Taking stock of doctors

When organizations like the American Medical Association
and the Association of American Medical Colleges start
saying there are too many doctors in this country, the
problem must be pretty far advanced. They aren't going to
offend their members by pointing out something that has
already become apparent to almost everyone.

As for proposing a solution, that's a more delicate
proposition. The medical groups would be only too happy to
get Congress in on the discussion at this point. That
would be appropriate.

Recently New York's teaching hospitals began a federal
experiment under which they will be paid not to train new
residents. But all teaching hospitals share this problem.
A new AMA study provides dimensions: U.S. medical schools
are graduating about 16,500 doctors a year, while teaching
hospitals are offering about 21,000 advanced training
positions in medical specialties.

Graduates of foreign medical schools are filling the
extra slots.

A big reason why teaching hospitals have overstocked
residents is that residents are a cash crop. Hospitals
bring these young physicians into their training programs,
pay them $ 35,000 to $ 40,000 a year and work them like
draft horses, meanwhile drawing a federal subsidy of $
100,000 or more for every one. The question of what happens
to those doctors when the residencies are done ought to
figure into the equation, but it doesn't.

In fact, another element of the problem appears to be
programs under which foreign medical school grads are
admitted to U.S. residency programs. Some come under
agreements with the federal government to go back and
practice medicine in their home countries once their
education is done here. Others come with a waiver that
would let them stay here if they pledge to practice in some
medically underserved rural or innercity area. The
suggestion by the AMA is that in both cases, physicians
often stay here to pursue lucrative specialties.

The result of this symmetry is that the percentage of
foreign medical school grads in U.S. residencies has jumped
from 10 percent in 1988 to 22 percent today. And perhaps
20 percent of the nation's 720,300 doctors are now
foreignborn.

The AMA would like to see Congress create a special
commission to advise how much to adjust the various
incentives and subsidies here. But the problem itself
illustrates that the notion of finetuning and the narrow
fix are illusory. A tweak here and there by the Health
Care Financing Administration isn't going to solve anything
not for long.

Congress itself needs to look at the whole organism.
The proper treatment will acknowledge the sensitivity of
the issue, and the contributions to American society by all
physicians here. But it will acknowledge, too, that the
supply of new doctors is overwhelming demand and something
needs to be done about it.

Call it a holistic fix: It seems to be what these
doctors need.

Mexico barely makes the grade Interesting how the U.S.
antidrug certification process is is viewed differently
from different sides of the border.

When President Clinton certified Mexico as an ally in
the war on drugs along with 22 other countries Sen.
Dianne Feinstein was among those who pledged to have
Congress revoke that status because of Mexico's
ineffectiveness in slowing the trade. In Mexico, however,
the three major political parties who rarely agree on
anything were united in calling the U.S. hypocritical
since the U.S. stands as "the largest illegaldrug
consuming nation in the world. "

Both points of view are too close to the truth, of
course.

Latest example of Mexican ineffectiveness: Just before
certification Mexico announced the arrest of Oscar Malherbe
de Leon who had led Juan Garcia Abrego's drug cartel since
his drug convictions in the U.S.

But just after receiving certification, the government
announced that Humberto Garcia Abrego, awaiting trial for
laundering millions for his brother Juan's drug cartel, had
escaped.

But equally true in the politics of annual
recertification is the fact that decertification of Mexico
bringing a plethora of economic sanctions to our neighbor
is the last thing this hemisphere needs at a time when
Mexico is still struggling to come out of a numbing
recession. The process creates plenty of anger and
frustration at home and abroad but the president must
recertify annually because of antidrug legislation passed
by Congress in 1986. In that process, six countries were
decertified Friday and three other did not receive
certification but will not face economic sanctions.

Where does all this leave Congress? Should Senator
Feinstein and her colleagues make good on their threats to
lead decertification? Let's hope not, at least not this
time.

Mexican President Ernesto Zedillo has had enough
embarrassments of late as he feebly tries to not let
reality like the recent arrest of his antidrug czar Gen.
Jose de Jesus Gutierrez Rebollo on drug conspiracy charges
take too much of the starch out of his antidrug
rhetoric.

Besides, President Clinton has laid out some "firm
expectations" of Mexico on the antidrug front, including
handing over to the U.S. drug lords who also face charges
here as well as toughening money laundering laws. Those
are specifics Congress can hold Mr. Clinton to next time.
True, Mexico has shown only glimmers of hope in its
antidrug campaign. But congressional decertification now
would be perilous to Mexican counternarcotics forces
already deeply shaken by the Gen. Gutierrez revelation.
And this latest certification debate, surrounded by recent
events, certainly leaves Mr. Zedillo knowing Mexico is
perilously near the end of its rope as an antidrug
certified republic.