Family medicine doctors in Louisiana have started to hail more and more from international medical schools in recent years, as the state looks for doctors to fill primary care shortages and international schools see Louisiana as a prime landing pad for graduates.
Louisiana's rural areas are especially in need of primary care physicians, as the state ranks low on national health and wellness measurements and access to care is a common problem. Baton Rouge family medicine physician Derek Anderson estimated that around 55 percent of the family medicine residency spots in Louisiana for newly minted doctors are now being filled by international medical school graduates, while around 45 percent have United States medical school graduates in them.
At Baton Rouge General, for example, six of the hospital’s eight new family medicine residents for 2018 attended medical schools in the Caribbean. The hospital announced the news on Match Day, held this past Friday, when medical students found out where they will train upon graduation.
Baton Rouge General has seen its percentage of residents who come from international medical schools spike over the past four years. International schools trained 63 percent of their residents in 2014, in comparison to 78 percent of their residents last year.
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Half of Baton Rouge General’s family medicine residents for next year attended American University of the Caribbean, a for-profit international medical school in St. Maarten that promises training like United States-based medical schools. The school will send 17 graduates to Louisiana for residencies next year, spread throughout Baton Rouge, New Orleans, Shreveport, Lafayette and Alexandria.
AUC has sent more than 200 graduates since 2000 to Louisiana for residencies. They estimate 20 percent of active physicians in Louisiana are international medical school graduates.
AUC’s students spend their first two years learning on the island, and then spend their third and fourth years rotating at various hospitals throughout the United States and the world. One of those hospitals is Baton Rouge General.
“From a Louisiana standpoint, without the schools like AUC, we would have a very difficult time trying to meet the demands and needs of our state in terms of health care,” said Anderson, who works for Ochsner and who is the lead clinical chair for the school.
International medical schools are not without critics, who have noted that admission standards are usually lower than they are at medical schools in the United States. And international schools can be more expensive than public university medical schools. In-state students at LSU Health New Orleans School of Medicine pay $15,687 in tuition for two semesters a year, while students at American University pay $21,695 in tuition per semester on a three-semester-per-year system.
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But Heidi Chumley, the executive dean of AUC, argues that hundreds of qualified students are turned away every year from U.S. medical schools. She said schools in the United States place high emphasis on standardized test scores and do not have enough spots for every qualified applicant. The vast majority of medical students at AUC come from the United States, and return for residencies.
“When we take students who are willing to go to another country, take an unusual path, expand their horizons, work really hard — they like to come back to the areas they’re from in the U.S.,” Chumley said. “They’re more likely to go into primary care; they’re more likely to go into underserved areas.”
Britta Haydel is one such alumna. She grew up in Plaquemine and graduated from LSU before she attended AUC for medical school. She rotated at hospitals in England, New York and elsewhere before she returned to Louisiana for her residency.
She’s now in her second year as a family medicine doctor at East Jefferson Memorial. Haydel said she expects to practice in Louisiana for the rest of her career. Medical school leaders, including Chumley, often repeat the refrain that doctors tend to stay near where they complete their residencies.
“I wanted to come back and help the population,” Haydel said. “After seeing how things are done around the world, I wanted to come back and help.”
Anderson said family medicine doctors have an especially important skill set for the health care needs of rural areas. They can treat people of all ages, treating both acute and chronic medical problems, and they can assess psychosocial issues as well, he said.
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Not all medical school graduates from the Caribbean choose family medicine. Megan Kaufman, another AUC alumna, is about to finish her second year as a pediatrics resident at Our Lady of the Lake Children’s Hospital in Baton Rouge.
Kaufman grew up in Kansas and first experienced Louisiana when she rotated at Baton Rouge General as an AUC student. It made such a good impression that she decided she wanted to return for her residency. Kaufman said she hopes to complete an infectious disease fellowship once she finishes her residency, and that she’d like to eventually practice in the South.
“The patients are so appreciative and they’re so warm,” she said. “You really get the feel that they appreciate you taking the time to listen to every worry that you have. It’s nice to feel like you’re making a difference.”
Kaufman said she has also found fellowship with other international medical school graduates at Our Lady of the Lake, though hospital spokeswoman Caroline Isemann said Our Lady of the Lake rarely matches with students from Caribbean schools for residencies.
Our Lady of the Lake is home to LSU’s graduate medical education program in Baton Rouge. Isemann said LSU’s medical schools and other medical schools across the United States have recently expanded their enrollments, which has allowed Our Lady of the Lake to match with more local students.
The number of LSU Health News Orleans medical school students choosing to stay in-state for residencies declined again this year down to 46 percent. Fifty-one percent of their students chose to remain in-state in 2016, and 56 percent chose to stay in-state in 2015.
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None of AUC’s graduates this year matched at Our Lady of the Lake, though AUC graduates are going into residencies that include Woman’s Hospital in Baton Rouge, pediatrics at Tulane and neurology at Ochsner.
Ochsner has also started its own international medical school program through Australia’s University of Queensland. Students in that program spend their first two years in Australia, and then they rotate at Ochsner’s hospital in New Orleans. The program can cost more than $56,000 a year.
More than 25 of this year's University of Queensland-Ochsner graduates are staying in Louisiana for residencies next year, with three pursuing family medicine. The rest include internal medicine at Ochsner, psychiatry at Tulane, pediatrics at Children’s Hospital in New Orleans and more.