America’s health care system is in a dire state. The country spends more on health care than any other nation, yet its outcomes continue to decline. Life expectancy is dropping, maternal mortality rates are soaring, and chronic disease is rampant. Emergency rooms are overwhelmed, primary care is collapsing, and for many Americans, access to quality treatment feels like a distant dream. The system is buckling under its own inefficiencies, propped up by bureaucracy, bloated insurance companies, and a medical-industrial complex that prioritizes profit over patient care.

To compound matters, America’s health care system is increasingly reliant on foreign-trained doctors. At first glance, this might seem like a pragmatic response to a physician shortage—a necessary, even inevitable, solution. After all, it is not obvious that it makes any difference if a doctor was trained in New York or New Delhi, Caracas or Chicago. Unfortunately, it turns out that there is a difference—a significant one. One in four physicians in the U.S. is now foreign-born, and while many undoubtedly are supremely competent, the question is not one of nationality but of standards.

Germany offers a sobering warning. The conservative German magazine Cicero reported how, in an attempt to address Germany’s own doctor shortages, authorities began easing restrictions on foreign medical professionals. Initially, the system welcomed well-qualified physicians. Over time, standards slipped. Before long, they vanished altogether. The result was as predictable as it was disastrous—a flood of doctors with wildly inconsistent training, triggering a surge in malpractice cases, botched surgeries, and fatal misdiagnoses. Desperate hospitals, more concerned with filling vacancies than with ensuring competence, turned a blind eye to glaring gaps in qualifications. Patients paid the price. What started as a bureaucratic failure quickly spiraled into a catastrophe measured in lives lost.

A senior physician in Lower Saxony—a state in northwestern Germany—was the first to sound the alarm, revealing to Cicero that among the foreign assistant doctors she supervises, only one in 10 meets the necessary standards for patient care. The issue extends far beyond language barriers, though those pose challenges as well. Far more concerning is the lack of familiarity with treatment protocols for life-threatening conditions like heart attacks and lung cancer. Medicine is not an industry where these errors can be tolerated. 

America cannot afford to ignore this reality. The problem is systemic and structural, not personal. A doctor’s nationality is irrelevant; his competence is everything. Sadly, though, American policymakers are failing to ask the hard questions: Are all foreign doctors trained to the same rigorous standards as their American counterparts? Do they understand the latest treatment guidelines? Can they deliver the level of care that patients in a first-world medical system should expect?

The stakes are too high for anything to be lost in translation—literally or figuratively. In medicine, precision saves lives. Miscommunication in a high-pressure environment can mean the difference between a patient receiving the right medication or the wrong dose. It can mean catching a stroke early or sending someone home with aspirin instead of an emergency intervention. 

Although the U.S. education system often gets a bad rap—and for good reason, given its embrace of nonsensical ideologies and declining academic standards—one area where it still excels is medical training. Despite the broader institutional rot, American medical schools continue to produce some of the best-trained doctors in the world. Institutions like Harvard Medical School, Johns Hopkins University, Stanford University, and the Mayo Clinic Alix School of Medicine consistently rank among the top globally. 

Yet many of the doctors practicing in the U.S. received their training elsewhere. One in five foreign-trained doctors practicing in the U.S. comes from India. While India has produced many skilled physicians, there is a wide disparity in the quality of its medical schools, a problem that has been extensively documented. A Washington Post piece titled “How bad are most of India’s medical schools? Very, according to new reports” sheds light on the alarming deficiencies within the system. It exposed rampant corruption, bribery, and even fraud in medical education. The piece exposed shocking practices like ghost faculty—nonexistent professors listed on paper—and fake patients staged to fill hospital wards during accreditation visits. Though The Washington Post first broke the story in 2016, the problem persists, largely unchecked.

How many of these undertrained graduates are making their way into U.S. hospitals? Are they properly vetted before being entrusted with patient care? While some Indian-trained doctors excel, the sheer inconsistency in educational standards makes it impossible to assume competency across the board. 

The argument here is not about closing borders to foreign doctors or suggesting that none of them have potential. Many are talented, hardworking, and eager to contribute. But the reality is that medical training standards are not universal. Standards vary drastically between countries. A degree from a foreign medical school does not automatically equate to readiness to practice in the United States. If a foreign-trained pilot had only a fraction of the training of an American counterpart, no one would be accused of xenophobia for refusing to board that pilot’s plane. The same logic must apply to doctors.

The solution to America’s doctor shortage should not be to lean more heavily on foreign-trained physicians but to address the root of the problem. The U.S. should prioritize expanding domestic medical education, funding more residency slots, and reducing barriers for American medical trainees. It makes no sense that thousands of qualified American students are turned away from medical schools due to artificially constrained class sizes while the system scrambles to import talent from abroad. If America truly values patient safety, it must invest in training doctors from within, ensuring that every physician practicing medicine in the country meets the highest possible standards.