A December 22 story in the New York Times unintentionally highlighted the one of the gravest problems with overpopulation. The story, Medical Schools in Region Fight Caribbean Flow, indirectly shows how job shortages, real or perceived, lead to issuing non-immigrant visas to foreign-born professionals who then never go home. By changing visa status, a non-immigrant becomes a permanent resident who adds to the overall population base through his presence and the children who eventually follow. According to the story, experts predict a shortage of 90,000 doctors in the U.S. by 2020. For a generation, Caribbean-based medical schools have attracted thousands of American students to their campuses by promising that during their third and fourth years, the students would be trained in U.S. hospitals, primarily in New York. These are students who, mostly for academic reasons, did not get into major American medical schools. Of more than 42,000 students who apply to U.S. medical schools, only about 18,600 matriculate. New York medical school deans claim that to meet the looming shortage, they want to expand their own enrollment. But their ability to do so is restricted by competition with the Caribbean schools for clinical training slots in New York hospitals. Foreign schools send about 2,200 students, more than 90 percent of them from the Caribbean, according to the state. St. George’s University in Grenada alone sends about 1,000 students, many through a 10-year, $100 million contract with the New York City Health and Hospitals Corporation which runs public hospitals. The practice of cross-training, first in the Caribbean and then in New York, predominantly involves Americans returning home. If the New York deans successfully restrict access to their hospitals from American foreign-trained doctors, then how will the medical doctor shortage be resolved? The most likely answer is that the schools will recruit from abroad and issue J-1, one of dozens of employment-based visas. Under the J-1 terms, the doctor must return to his native country after completing his residency. But, no surprise, few go home. Instead they rely on one of the loopholes, practicing in an inner city, to remain in the U.S. indefinitely. That, in turn raises questions about the quality of care patients will receive from foreign-born and/or educated doctors. The Government Accountability Office (GAO), a federal agency, compared the academic and professional performance of medical students from domestic and foreign schools. In its report released last June, the GAO found that on average, foreign-trained students lagged behind their American-trained peers in passing the medical licensing exams. Whether New York succeeds in limiting access to its hospital by foreign-medical school staff, the doctor shortage problem would not exist if the state’s population didn’t continue to increase. According to demographic data compiled by the New York Department of City Planning, the five boroughs population will increase by 14 percent from 2000 to 2030. The majority of growth comes from immigration with many of the immigrants needing significant medical care. In the end, New York’s problem is a population merry-go-round. A shortage of medical professionals leads to adding more people through the short term remedy of issuing more visas. The logical solution to the doctor shortage would be the long-term answer: investigate why more Americans don’t pursue medical careers. A good place to start would be to increase the federal subsidies to medical schools so young American students don’t have to incur massive levels of personal debt to become doctors.