Page 6 - Mecklenburg_Medicine_October-2020

President’s Letter
Physician Immigration and
Sugar-Sweetened Beverages
TBy John R. Allbert, MD
he election next month is critically important for the
direction our country will take. As medical professionals,
we are now, more than ever, realizing the importance
of advocacy and communicating with our legislators to
advance the quality of health care in our country. We do not all agree
on every issue but, before the end of my term as president, I want to
address two topics I think most of us would be in favor of 1.) increase
U.S. medical school enrollment, and 2.) reduce the quantity of “added
sugar” to food and drinks.
In 2025, the physician shortage in the United States is estimated to be
125,000. Our country currently is ranked near the bottom of developed
countries with respect to medical graduates per population (7.3/100,000),
just ahead of Turkey and about half that in countries like Austria and
Hungary. I wonder about this, knowing so many outstanding young
Americans are not able to get
In 2025, the physician accepted to U.S. medical schools.
shortage in the United How will we address this shortage
of trained physicians? Well, just as
States is estimated our country has managed the need
to be 125,000. for skilled tech workers, farm labor,
construction workers and hotel
service employees, we probably will
import them. Currently, 23 percent
of residency slots are filled by international medical graduates, (IMGs), specialty feels is important, consider two other asks. Encourage them
and a quarter of physicians practicing across the country are IMGs, with
most coming from medical schools in India, Pakistan and the Caribbean.
Because of the anticipated physician shortage, the American Board of
Medical Specialties already has been charged with simplifying board
certification for physicians trained outside the United States.
Why does our country not educate enough physicians? Is it because it
will cost us less to have other countries educate them?
The majority of IMGs pursue primary care and work in underserved
rural and urban areas where U.S.-trained physicians are difficult
to recruit. Former Sen. Kent Conrad (D-North Dakota) introduced
legislation to grant waivers to IMGs on J-1 visas to stay in the United
States if they practiced in rural areas, and more than 8,500 IMGs have
used these waivers since 1994.
However, not all IMGs are working in areas that U.S. graduates avoid.
In a globalized economy, the countries that pay the most and offer the
greatest chance for advancement tend to get the top talent. Why else
do South American soccer players move to Europe to play? Likewise,
talented IMGs seek opportunities to practice medicine here. Many of
the of the academic leaders and innovators I know in my specialty are
IMGs. They make up 15 percent of professors and are responsible for
at least 18 percent of peer-reviewed research publications. With this
in mind, foreign graduates are crucial to the delivery of high-quality
medical care in this country.
6 | October 2020 • Mecklenburg Medicine
With the physician shortage in sight, should we burden other countries
like India and Pakistan with the cost of investing in their citizens’
medical training, only for us to recruit them when their own countries
might need their expertise more? For example, right now 530 Ghanaian
doctors practice in the United States. This is 20 percent of the total
number of physicians who currently practice in Ghana, a country that
needs the doctors it trains.
The second pressing issue is to reduce the quantity of added
sugar to food and drinks. Sugar-sweetened beverages (SSBs) —
sodas, energy drinks and sports drinks — are the biggest sources
of added sugar in the average American’s diet. Sugar-sweetened
beverages account for 4-13 percent of diabetes cases in this country
and are responsible for an increased risk of death from diabetes,
cardiovascular disease and cancer. Recent data indicates that when
a higher portion of total calories come from sugar, the risk of death
from cardiovascular disease is threefold higher. Strategies that may
reduce the consumption of sugar include taxation, more visible
labeling changes and mandating reformulation.
Several years ago, I went to dietary counseling. The most important
piece of advice I received was to read the label and, if an item has more
than 8 grams of sugar per serving, not to buy it. SSBs have much more
than 8 grams of sugar. The FDA has made progress with new labeling
requirements that focus on total sugar and added sugar, both in grams
and as a percentage of daily value. However, we can do better. More
visible front labeling, particularly “High in …” has been shown to
influence customer purchasing.
Taxing these drinks, as we tax alcohol and tobacco, has been
shown to decrease consumption. Britain, as part of an anti-obesity
campaign in 2018, began taxing the equivalent of $0.32 per liter of
any SSB containing more than 8 grams of sugar per 100 milliliters.
Sales of carbonated, sugar-sweetened soft drinks have fallen in
response to the tax, compelling manufacturers to reduce the sugar
content by an average of 42 percent. If we follow this example, it is
estimated that healthcare savings from a sugar tax would be more
than $100 billion a year.
Right now, legislators are very open to hearing your concerns.
In addition to what you personally feel is important or what your
to begin providing more funding so medical schools can increase
enrollment or states can open new medical schools, and second, like
other unhealthy products such as tobacco and alcohol, start taxing
sugar-sweetened beverages.