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Home Publications Blogs Beat the Press Doctor Shortage? NYT Has Never Heard of "Immigration"

Doctor Shortage? NYT Has Never Heard of "Immigration"

Sunday, 29 July 2012 07:59

Apparently NYT reporters never heard of immigration. This is the only way to explain a front page piece that discusses an alleged shortage of doctors in the United States that never once discusses the possibility of bringing more doctors in from other countries.

As a practical matter this should be very easy to do since doctors in the United States earn on average about twice as much as their comparably trained counterparts in Western Europe and Canada.They earn five to ten times as much as doctors in the developing world.

If the government were to set up mechanisms that could fast track the certification of doctors from other countries so that they could quickly establish that they have been trained to U.S. standards and then would be free to come to practice in the United States just as any native-born doctor, it is likely hundreds of thousands of doctors from around the world would quickly take advantage of the opportunity. (In the case of developing countries, it is easy [even a DC policy wonk could do it] to design mechanisms where they would be compensated for doctors who came to the United States so that they could train two or three doctors for every one that came to the United States. This would ensure that developing countries gained from the arrangement as well.)

It is incredible that the NYT is so committed to protectionism that it would not even discuss immigration in this context of a doctor shortage. This protectionism is far more harmful both economically and to the country's health than the trade barriers that the NYT has often written about. It is perhaps worth noting that the protectionism that gets highlighted in the NYT and other media outlets tends to favor less-educated workers.


Comments (15)Add Comment
Domestic trade barriers are the primary problem
written by LSTB, July 29, 2012 8:55
Importing doctors for cash would ease the shortage in the U.S., though Dean has never addressed how foreign countries would do with fewer, expensive-to-train doctors. There might be a global doctor glut with a localized U.S. shortage, but I doubt it. Simply shifting the shortage to developing countries means the immigration plan is taking human capital from developing countries to mollify a problem created by domestic trade barriers, not foreign ones.

A better long-term solution would be to ease the requirements Americans must meet to become doctors, e.g. allowing people to go to medical school directly after high school (saves four years), or coming up with fast-track certification procedures to allow experienced nurses to become doctors. They might not be as good in diagnosing weird diseases, but it doesn't take hundreds of thousands of dollars in student loan debt to train someone to say, "Turn to the left and cough."

Speaking of which, reducing the student debt burdens of existing doctors so they can move into general practice from specialties (something beyond Income-Based Repayment) would ease distortions caused by the student loan system.
What Exactly is a Doctor Shortage Anyway?, Low-rated comment [Show]
Response to last mover
written by Michiganmitch, July 29, 2012 10:41
As Dean pointed out, doctor pay is already inordinately high. The "free market" as often the case isn't really free in that the AMA can and does exert considerable political and institutional pressure to maintain an artificial shortage to guarantee full employment and high compensation. Government needs to work for the population instead of the AMA and other interest groups like the for profit insurance companies, big PHARMA and the medical equipment industry to bring costs more in line with the other industrialized democracies.
We already importing training
written by Hugh Sansom, July 29, 2012 11:49
A quick scan of medical degrees at doctors' practices in my (very wealthy) neighborhood of Brooklyn shows that, even if we are not allowing doctors from abroad to immigrate, we are allowing foreign training. An enormous number of doctors around here have degrees from foreign institutions. I do not know what the current figures are, but when I was an undergrad, students who failed to get into American medical schools went abroad and then returned with their foreign degrees. The pre-med students I saw in chemistry classes were very blunt about their plans. Their goal was a high-paying practice in the US. Where they go their training was secondary. Why would an Indian trained in India be any less qualified than an American trained in India?
Poor countries subsidizing the rich
written by f.fursty, July 29, 2012 1:49
Thank you for mentioning -- if only parenthetically -- the loss of doctors that would result in developing countries if the U.S. were to throw open its borders to foreign-trained physicians.

The U.S. is the richest country in the world. It seems odd that it cannot afford to train its own medical practitioners, and must instead poach them from poorer countries -- sometimes the poorest countries with the fewest physicians per capita.

You say that it is easy to design systems to ensure that foreign countries are not penalized by losing their physicians, trained at their taxpayer expense, to the United States.

If it is so easy, I wonder if you could elaborate, and also point us to some places that have such programs and where they work. I have seen, for instance, that the British National Health Service drains nurses from places like Malawi -- a practice that only hurts the very poor country of Malawi while subsidizing the very rich country of the UK. I don't know of any benefits that Malawi gets from this practice, but perhaps I am not informed enough.

It takes a long time to train a physician. I would like to know where such practices are in place and how they work.

Thank you for your efforts and your continued blogging.
written by skeptonomist, July 29, 2012 3:04
I envy Dean his excellent health. Evidently he never has a serious illness so has little idea of how many foreign physicians there are in this country. There is certainly a shortage of physicians in this country and their compensation is excessively high, but international free markets are not the solution to everything. What could be pursued instead is more rapid training of US physicians and more of them, with increased use of information technology. A great deal of non-emergency diagnosis could be done better by computer. The overly-rigorous and extended emphasis on rote memorization is at this point more of a barrier to keep the number of physicians down than training which is - or should be - necessary for efficient medical care.
Easy Plan for Compensating Developing Countries
written by Dean, July 29, 2012 4:25
In response to f.fursty's request, we could have a tax of 10 percent imposed on the gross pay of any doctor who was educated overseas in part or whole at that government's expense, with the tax being sent to the country. This could be for a period of 10 year or so after they start working in the United States.

In most developing countries this should easily cover the cost of training two or three doctors (remember average pay here is on the order of $260k a year). From the standpoint of developing countries, this would seem to put them way ahead, since as is noted, they are already losing health care professionals and getting no compensation. So the question is whether we want to see them lose some professionals and get no compensation or have them lose even more and get substantial compensation. That one seems pretty simple to me.

As far as the numbers of foreign born doctors -- this is the old Mexican avocado theory of international trade. Yes, there are many foreign born doctors in the U.S. I can also go to the grocery store and buy an avocado grown in Mexico. The latter does not mean that we have free trade in agriculture, nor does the presence of many foreign born doctors mean that we have free immigration for qualified physicians.

If we removed all unnecessary barriers to foreign doctors we might have two or three times as many as we do today. It is simply much cheaper to train a qualified doctor almost anywhere else in the world than in the United States. Why not get our doctors from where they can be trained most cheaply and thereby save patients in the United States big bucks?

As long as the AMA controls the # of doctors and
written by fairleft, July 29, 2012 10:32
what 'doctoring' must be done by doctors, there will be a 'shortage' of doctors. Duh. That's the fundamental roadblock. After that wall is broken through, there will be tens of thousands of young American men and women happy to double the doctor force and make half the wages our current doctors do. Immigrant doctors should of course only be a temporary stopgap while the flood of future American citizen doctors is going to med school. That Baker doesn't 'get' the preceding has long been one of the few weaknesses in his economic thinking.
written by f.fursty, July 30, 2012 12:43
Thanks for your response. Such a tax seems logical in principle, although I can imagine many barriers to its successful implementation.

I wonder whether you can point to any examples of such a system being successfully implemented anywhere else in the world. The U.S. has a shortage of physicians but it hardly has the lowest numbers per capita, even among wealthy countries. Do you know of any national health systems in wealthy countries that compensate the poorer countries from which they poach? It would be heartening to know of an existing policy that works and which might serve as a model.

I fully agree with your general point about the hypocrisy of trade agreements, which open up working class labor to international competition while protecting white collar workers. It is just one glaring form of class warfare going on in this country.

The U.S. has wildly excessive health care costs costs. But it seems to me that a better course of action would be to address the massive dysfunctions of the U.S. health system directly (for instance, make it cheaper to train doctors here, invest in primary care, etc.) than to, in a sense, outsource our problems to the rest of the world.

The idea of importing physicians from poor countries strikes me as the same kind of non-solution that involves the re-importation of drugs from Canada: it accepts the U.S. inability to negotiate lower drug prices, relying instead on the Canadians' political will to negotiate with drug companies, even as it jeopardizes their continued ability to do so.

How about addressing the dysfunction and corruption of the U.S. medical-political complex head-on and negotiating with the drug companies directly?

But I may just be too pessimistic (or optimistic?) in this regard.

Thanks for your continued blogging and work.
But wasn't the article mostly about primary care physicians?
written by Kat, July 30, 2012 7:08
Their mean wage is significantly lower than 260K.
Ob/Gyn's make closer but also have some of the highest malpractice insurance rates. [url=http://www.bls.gov/oes/current/oes291064.http://www.bls.gov/oes/current...291064.htm
written by liberal, July 30, 2012 7:47
skeptonomist wrote,
What could be pursued instead is more rapid training of US physicians and more of them, with increased use of information technology. A great deal of non-emergency diagnosis could be done better by computer.

Completely agree---the lack of modernized process management (electronic records, expert systems, modernized patient management plans, etc etc) is astonishing. It really shows the base corruption of the medical profession.

One added note, though---part of any such plan would allow for greater use of nurses and physician assistants.
written by John, July 30, 2012 8:27
It's not clear to me why Dean doesn't look to the internal barriers of entry - the severely limited access to training as a doctor imposed by the AMA - as critically as the immigration barrier. Vast numbers of young americans would choose careers as doctors, if only it were possible to get into medical school.

Another favorite saw of Dean's is immigration barriers for lawyers. Right now we have a huge glut of expensively trained lawyers for whom there is no well-paid work. There are a few jobs for $160k/yr - an example of the stickiness of wages - and for everyone else there is heavy competition for $50k/yr jobs that require 80+ hrs/week of work. What we need for lawyers is a more sensible business model that connects those who need legal services to lawyers who will work hard for good wages with a reasonable schedule. What we don't need is foreign lawyers coming over to compete for the handful of $160k/yr jobs in Manhattan.
AMA does limit entry..no secret...
written by pete, July 30, 2012 12:08
In response, at least in Texas, nurse practitioners are booming. Doctors do not even have to be in the office, but do take a cut, much like a senior partner in a law office. NPs can prescribe some medicines, order xrays and so forth. Its not quite like Bangkok in the flood last year, where the free market was just unbelievable, with boats and drinking water showing up all over the place where needed, but given enough leeway, and incentives, the problem can be solved without massive intervention, and in spite of the AMA/SEIU monopoly powers.
written by saurabh, July 30, 2012 6:19
Chaining NPs, who could be taking a huge fraction of the primary care burden and are much cheaper to train, to doctors is another way to restrict the supply of medical professionals and keep an MD valuable. Why aren't there tons of general practices run exclusively by NPs? Because doctors don't want it that way, period.
written by liberal, July 30, 2012 9:22
pete wrote,
In response, at least in Texas, nurse practitioners are booming.

Yeah, while I don't know about TX, I have read here and there about how in place X and time Y, it's increasing.

What I don't understand is why it hasn't increased everywhere, and already.

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About Beat the Press

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being The End of Loser Liberalism: Making Markets Progressive. Read more about Dean.