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Fixing Rural America’s Healthcare Crisis
Guest Opinion


St. George’s University

Imagine going into cardiac arrest and the closest emergency room is more than 30 miles away. Or suppose your child is struggling with depression, but there isn’t a single psychiatrist in your county. Or consider experiencing unexpected pregnancy complications – yet living hours away from a hospital that has the resources to help.

This is the reality for much of rural America – where limited access to care is the norm. Absent action, this public health crisis will worsen over the next decade.

U.S. medical schools aren’t turning out enough doctors to fill the gaps in care that rural America faces. Consequently, the country must look abroad, to graduates of international medical schools, to fill its yawning physician shortage.

International medical graduates have a long history of providing care for underserved populations. Many of them are U.S. citizens who chose to pursue their studies abroad – and now want to return home to practice.

Roughly 20 percent of Americans reside in rural areas. Yet only about 10 percent of doctors work there. As a result, many rural Americans struggle to access care. One recent survey found that at some point in the past few years, one-quarter of rural residents did not get care when they needed it.

Several specialties are especially short on doctors. Nearly 80 million Americans live in federally-designated “primary health care health professional shortage areas.” Roughly two-thirds of rural counties don’t have a single psychiatrist. Just 6 percent of OB-GYNs work in rural parts of the country.

Without sufficient access to care, rural Americans post worse health outcomes than their peers elsewhere. Rural Americans are more likely than those living in non-rural areas to die from heart disease, cancer, and stroke. Americans in urban areas live almost three years longer than their rural counterparts, according to a 2013 study published in the American Journal of Preventive Medicine.

Unfortunately, these trends could worsen over the next several years. The country will need upwards of 122,000 additional doctors by 2032. The Association of American Medical Colleges predicts that “rural and historically underserved areas may experience the shortages more acutely.”

International medical graduates could help turn back these trends. Consider a recent study published in the medical journal BMC Family Practice. The analysis concluded that IMGs are more likely “to look after underserved populations, and to live and work in rural areas” than U.S.-trained graduates.

According to a Johns Hopkins analysis, “Compared with U.S. graduates, international medical graduates tend to practice in primary care and in underserved and rural areas.”

In parts of the country with per-capita incomes of less than $15,000 annually, nearly half of doctors were trained overseas.

Doctors trained abroad are particularly prepared to fill gaps in critical specialties that U.S. graduates tend to shun. In 2019, international medical graduates opted for primary care residencies at twice the rate of U.S. grads. About three in ten U.S. psychiatrists attended medical school outside the country.

One-third of graduates of the school I lead, St. George’s University in Grenada, practice in medically underserved areas. All told, St. George’s is the second-largest provider of doctors to the U.S healthcare system. Our graduates pursue careers in a number of specialties – from emergency medicine and psychiatry to pediatrics and surgery.

Rural America is facing a healthcare crisis. International medical graduates have proved that they’re well-suited to address it. We should invite them to do so.


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