Has Anyone Heard of Immigration?

Apparently not at the Washington Post. It ran an article projecting a severe shortage of doctors due to the retirement of large numbers of baby boomers. The article never discussed the possibility of allowing more foreign doctors into the country.

The current rules on foreign doctors are highly protectionist to ensure that doctors can command high salaries. However, if shortages become too severe, the country could easily opt to relax these rules. There is no shortage of smart and ambitious kids in the developing world who would eagerly seize the opportunity to train to U.S. standards and work as doctors in the United States. This flow could easily meet any future demand for doctors in the United States.

It would also be a simple matter to attach a tax to the earnings of these doctors that would be paid to the home country. This tax could be used to train 2-3 doctors for every doctor that practices in the United States, thereby ensuring that the health care in developing countries improves by this arrangement as well.

Remarkably the Post does not discuss the possibility of increased use of foreign physicians even though it is almost fanatical in its support of free trade in other circumstances.

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written by izzatzo, June 14, 2010 7:16

Just more drivel from those who don't understand how free markets work. Read Econ 101. Really, this is as basic as it gets. A shortage means the market is not clearing at a particular price because quantity demanded exceeds quantity supplied. Shortages are corrected by price increases after which the market clears, so there's no one trying to see a doctor below the market clearing price.

The only real shortages are due to government interference like Medicare and Medicaid caused by artificial low prices which force doctors to leave in a distorted market. If prices can't support domestic doctors they certainly can't support immigrant doctors.

Just look around at all the places where there's no doctors. That's not a shortgage. Those are market clearing signals that say price is not high enough to lure a doctor there in first place, despite attempts by a bunch of free loading baby boomer retirees who want the government to subsidize their health care just like Social Security, funded by taxes on the younger generation who don't even need doctors.

Stupid liberals.

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written by MB, June 14, 2010 8:02

Why are you so against doctors making good money? WHy always only them for the most part??

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There are other ways to free up the doctor-market
written by Jorge, June 14, 2010 8:50

American doctors are paid considerably more than they should be, partly because of restrictions on training and practice that favor the well-off or others who know how to work the system.

Why doesn't Dean discuss the restrictions? Perhaps it is because he overestimates the intelligence of the average doctor? Or perhaps he has made a policy decision, that people can only grasp the very simplest solutions? Unfortunately, the solution he has chosen does help with the way our system denies opportunity to many less fortunate Americans.

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written by john, June 14, 2010 9:04

Dean,

Do doctors really command high salaries? Some sub-specialist may, but certainly the primary care doctors do not. I recently calculated the total compensation per hour work of the average pediatrician and compared it to our average unionized Los Angeles city fireman. Accounting for educational expenses, lifetime hours worked, pension contributions etc... I calculated the fireman earns DOUBLE per hour compared to the pediatrician.

I look forward to your next article deploring the unionization of public safety employees and the outrageous salaries they have engendered. I am sure you will detail how they gained control of the political system in many of our major cities and are proceeding to bankrupt them.

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What about training doctors and nurses in US?
written by Art Perlo, June 14, 2010 9:59

What about a serious program to give all kids in the US an education that would enable them to train for medical (and other) professions? How about a federally-funded program to expand medical schools and pay for the education of doctors and nurses, along with an aggressive recruitment program starting in high school for kids from currently underserved urban and rural communities. This would have the added benefit of training people whose main interest is providing health care, vs the present system which favors medicine as a business.

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written by diesel, June 14, 2010 10:39

The number of students admitted to medical (and dental) school is the bottleneck in the American system. The Associations work hand in glove with the Universities to maintain that restriction. Their rationale is that should they relax admission standards even one iota, the level of competence in their professions would plummet. For some obscure reason, they reason that in medicine, unlike any other field, competition would yield a lower quality product.

Oddly enough, MDs are always complaining about how overworked (and underpaid) they are, so one would think they'd want more fellow sufferers to share their work load. But no. They slog along. Underappreciated and unhonored even in their own country. Sad really. A lonely life of sacrifice and humility. Penance of a sort possibly. For some kharmic debt incurred in a previous life. Such nobility. All too rare in today's money grubbing commercialized world. An example for us all.

Art Perlo @ 8:59 am
written by Ethan, June 14, 2010 1:53

Spot on!!
I have long advocated three things in this area:
1) Encourage salaried physician clinics such as Mayo and Cleveland Clinics where care is (reportedly) excellent, and costs are (comparatively) modest.
2) Eliminate monopoly profits on drugs and medical devices – governments and universities already provide much of the financing and facilities/personnel for basic research, and much of drug company research is only trying to get around a competitor’s patents.
and finally -- and more to your point --
3) Subsidized medical educations so we increase the supply of physicians -- and particularly physicians who need not demand high fees in order to pay off staggering student loans. A secondary benefit might be what you mention that we attract to medical careers more people interested in service rather than money.

P.S. There is a good introductory article on medical costs and containment ideas in the June 1, 2009, New Yorker -- under Annals of Medicine, The Cost Conundrum, by Atul Gawande -- available on line at newyorker.com/archive.

How about training more doctors.
written by asdf, June 14, 2010 2:19

If salaries are too high and we need more labor to bring prices down in a sector, we could start accepting some late bloomers and A- students in to those fields. See if they can hack the advanced training. Many will be able to. No big deal. No need to increase immigration. No need to increase taxes.

Microcosm
written by Xelcho, June 14, 2010 4:01

If one chose to read Mr. Baker's "conservative nanny state" they would quickly realize that premise was supported by the medical professions own studies. The issue is similar for licensing of engineers, of which I am one. State rules vary and the accreditation system is arbitrary, as long as the schools are US based. If the system was opened to "nafta" style competition that the UAW is enjoying, one would expect the costs would normalized at a level less than 4 times the national average income. I wonder why this is not the case... Any ideas?

Surely *we* could educate more doctors
written by Charles Peterson, June 14, 2010 11:56

I like what Dean is saying, and really show Post's "free trade" hypocrisy, but wouldn't it be better yet for the USA to find some way to educate more doctors here? Then we create more jobs in Medical Education as well as in Medicine. And contruction of new teaching facilities, etc, etc. These are all excellent jobs, and we could use them. True, there does seem to be some kind of sticking point, maybe it's in some mindset of someone that can't be changed, we need to know where that sticking point is.

WRT the point made by John at 8:04 that sounds pretty hard to believe, why don't you post your calculations. I wondering if you're only counting hours firemen are actually fighting fires instead of waiting on call. You couldn't pay me enough to do that kind of work. I've heard similar claims about meter maids in San Francisco getting paid more than physicians because of the city union. That one doesn't pass the laugh test. Every time I've looked into claims about unions boosting compensation to stratospheric levels, they've turned out to be bogus. But the claims keep being recycled.

Has Anyone Heard of Immigration?

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