohio in 1990, where his cousins were practicing medicine.

Wishing to follow in his cousins’ paths, Kayali asked what he might expect from America.

They halfheartedly told him a joke that went along with the generalization that Americans are egotistical and care only about money.

“A stranger comes to America and finds a booth that says ‘Two questions for $100,'” Kayali began, barely able to get the words past his own laughter. “He asks a woman, ‘Is that a lot of money for two questions?’ She replies ‘Yes. What’s your second question?'”

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But the international medical graduate found the opposite to be true in middle America. Here, he said, he found warmth, compassion and acceptance.

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Dr. Nazir Kayali has his plate dished up by daughter, Sarah, 17, as they sit down for dinner at their home in Bettendorf. Having lived in Des Moines for his residency and in the Quad-Cities previously, Kayali, a Syrian-born pediatrician, has called Bettendorf home for the past five years.

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Having lived in Bettendorf for the past five years, Kayali boasts that the Quad-Cities is his third stint in Iowa, having secured his H-1B visa to complete his residency from 1993-1996 at Iowa Methodist Medical Center in Des Moines. Out of all the hospitals in the nation, his first choice was in Iowa’s capital city.

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He then came to the Quad-Cities from 1999 to 2007, returning to Syria so his children could get to know their family in Aleppo.

But his Iowa memories and experiences stayed with Kayali.

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When war made Syria too dangerous, the pediatrician with a soft spot for Iowa was relieved to learn of an opportunity in the safe place he had come to know more than 6,200 miles away. And it called his family back.

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“I’ve had a very positive experience,” Kayali said. “The acceptance and the people, from residents, staff, colleagues and patients; it was all so incredible.”

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The sentiment is the same for many of the international medical graduates who have immersed themselves in the community, including Dr. Sarojini Ratnakar, who joked that she took the easy path to practicing medicine in the United States.

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The Indian-born and -trained hospitalist for Genesis Health System did not have to jump over the same hurdles that other international medical graduates did. Her husband already had a visa, so she was able to come as a spouse.

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Dr. Sarojini Ratnakar talks with patient Marcia Johnson of Bettendorf in her room at Genesis Medical Center-East Rusholme Street, Davenport.

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Ratnakar’s story, however, is similar in that she, too, came to the U.S. to make a better life and has settled into the void created by the country’s physician shortage.

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In America’s heartland, where the shortage is more pronounced, the challenge isn’t so much in finding qualified doctors. The real test is in convincing them to stay.

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Iowa ranked seventh in medical students per 100,000 population, but the state has one of the lowest physician-to-population ratios in the country. In other words, medical students are graduating in Iowa; they just aren’t practicing here.

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Even more alarming is Iowa’s consistently low ranking in retaining physicians who earned their medical degrees in-state.

Since 2006, the retention percentage for in-state graduates has fluctuated between 34 percent and 36 percent for physicians, according to data from the Association of American Medical Colleges, or AAMC.

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Hospitalist Dr. Sarojini Ratnakar, who was born in India, reads a chart before going to the patient’s room at Genesis Medical Center-East Rusholme Street, Davenport.

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Ratnakar said she struggled when she first came to practice in Iowa in 2004.

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“I moved from Atlanta, because my family was here, but at the beginning, I really wanted to go back,” she said.

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As she immersed herself in the Quad-Cities, however, something changed.

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“It’s the people here,” she said. “I wanted to go back, but now I won’t leave, because this place is just fantastic. I would not trade it for anything.”

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Just like Ratnakar, other international medical graduates are starting to form attachments and a sense of place and are not necessarily waiting for a door to open elsewhere.

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Community Health Care CEO Tom Bowman has become familiar with the doctor shortage in his 10 years at the Davenport clinic.

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Bowman said Community Health Care, or CHC, tries to fill the gaps in medical treatment in the community and, in order to do so, relies heavily on sponsorship of international medical graduates through J-1 or H-1B visas.

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Foreign graduates accounted for more than 50 percent of CHC recruits in the past decade, and they haven’t always been keen on staying in the area.

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“Some of it, even though we’re not as rural as some parts of country, is that they tend to gravitate to more diverse and urban areas,” Bowman said. “But we’re getting better on that front.”

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In the past 15 years, Community Health Care has sponsored and employed 33 international medical graduates, but only 17 have remained here. However, when narrowing the focus to the past decade the percentage of doctors sticking around increases from 50 percent to about 65 percent, the Quad-City Times (http://bit.ly/2mPonTy ) reported.

Hospitalist Dr. Sarojini Ratnakar looks over the patient board for the night at Genesis Medical Center-East Rusholme Street, Davenport.

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The same can be said of the percentage of active physicians who are international medical graduates, practicing in Iowa. As of 2014, their numbers increased from 17 percent to 18.6 percent, making foreign doctors second only to Iowa-educated doctors in the recruitment pool.

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From 2006-14, foreign doctors accounted for almost one-third of physician growth in Iowa, according to data from AAMC. In fact, foreign graduates have become such a mainstay in American medical care, they now account for about 1 in 4 physicians.

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“Foreign graduates are very hard workers, so they really don’t mind going to any place,” Ratnakar said.

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The sprawling city of Kingwood, West Virginia, county seat of Preston County, was home to just more than 3,000 people when Kayali practiced there after his three-year residency in Des Moines.

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“(It’s) a small town in the mountains where no one else would go,” the Bettendorf pediatrician said.

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Except for his family’s social life, Kayali said, the little town produced a positive experience. But it also was the place in which he first experienced the struggles that strike a community that is medically under-served. Some of the most basic conditions were worsened, he said, by the lack of physicians in the area.

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“I would see really sick kids, and I wouldn’t imagine seeing such cases in the United States,” Kayali said.

For rural areas in the U.S. like Kingwood, it’s difficult to attract physicians, which is why foreign physicians have become such a vital resource.

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A study commissioned by AAMC found that the U.S. will have a shortage of 61,700 to 94,700 physicians by 2025, and rural areas can expect to suffer the most. Those regions of the country typically lack the amenities, diversity and financial incentives available in urban areas, making them less desirable to many incoming physicians.

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As an incentive, foreign graduates can prolong their stay in the U.S. by serving in medically under-served areas with modest populations where other health providers are scarce.

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With J-1 visas, states can sponsor physicians through the Conrad 30 waiver, which allows 30 international medical graduates to stay in the country as long as they practice their medical specialty in shortage areas for a minimum of three years.

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J-1 visas typically require participants to return to their home country for two years to apply the knowledge and training they acquired in the U.S.

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Over the past 10 years, more than 10,000 physicians in the U.S. stayed and served in shortage areas under Conrad 30, according to AAMC President Darrell Kirch. In the same decade, the Iowa Department of Public Health sponsored 292 foreign doctors out of the potential maximum of 300, meaning Iowa used 97 percent of its allotment of Conrad 30 doctors. In comparison, the national average is 59 percent.

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From 2007 to this year, Scott County ranked eighth in the number of Conrad 30 waivers granted in the state with 18.

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But the number of state-sponsored waivers has decreased since 2012, when the Department of Health and Human Services took over applications for Federally Qualified Health Centers such as CHC.

While Scott County did not receive a single Conrad 30 waiver out of the 30 recommended by the state this year, it does not mean the need isn’t there.

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Information from: Quad-City Times, http://www.qctimes.com

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One Response to “Physician Shortage: Hospital postponing elective surgeries for March break — Rural areas of the U.S. brace for doctor shortage — Foreign Medical Graduates Essential to U.S. Health Care”

  1. daveyone1 Says:

    Reblogged this on World Peace Forum.

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