The United States is in the midst of the worst public-health crisis in a generation. So why are many of the nation’s newest doctors unable to find work?

More than 6,500 recent American medical graduates are currently sitting idle, having been passed over by residency programs around the country. At the same time, the government continues to issue thousands of visas to foreign doctors each year, ­despite the medical talent languishing at home.

Relying on foreign physicians was difficult to justify even before the pandemic. But at a moment of crisis-level unemployment, and crippling demand for medical care, letting an army of American doctors sit on their hands is bonkers.

By the time American doctors graduate from medical school, they have spent nearly a decade navigating one of the most intensive and competitive systems of professional training on the planet. They have distinguished themselves in pre-med programs, performed well on the Medical College Admissions Test, defied the odds by earning entrance into a medical school, then completed their degrees at great financial expense. The average medical school debt in the United States exceeds $200,000.

But many of these US citizens never get to apply their skills in a residency program — and as a result, they can’t practice medicine. This year alone, more than 2,000 seniors at accredited US medical schools didn’t match for a residency position.

These are capable physicians who’ve already treated patients during their clinical rotations in medical school. All have passed rigorous qualifying tests, including the US Medical Licensing Examination.

But residency programs nevertheless rejected these American grads — who spend thousands of dollars in application fees alone — to make room for foreign applicants.

Sometimes, the hospitals that host residency programs have a financial incentive to accept foreigners rather than Americans. The Saudi government, for example, covers the cost of residency for certain Saudi doctors. That means residency programs can potentially bring in hundreds of thousands of dollars for each Saudi doctor.

The Educational Commission for Foreign Medical Graduates, which must certify foreign doctors before they can receive J-1 visas, also has a financial interest in this status quo. ECFMG brings in an estimated $1,050 per foreign doctor it certifies and charges applicants up to $4,000 in exam fees. The organization had a total revenue of nearly $90 million in 2018.

Nonfinancial factors play a role, too. Many residency-program administrators were themselves J-1 visa holders at one point. And they show a bias for their countrymen. It’s no coincidence that roughly 50 percent of all foreign doctors on J-1 visas hail from just three countries — Canada, India and Pakistan.

Given these perverse incentives, it’s no surprise that more and more foreign doctors are coming to the United States to complete their residencies. The federal government approved more than 11,000 J-1 visas for foreign physicians in 2018. That’s an increase of 67 percent since 2008.

Not all of those J-1 applicants applied for residency slots, of course — but many did. This year, more than 4,000 noncitizens secured spots in US residency programs.

Fortunately, policymakers and leaders in the medical community can address this distortion. Taxpayer-funded residency programs are under no obligation to admit qualified US medical grads over foreign doctors. Program administrators ought to be required to exhaust the pool of American doctors before considering foreigners.

The Trump administration could also extend its suspension of the J-1 and H-1B visa programs to include foreign doctors. That would help unmatched American grads fill positions that would have otherwise gone to foreign physicians.

Finally, Congress could fund more residency slots at US medical institutions. Creating more training opportunities wouldn’t just reduce the number of unemployed physicians. It would also help stem the doctor shortage plaguing the nation. Today, the United States has 2.59 doctors per 1,000 residents. That’s among the lowest ratios of any developed country.

The COVID-19 pandemic has created a surge in demand for medical care — and an employment crisis unlike anything since the Great Depression. ­Allowing American doctors to remain jobless only exacerbates these problems.

Esther Raja, M.D., is a graduate of Xavier University School of Medicine and an advocate for America’s unmatched medical graduates.

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