By Rob Sanchez
04/16/2010
The Wall Street Journal has joined a chorus of news reports that claim that there is a looming shortage of doctors. Of course we have heard similar shortage shouting about doctors for decades, but this time the hysteria is centered on the fact that Obamacare will give millions of additional people access to health care — and that will create problems for a system that won’t be able to cope with the need for large numbers of new primary care physicians.Where there is shortage shouting there is usually someone calling for more H-1B visas, or some other type of scheme to allow more foreign workers into the U.S. The following paragraph from the WSJ activated my alarm bells:
While doctors trained in other countries could theoretically help the primary-care shortage, they hit the same bottleneck with resident slots, because they must still complete a U.S. residency in order to get a license to practice medicine independently in the U.S. In the 2010 class of residents, some 13% of slots are filled by non-U.S. citizens who completed medical school outside the U.S. Medical Schools Can’t Keep Up, By Suzanne Sataline And Shirley S. Wang, Wsj, April 12, 2010There you have it folks! If the U.S. could find a way of stealing more doctors from foreign countries we could supply all the doctors we need to solve the impending medical care crisis that Obamacare is going to create. Ooops! Wasn’t Obamacare supposed to solve the crisis?
There is one problem that the cheap labor lobby and the open border globalists will have to solve before they let more foreign doctors into the U.S. It’s not as simple as increasing the number of visas, because as I have explained before the number of visas that can be issued to foreign doctors is almost unlimited. To learn more about doctor visas please read my recently published article: The Most Generous Nation in the World … at Giving Jobs Away, by Rob Sanchez.
Whenever you hear that we need to expand immigration or create a new visa to import more doctors, just remember that what you heard is pure bunk!
So, the availability of visas is no obstacle to bringing in more foreign doctors because an unlimited number of doctors could immigrate to the U.S. to practice medicine if they could get certified to do so. In order to get certified all medical graduates (whether citizen or foreign national) have to serve out a period of from 3 to 7 years of indentured servitude which is commonly called "residency" (medical students claim it’s slavery but that’s because they don’t understand what indenture means). Increasing the number of doctors requires more residency positions — and that decision is controlled by the American Medical Association (AMA).
This is how the system works, according to the AMA:
The Educational Commission for Foreign Medical Graduates (ECFMG) serves the public interest by offering a program of evaluation, examination, and certification for physicians who were educated outside the United States and Canada. Physicians educated outside the United States and Canada, termed international medical graduates (IMGs), may be citizens of the United States or Canada who chose to be educated elsewhere or non-citizens who were admitted to the United States by US immigration authorities. Educational Commission for Foreign Medical Graduates, AMAWhile the AMA argues that their strict certification standards increase the quality of physicians, protagonists claim that the AMA deliberately limits the number in order to create artificial shortages of doctors, which in turn causes the wages of doctors to increase because of market pressures.
Assuming that the AMA is going to retain their control of the market when Obamacare is in place, there doesn’t seem to be a way for greedy hospitals to import more foreign doctors, but wait … . how about a scenario where the rug is pulled out from underneath the AMA by passing laws that allow residencies in foreign countries? In this scenario a doctor could transfer their residencies in the same way college students change schools.
Uber-libertarian Dean Baker has thought this thing through. He suggests that the government usurp the AMA to increase the number of doctors. Side benefits will include a dramatic decline in the salaries of doctors as the foreigners flood into the U.S. and compete for jobs. Ahhhhhh! It’s the old supply and demand curve, which is usually denied by economists, libertarians, neo-cons, and neo-liberals when they advocate expanding the labor force by using immigration.
What if, however, the government sought to remove the licensing barriers for foreign physicians? Compensation in the most highly paid medical specialties averages far above $250,000 a year (even after paying malpractice fees). Many doctors trained outside the United States would find these positions attractive even if they only paid $100,000 a year. Opening medical practice to foreign competition would allow for the same sorts of gains from trade that we have seen with opening trade in apparel and textiles — except that we spend far more on doctors each year than we do on clothes. Why Don’t We Globalize Health Care?, by Dean Baker, Counterpunch, August 4, 2009You gotta like the way Baker compares doctors to textile workers! Personally I think it would do doctors some good if their bloated egos were cut down! If that doesn’t bust the behinds of overpaid American doctors Baker has other plans to shrink the AMA’s influence, like for example increasing "medical tourism" (from the same article).
There are clear ways to take advantage of lower costs in other countries, making our own system more affordable without diminishing the quality. We could allow more foreign-born doctors to work in the United States, for instance. We could encourage the "medical tourism" that allows Americans to have major procedures performed in other countries, and we could permit Medicare beneficiaries to buy into the lower-cost healthcare systems of other wealthy countries.Baker’s strategy for forcing down the salaries of doctors seems to make sense, in the short term. Unfortunately the laws of supply and demand will dictate that American students won’t choose medical careers as doctors, which will reduce the supply of domestic doctors. Of course third-world countries could probably send us as many replacements as we need so if price and availability is the main issue, Baker’s solution makes sense.
Don’t think for a second that the medical robber barons in the U.S. were the first to think about the idea of global physicians. Europe is way ahead of us. Here is one from the BBC:
… patients risked being treated by doctors who were incompetent or were not fluent in English. [snipped] European regulations which allow free movement of labour mean the GMC is unable to carry out clinical or language checks on doctors from EU countries as it does for those from elsewhere in the world."System of vetting foreign medics 'needs improving'", by Nick Triggle, BBC NewsCanada is experiencing the controversy in a big way. Their "problem" will be solved by calling it an issue of basic human rights! If Canada is an example of our future, expect the AMA to be characterized as racists, protectionists, and xenophobes.
Watch this video for what’s going on in Canada: Doctors Without Residency
This short documentary highlights how discrimination prevents foreign-trained doctors from practicing in Canada — even after they've received their Canadian qualifications. Interviews with medical professionals and human rights advocates illustrate how systemic racism plays a role. Doctors Without Residency,Tetchena Bellange, 2010So, what does the future hold? Senator Bill Nelson (D-FL) and Congressman Joseph Crowley (D-NY) sponsored a bill that would increase Medicare residency slots by 15%. That’s not going to help much if there is really a shortage. I predict there will be big pressure for a bill that will allow foreign doctors to transfer their residency, or there will be legislative proposals to allow some type of limited global residency like the EU. It will be interesting to see how long the AMA will be able to resist onslaught of foreign doctors. Remember PATCO?
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