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NPR Can't Even Talk About Immigrant Doctors

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Thursday, 07 August 2014 04:47

There is a widely believed, but largely silly, view that rising inequality is the result of technology and globalization. NPR gave us an illustration of how silly this view is in a segment on plans in California to reduce the duration of medical school from four years to three years.

The ostensible motivation was to help address a shortage of primary care physicians. The reason why the piece is relevant to the larger issue of inequality is that it never once mentioned the possibility of bringing in more doctors from other countries. Doctors in the United States earn on average twice what their counterparts do in other wealthy countries. Since we have no notable differences in health outcomes, the implication would be that our doctors are of no better quality on average than those in Europe and Canada.

This would suggest that there is a vast pool of doctors who could benefit from coming to the United States and working for more money than they would receive in their home country. The pool of potential doctors is even larger if we include doctors from developing countries who could be required to train to U.S. standards. To ensure that developing countries benefit as well, we could repatriate tax revenue from expatriate doctors so they can train two or three doctors for everyone that comes here. (If you plan to complain that this policy hurts developing countries read the last sentence as many times as necessary to understand it.)

What is striking is that the issue of bringing in more doctors from other countries never got mentioned in this piece or in other new stories that raise the question of doctor shortages. Bringing in immigrant workers is raised all the time in other contexts such as alleged shortages of nurses, STEM workers, and farm workers.

The fact that immigration is not discussed in the context of a doctor shortage has nothing to do with inevitable processes of globalization or technology. It has to do with the power of doctors relative to other workers. Doctors are able to prevent their wages from being driven down by foreign competition; other workers have less power. It really is that simple.

 

Addendum: The above comment is not entirely fair to NPR. Planet Money once had a segment in which I discussed the possibility of bringing in more foreign doctors as a way of saving money on health care.

 

Second Addendum:

I see from comments that folks have noted the number of residency slots as the source of the limit on the supply of doctors. There are two points to be made on this. First, this rule is a textbook protectionist restriction. The requirement that people have to do a residency in the United States did not come down from the heavens, it was imposed as a way to restrict the number of doctors.

This gets us to the second point. The number of slots was cut back in 1997 at the insistence of the A.M.A. and other doctors' organizations because they said there were too many doctors and it was driving down their pay. So the pieces of the puzzle all fit together easily.

Comments (11)Add Comment
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written by Last Mover, August 07, 2014 9:12

There they go again with the "shortage" thing. Never mind that it implies either higher pay necessary to attract more doctors, or more doctors to compete with existing ones to drive pay down - either one a correction of the shortage.

By cutting medical school to 3 years they use non-price rationing to increase quantity to "alleviate" the shortage.

But what are they really saying? They mean one, doctor pay is already plenty high to attract doctors and two, this tiny trickle of an increase in doctors will in no way threaten to drive down doctor pay. So a "shortage" in terms of a price adjustment correction is not the issue.

Instead they choose in highly selective fashion, to loosen ever so slightly the tight noose they have on the supply of doctors - to increase quantity at the same monopoly protected price.

They don't talk about immigrating more doctors because they would have to talk about the "shortage" in terms of price (doctor pay), and how an outward shift in the supply curve of doctors could actually drive pay down to correct the shortage.

And that is absolutely off the sock puppet radar when it comes to correcting a "doctor shortage".
...
written by James, August 07, 2014 11:45
Isn't it true that it is, more specifically, a shortage of general practitioners ? I've read that many graduating medical students prefer to go into specialties that pay more than general practice in order to pay off the high cost of medical school.
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written by PeonInChief, August 07, 2014 11:47
We could also simply make it cheaper for people to become doctors, opening more slots in medical schools, providing more internships and residencies, and providing better subsidies for students. In exchange, doctors would make much less than they do now, although they'd certainly not be starving.
More Canadian Doctors?
written by Allan Lane, August 07, 2014 1:48
Some years ago, my doctor left Canada for the United States, hoping to make much more money. Well, he's back. He told me that he did, indeed, make a lot more money, but that his extra income was eaten up by the huge insurance rates he had to pay to protect himself against the enormous malpractice settlements that people are awarded in the US. My parents tell me that they have had similar experiences with their friends who are doctors. The wages look enticing, but the difference is eaten up by malpractice insurance costs. I think this is a relevant point when talking about wage differences and about attracting foreign doctors to the US (where I now live, and love, but for the health care system, which is insane!).
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written by skeptonomist, August 07, 2014 4:13
If specialists make a lot more money than GP's, then according to standard market dogma the shortage is in specialists. But again, physicians are not really part of a classical market in which everybody shops around by price. Specialists demand more money and they get it, even though they don't necessarily have greater skills and aren't necessarily more useful.
...
written by urban legend, August 07, 2014 5:04
Don't let NPR off the hook. Once is not enough. That alternative, even via the "some economists say," should be in every single report on the subject they do.
A medical doctor in the US has a phd while a doctor from anywhere else has a BS
written by bornagaindem, August 08, 2014 9:25
Even in europe this is the case. This does not lead to better care and is not necessary but it is how the AMA keeps a tight rein on the numbers of doctors produced and keeps wages high. There is a large discrepancy in the pay of general practitioners and specialists That is why there is a shortage. Force the AMA to open more medical schools and everyone will benefit. Or bring back the 6 year medical degree program. I would rather do that than bring in immigrants for something that we can supply ourselves when we have such high unemployment (given the real number is at least 2x as high as the advertised 6+% one).
ps : malpractice insurance
written by bornagaindem, August 08, 2014 9:38
If your canadian doctor wants to have low malpractice insurance tell him to come to Texas where they have dropped 27% for doctors. Of course payouts by the insurers have dropped by 67% and patients haven't seen any drop in their premiums and there has been no decrease in unnecessary tests at all (in fact there are more than the national average)so no one really benefits from this except the insurance companies.
...
written by elboku, August 08, 2014 11:23
Malpractice as costs in health care- the myth will not die.
From AAJ: Other authorities have also found that the direct costs associated with medical negligence are a tiny fraction of health care costs. According to the National Association of Insurance Commissioners (NAIC), the total amount of money spent defending claims and compensating victims of medical negligence in 2010 was $5.8 billion, or just 0.3 percent of the $2.6 trillion spent on health care in the U.S. that same year.iii
none
written by quickkick, August 09, 2014 2:51
All 50 states and U.S. territories require all U.S. medical graduates and foreign doctors to have U.S. residency training before obtaining a license to practice medicine. The general public has no idea that there is a "bottleneck" in doctors obtaining licenses. Last year 40,300 applicants completed all U.S. licensing exams and competed for 25,900 residency positions. 12000 applicants could not find positions which included 5000 U.S. citizens. When general practice doctors are having 30+ job offers, they will skip out on rural areas and inner city areas as they are doing today. Increasing residency positions is required before any immigrants or even new U.S. graduates can create any additional supply in doctors.
The residency problem: so bad, even our politicians ought to be aware of it
written by Rachel, August 10, 2014 10:17

From the Office of the Dean, at Weill Cornell Medical College, October 16, 2012

...there will probably be about 63,000 fewer physicians than we need to meet patient demand by 2015. By 2012 that number is estimated to soar to 130,600.

One solution would be to train more doctors. ...Weill Cornell is investigating the possibility of increasing the size of its incoming class. However, there's a major obstacle.... The number of residencies in the US is tied to Medicare funding and has been capped at the same level since 1997. So graduating more MDs doesn't get us very far unless we have more residencies to train these newly minted doctors.




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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.

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