Will Tennessee Threaten The Medical Workforce In New Zealand (with A Little Bit Of Help From Dolly Parton)

Thursday, 12 October 2023, 5:37 am
Opinion: Ian Powell

Recently I came across an interesting article by Alicia Gallegos and published in the Medscape Journal of Medicine (26 June).

I had not previously considered the possibility of a development in the American state of Tennessee potentially impacting negatively on Aotearoa New Zealand’s health system.

This prompted me to think about a potential indirect and unintended threat to the medical workforce in Aotearoa: New Tennessee law to speed up medical licenses for international medical graduates.

The publication is a medical journal published exclusively online. The potential threat is a new American state law allowing international medical graduates by bypass United States residency requirements.

My Tennessee Mountain Home

The state is Tennessee, a landlocked state in the southeast of the United States. It is the 36th largest by area and the 15th most populous of the 50 states. With a population of around seven million, it has about two million more people than New Zealand.

Nashville is the capital and largest city, anchoring its largest metropolitan area. Memphis is another well-known city along with Clarksville.

Although its most famous celebrity is Dolly Parton. Tennessee can also claim as its celebrities Quentin Tarantino, Morgan Freeman and Justin Timberlake.

Particularly its mountains, valleys and people, the state  is beautifully portrayed by Dolly Parton in her song, My Tennessee Mountain Home: Dolly Parton on the beauty of Tennessee.   

What Tennessee’s law change does

There is a routine pathway for international medical graduates (IMGs) in the United States to get a medical license to practice in the country.

It involves a requirement to complete at least six years of post-graduate training ( first ‘residency’ and then ‘fellowship’) in a medical specialty such as paediatrics or orthopaedics.

Compared with New Zealand and many other countries, where comparable post-graduate experience overseas is recognised, this helps explain why the United States has a low dependency on international medical recruitment.

New Zealand is much more dependent on international medical recruitment. Whereas over 40% of practising doctors in New Zealand are IMGs, in the United States it is as low as around 25%.

However, in April, Tennessee adopted a new law which bypassed these requirements. It created a quicker pathway for IMGs to secure medical licenses in order to practice medicine in the state.

There is nothing to suggest anything sinister behind this law change. In the context of Tennessee’s health system, it appears to make sense.

The new law enables experienced IMGs who have received further medical training abroad to skip these US postgraduate residency and fellowship requirements, provided they meet certain qualifications.

In Tennessee, at least, IMGs can now obtain a temporary license to practice medicine much earlier.

What is the potential threat?

New Zealand’s current medical workforce crisis, particularly in our public hospitals, is primarily driven by uncompetitive remuneration. There is a massive over 60% specialist pay gap with Australia.

This means that we lose specialists (and doctors training to be specialists) across the Tasman. It also means that we can’t compete with Australia to recruit specialists from other countries.

This pay gap is the greatest obstacle to addressing the specialist workforce specialist workforce shortages in Aotearoa’s public hospitals.

To date, the United States has not been a threat to Aotearoa’s medical workforce. Its state medical licensing requirements have been a big factor in this situation.

The law change is driven by a predicted doctor shortage in Tennessee. The intent is to mitigate this shortage and increase the number of doctors working in “underserved areas of the state”. These shortages are not limited to Tennessee.

Consequently, the threat is not Tennessee itself. The threat is if enough of the other 49 states decide to take similar legislative steps.

If so, the 25% of IMGs in the United States will gradually be expected to increase. It will then be competing directly with New Zealand.

Separately the American Medical Association (AMA) is using its influence to encourage state licensing boards and other credentialing institutions to streamline the verification process for IMGs.

The response of the New Zealand government to the medical workforce crisis has, to date, been to ignore it. This has had a devastating effect on the health and wellbeing of this workforce.

It is only a potential threat at this stage. However, there is a proviso to this. Potential means having the capacity or showing the capacity to develop into something in the future.

What if this Tennessee law change takes off in other states affected medical shortages? What happens if the AMA’s advocacy of streamlining the medical license process succeeds?

If both or either eventuates then this will make the irresponsibility of this political ignoring strategy even more irresponsible. Not even a great Dolly Parton song will help out.

© Scoop Media

Ian Powell

Otaihanga Second Opinion is a regular health systems blog in New Zealand.

Ian Powell is the editor of the health systems blog 'Otaihanga Second Opinion.' He is also a columnist for New Zealand Doctor, occasional columnist for the Sunday Star Times, and contributor to the Victoria University hosted Democracy Project. For over 30 years , until December 2019, he was the Executive Director of Association of Salaried Medical Specialists, the union representing senior doctors and dentists in New Zealand.

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