Why does N.J. have so many foreign-trained doctors?

New Jersey tops the nation in the percentage of active physicians educated overseas, according to newly-released data. Watch video

WOODBRIDGE -- When New Jersey patients peruse the walls in their doctors' offices, chances are good they will find a degree from a foreign medical school.

New Jersey tops the nation in the percentage of active physicians educated overseas, according to newly-released numbers from the Association of American Medical Colleges, a non-proft national group that tracks data about doctors.

More than 38 percent of New Jersey's 25,930 doctors went to medical school outside the U.S., according to the 2014 data. That is more than double the percentage in most other states and well above places like Montana and Idaho, where patients have a minimal chance of running into a physician trained outside the U.S.

The nearly 10,000 physicians in New Jersey who went to overseas medical schools include mostly immigrants who trained in their home countries and relocated to the U.S. to practice medicine.

But the numbers also include Americans who studied at medical schools in the Caribbean or other foreign countries that cater to U.S. students who did not have the grades or test scores to get into medical schools at home.

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Wherever they come from, large numbers of foreign-educated doctors are finding jobs in New Jersey, New York (which ranks second in the nation with 37 percent of its physicians coming from foreign medical schools) and Florida (which ranks third with 36 percent), according to the ranking.

"They are clearly doing something to attract international medical graduates," said Atul Grover, chief public policy officer for the Association of American Medical Colleges, which compiled the data for its "2015 State Physician Workforce Data Book."

The most obvious explanation is that states with high numbers of immigrants tend to be welcoming to foreign doctors, Grover said.

"Immigrants tend to move where they know people," Grover said.

It is difficult to assess whether doctors who attended foreign medical schools provide any better or worse care for patients in the U.S., Grover said. There have been few studies. But statistics show medical students trained at overseas medical schools tend to score higher on standardized tests than their American-trained colleagues.

"We haven't got great outcome measures," Grover said. "But foreign graduates tend to do very, very well on those standardized tests."

Under the U.S. system, most physicians attend undergraduate medical schools, then are required to serve a residency at an American teaching hospital or medical institution before they can be licensed to practice in the country.

Residencies are required for "both technical knowledge and cultural reasons," to help doctors learn how to work in the U.S. medical system, Grover said.

New Jersey hospitals attract high numbers of overseas applicants for their residency spots. Last year, 53 percent of the nearly 2,900 residencies at New Jersey hospitals and institutions were filled with physicians who attended foreign medical schools, according to the data.

A growing number of New Jersey's residency spots are also going to U.S. students who attended Caribbean medical schools.

Ross University School of Medicine, which has an office in Woodbridge, sends U.S. students to its campus on the Caribbean island of Dominica for medical school. Then, many students return to the U.S. for their residencies and eventually get jobs or open up medical practices.

"Many Ross University School of Medicine students call New Jersey home and choose to return to the state to complete their residency training. Over the last five years, more than 200 Ross graduates have entered residency training in New Jersey," said Joseph Flaherty, dean and chancellor of Ross University School of Medicine.

Flaherty said his students consistently perform as well or better than U.S.-educated medical students on licensing exams.

"In addition to excellent training, Ross medical students are more representative of the diverse population of New Jersey than the average U.S. medical school graduate, which studies show contributes to better medical care," Flaherty said.

Many students turn to overseas medical schools because of the lack of seats in U.S. schools. Though there has been a push to increase the number of spaces in medical schools nationwide, New Jersey still ranks low in the number of students going to medical school in their home state.

New Jersey is home to Rutgers University's two medical schools - New Jersey Medical School in Newark and Robert Wood Johnson Medical School in Piscataway-New Brunswick - and Rowan University's Cooper Medical School in Camden and School of Osteopathic Medicine in Stratford.

Seton Hall University is expected to open the state's first private four-year medical school in the fall of 2017. The new school, located on the former site of the Hoffmann- La Roche campus in Nutley and Clifton, is expected to enroll as many as 150 new students each year and help provide more in-state medical school seats for New Jersey students.

The influx of new medical school students will come as New Jersey's doctor population in aging.

The latest numbers show New Jersey's physicians are among the oldest in the nation. About 33 percent of the state's active physicians were age 60 or older in 2014, according to the new data from the Association of American Medical Colleges. That is the third highest percentage in the nation, behind New Mexico and Hawaii.

Only about 13 percent of the state's physicians are under age 40, indicating New Jersey could use some new doctors from the U.S. or abroad to replace the growing number of physicians expected to retire in the next few years.

"It is going to be worse in the states like New Jersey where the population (of older physicians) is higher," said Grover, who helps track the numbers for the Association of American Medical Colleges. "We're just trying to keep a close eye on it."