New Jersey is headed for a doctor shortage within the next decade unless experts come up with solutions to avoid that outcome.
Efforts are already underway to make colleges, medical schools and residency programs more attractive. Meanwhile, international students and doctors have been quietly filling some of New Jersey’s health care gaps.
There are about 280,000 international medical graduates in the United States, or about one in every four doctors, according to the American Medical Association.
International medical graduates, whether they are U.S. or foreign citizens, graduate from medical colleges outside the United States.
“The typical international medical graduate is more likely to serve underserved areas for a number of reasons,” said John Slotman, vice president of graduate medical education policy and teaching hospital issues at the New Jersey Hospital Association.
Many international medical graduates also become primary physicians.
New Jersey is on course to be short about 2,500 of these physicians in the next couple years, experts estimate.
Dr. Yaser Mourad was part of the international graduate community when he came to Atlantic City from his home country, Syria, to practice medicine.
“America is one of the best countries in the world for medicine and continues to be the best,” Mourad said. “When I finished medical school in Syria, I had always dreamed to come here to do a sub-specialty.”
Mourad entered a residency program in 1990 at Atlantic City Medical Center, now AtlantiCare. He moved on to a nephrology fellowship at Thomas Jefferson University Hospital in Philadelphia, only to return to Atlantic City as a hospital attending physician.
Now AtlantiCare’s chief medical quality officer, Mourad said he wanted to give back to the community that welcomed him to this country by returning and serving patients in the Atlantic County area.
“With all this diversity, it gives us strength, because people bring different things to the table,” he said. “We came here as immigrants and, while big cities are always attractive, it’s more serene here, and giving back to the country and communities that accepted us is extremely important.”
The 2016 New Jersey Survey of Medical Students, published by the New Jersey Council of Teaching Hospitals, reported 45 percent of the state’s medical residents and fellows planned to work in suburban locations, while 27 percent planned to go to inner cities or rural areas.
Slotman said international graduates such as Mourad were more likely to work in underserved and rural areas after they recognized the shortages that often exist in those communities.
In 2014, there were 2,099 patients for every one primary care doctor in Cumberland County, one of the largest ratios in the state, according to this year’s County Health Rankings report. Data continue to show demand for health care outpaces the production of primary and general physicians.
The country’s dependence on international medical graduates, both domestic and foreign, was exposed more publicly this year when President Donald Trump attempted to pass stricter immigration laws that have made it difficult for some professionals who hold J-1 visas.
“Quite a few of our teaching hospitals have physicians on staff who originate in parts of the world that were identified in that executive order,” Slotman said. “People rely on those physicians who come from all over the world. Anything that impacts the ability of residency programs to recruit holds a potential impact.”
Dr. Fred Jacobs, a New Jersey physician and executive vice president at St. George’s University in Grenada, said that while foreign students and doctors add to the physician population in New Jersey, the state needs to focus on creating better incentives for all medical students to stay and work in local communities.
Some ideas already in development include debt-forgiveness programs, more in-state medical schools and a push for additional residency positions at hospitals.
A high cost of living and lower salary offers hurt the state’s retention rates, but Jacobs said with more work, people who grew up in New Jersey may be more inclined to study, train and work in their hometowns. People abroad may be encouraged to plant roots in the state as well.
“Every time I speak with someone on their way to becoming a doctor, I encourage them to come and apply to all our hospitals here in this country,” Mourad said. “I know they will do well and be a great asset to whatever community they come to.”