CONGRESS IS ABSOLUTELY wrongheaded in its attempt to force American medical schools to admit students who went abroad for training. Its action springs from the House health subcommittee's unyielding conviction that the country faces a shortage of doctors. In recent years that assumption has become increasingly dubious. There is already evidence that a surplus of doctors, in certain specialties and in certain regions of the country, is contributing to the rapid rise in health-care costs. The proper public policy is not to bring home the expatriate medical students, but rather to discourage Americans from enrolling in foreign medical schools.
The current law, passed last year, is bizarre. It says that any American attending medical school abroad, as of last October, has a right to transfer into the third year of an American medical school - and the American school, to get federal aid, must take the student. The only condition is that the student must pass the standard test for second-year students. In other words, the American schools would have to admit next fall the same students they rejected last year. Several of the leading schools have declared that they will forfeit federal aid rather than comply. Fortunately, the health subcommittees in both house of Congress seem to be having second thoughts about the legislation, and it may well be changed before it is supposed to go into effect next fall.
The chairman of the House subcommittee, Rep. Paul Rogers (D-Fla.), has drafted a bill that drops the expiicit reference to the expatriate students. Instead, it would required the American medical schools to expand their third-year classes. The new slots would be filled, obviously, by students who had done two years' work abroad. That would be an improvement, but only a marginal one. Sen. Edward Kennedy's health subcommittee is a great deal more skeptical about the alleged doctor shortage and the need to rely on any foreign training at all. If there is to be a rational repair of the present botch, the initiative will probably have to come from the Senate.
For thousands of bright young Americans, the study of medicine is more than an interest or a goal; it has become an obsession. Every year hundreds of them, unable to get into medical schools here, go abroad. In the past many went to Europe, but the European medical schools are now all but closed to foreigners. Increasingly, the Americans now turn to the Caribbean, where the training tends to fall well short of standards in this country. The congressional justification for the present law is that these students will eventually return to the United States anyway, and many will pass also true that the parents of some of these students have carried on vigorous political lobbying campaigns in their behalf. Any repatriation law, however temporary, is only likely to encourage more Americans to enroll in foreign medical schools in the future.
The large expansion of the American medical schools over the past decade will produce enough doctors for this country - and perhaps too many. It would be grotesque for Congress to keep pushing further expansion simply because more students want to be doctors. It would be even worse for Congress to encourage students to enroll abroad, in universities that ought to be using those facilities to train physicians for their own countries. The best remedy for the present repatriation law is not to try to fix it up or fiddle with it, as Rep. Rogers suggests, but instead to acknowledge a mistake and revoke it.