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We Could Also Import More Doctors

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Thursday, 05 December 2013 05:41

Interesting piece on the prospects of a doctor shortage by Scott Gottlieb and Ezekiel Emanual in the NYT. Interestingly they never discuss the possibility of bringing in more qualified doctors from other countries. It's much cheaper to train doctors (to U.S. standards) in other countries than in the United States. If the political system were not so completely dominated by protectionist Neanderthals, opening up our system to foreign trained doctors would be a central item on the trade agenda. The potential gains to the economy from reducing doctors' wages to the level paid in other wealthy countries would be close to $100 billion a year (@ $800 a year for a family of four).

Comments (13)Add Comment
How to create a doctor shortage
written by Loud Liberal, December 05, 2013 6:48
During the last years of the Clinton Administration congress inserted into a budget, at the last possible moment, a wonderful gift to the AMA: Teaching Hospitals received $100k for every intern that they did NOT accept.

The intended goal of this policy was quite clear: with less internship positions available there would be less practicing physicians in the marketplace.

What was the official rational for this? The American Medical Association (AMA) which pushed the legislation issued a PR blitz to explain the findings of an obscure Dartmouth study, which found that more doctors equaled more medical tests ordered for their patients. The study revealed that doctors who faced competitive threats from other doctors had a tendency to (pad their income and) over-order medical tests for their patients. However, the study concluded, that with less doctors there would be far less tests, so therefore healthcare would be less expensive across the board. Never mind the laws of supply and demand, the AMA said, the medical tests are the only concern the public should care about. Congress agreed.

The AMA PR added that hospitals could use the money to hire more RN's or improve their service in some other way.

Did it work? Did the savings the promised materialize. We all know healthcare has gone through the absolute roof since the Clinton administration, but perhaps the folks behind the Dartmouth study the rate of increase was far less. But I don't think anyone in the medical field would believe them.

So the Republican congress instituted a socialist/anti-marketplace measure to deliberately lower the population of doctors. The budget was later signed into law by President Clinton.

What is the point of this story? Be skeptical of any source that wants to deliberately keep the pool of doctors low. To be sure there will be advances in productivity of medical care- but enough to cover the anticipated shortage 130,000 more doctors than medical schools are producing?
Medical Industrial Complex Discovers Health Care is a Market Failure
written by Last Mover, December 05, 2013 7:01

Given the permanent train-wreck state of health care in America, it's not a stretch to envision total deregulation of health care altogether to see what happens, such as:

Bright, tech savy young people in America with general skills and education could literally practice a large part of health care effectively in short order with no formal training whatsover, simply by watching and learning hands on.

Ditto for consumers who could diagnose and treat themselves with data and software programs.

The predictable outcry from the medical industrial compex to even consider such wanton wrecklessness no longer applies under current conditions, which can't get much worse for a developed nation sliding backwards as fast as America.

Full speed ahead. Damn the risk of deregulation. Risks will be reduced, not increased.

Oh wait. It won't happen. The free market crowd, including the medical industrial complex which operates in disguise behind layers of protectionist regulations, won't let it happen. Not even at such a mild level as imported doctors.

You see, such freed up markets exhibit all sorts of failures that will harm you. Thousands if not millions will die of mistakes, fraud, undertreatment, overtreatment and overpriced treatment.

For starters are quacks who will enter the field and sell you snake oil instead of health care. From there are underqualified personnel who won't give you the best gold plated health care available - say several hundred thousands worth more than you need - rather than only enough to keep you healthy with a longer lifespan, which means nothing but losses for the health care industry.

Wake up America. Health care is a proven market failure. The medical industrial complex has been warning of these failures for years. Let Big Brother Health Care treat you instead.

Besides, under Obamacare you can't even keep your imported doctor if you wanted to. Stop Obamacare. Stop deregulation and free markets. Let Big Brother handle it instead like he always has.

America deserves nothing but the best. Nothing but the best health care in the world. And we do mean all or nothing don't we America.
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written by Bill, December 05, 2013 12:00
Dean, have you commented on this piece by Paul Collier? Do you worry that US by importing doctors and other skilled people creates a brain drain that hurts poorer countries? Not sure I buy it myself, but a valid concern to raise.
http://www.nytimes.com/2013/11/30/opinion/migration-hurts-the-homeland.html?smid=pl-share&_r=0
...
written by g, December 05, 2013 1:31
Since legal field has been destroyed as a profession, software engineers in this nation who are pesky enough to ask for 3% wage increases are about to get their just desserts with massive importation labor in the immigration bill..why do in the medical profession as well?


No job in this nation will pay enough to justify the time and tuition in this nation..we will truly become a nation of owners and workers...hint be an owner..
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written by watermelonpunch, December 05, 2013 2:08

@ Bill

I think your concern is addressed by Dean Baker recently here:

http://www.cepr.net/index.php/...nyt-asking

(We could design a mechanism to ensure that earnings of foreign doctors are taxed and repatriated to home countries so that developing countries could train 2-3 doctors for every one that comes to the United States. Even an economist could figure out how to design such a mechanism.)
docs AND nurses AND radiologists will fight this...
written by pete, December 05, 2013 3:09
Most health care costs are not doctor's salaries. This is simply silly, ask anyone who sees a hospital bill. To really make inroads in reducing costs it is all the nurse's and tech's costs, where the US also leads in compensation. These are also limited by unions, and Dean's buddies/funders at the SEIU also attempt to raise the staffing levels so total nursing costs are even higher. This focus on doctors is disengenuous.
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written by watermelonpunch, December 05, 2013 3:53


Radiologists ARE doctors!


Also, this post wasn't about a possible nurse shortage. It's addressing the proposed DOCTOR shortage.

One proposed solution to help the doctor shortage & health care costs, is to give more responsibility & work to nurses. That people are suggesting this seems to suggest that nurse practitioners are cheaper than doctors.

If there were too many nurses, or they were not needed, I think hospitals would very easily cut them. And, in fact, many hospitals have cut nursing staffs severely in recent years... sometimes even though more are needed.

Also, in areas where nurses are in high demand and there is a shortage - they do get paid well - which of course actually makes sense. But that is NOT true of everywhere in the country.

Furthermore, I don't think medical test technicians are the highest cost part of the high tech testing part of healthcare. The machines themselves are what's truly astronomical. A lot of the tech positions don't actually pay all that well.
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written by AlanInAZ, December 05, 2013 5:18
It's much cheaper to train doctors (to U.S. standards) in other countries than in the United States.


If we accept Baker's assertion that it is cheaper to train to US standards anywhere else and training capacity can be cheaply expanded to include replacements for the influx of immigrants to the US, why not just send our own boys and girls to these places for training. At least the returning doctors will speak English.
27% of Doctors Are Foreign Born; 70% Become Citizens
written by jerseycityjoan, December 05, 2013 5:39
I don't see how banging this drum is going to get us anywhere.

Have doctor salaries been reduced by having over a quarter of them come from overseas? No.

At best, we could only push around foreign doctors for a brief time, when they are on some kind of temporary visa.

Once they have their green card, what kind of special rules are we going to make them follow that we don't do for any other green card holders? 70% of the foreign doctors naturalize to become American citizens.

http://www.migrationinformation.org/usfocus/display.cfm?ID=898

There are so many available targets that we can go after in healthcare.

Why focus on a target that is not really available?

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written by Regular American, December 05, 2013 7:13
I actually agree with Dean that his doctor importing idea would be a very good public policy and would save a lot of money for everyone. Except doctors, who are mostly well off. His hammering this home of this point exposes a lot of hypocrisy among the free trading economists and punditry. But I still find his focus on this aspect of the immigration debate to be very pernicious.

Right now VSP Democrats, the GOP leadership, Corporate America, and the media are all colluding for another amnesty and massive increase in legal immigration that will add tens of millions of people to the labor market. This will exacerbate the crisis levels of unemployment and inequality. If someone isn't shouting at the top of his lungs that mass immigration is part of the problem then it's really hard for me to tell if they're on the side of regular Americans like myself.
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written by watermelonpunch, December 05, 2013 8:41
written by Regular American, December 05, 2013 8:13
His hammering this home of this point exposes a lot of hypocrisy among the free trading economists and punditry.


Exactly. And that's exactly what's needed.

You can't convince others by trying to get them to agree with your viewpoint, because they don't share it.
You can get them to think by showing them how something is THEIR viewpoint.


And I think that's what trips people up about Dean Baker.
Dean Baker is shrewd, no doubt about that.
You only have to read his book (or just the title) "The end of loser liberalism"... to get the picture here.
He's not a loser liberal. He's a winner.

But more importantly, he sticks to economic expertise & integrity with that. He's not just a shill for a particular political cause, he's simply attempting to be on the side of truth. Which is worth a lot more in an economist, isn't it?
We don't ask our economists to decide upon policy. We depend on our economists to give us a heads up on how various policies may or may not work, and the possible economic consequences, whatever they may be.
Dean Baker would seem to be serving this purpose.
And in that sense, his job is done at that point, isn't it?


Also, unfortunately those who shout at the top of their lungs about immigration being the problem... Sometimes cause unintended consequences with their idea of good policies too.

My representative in Congress is Lou Barletta.
Very well known for being a one-issue politician - and his issue has been immigration, and he has indeed shouted at the top of his lungs about the problems of mass immigration.
But he's also NOT always been squarely on the side of ordinary Americans either. (Though he has defected from the Republican party line a number of times on various issues, I will give him that.)
Unfortunately, he's a good example of the road to hell being paved with good intentions on the topic of immigration.
I really don't think he's quite the devil bigot as some see him. But he's also not the kind of nuanced, reality aware, thoughtfully considerate, policy decider we need either.


The problem I think is that unfortunately the people who scream at the top of their lungs about immigration are, unfortunately, doing so purposely, or unintentionally perhaps, in a way that stirs hatred & fear of PEOPLE, rather than on POLICIES.

I think we should stop blaming individual immigrants for our poor policies.


This is where I think some conservatives could learn a thing or two from Dean Baker.
They should start talking about policies in humane terms, and stop simply trying to get other people to hate brown people.
If We Lowered Their Costs, Doctors Could Charge Less
written by jerseycityjoan, December 05, 2013 11:59
If we are going to get doctors' salaries down, the only way I can see to do that is renegotiate the current deal for all doctors who participate in our government medical programs and/or accept private insurance.

While our doctors make more than those in other First Would countries, they have much higher expenses for: student loan repayment (extra to the tune of hundreds of thousand of dollars in many cases); malpractice; office staff. They lose a lot of productive time over uncompensated time spent insurance matters too.

I think we will have to make a grand bargain at some point: Offer ways to to get their costs down, in exchange for them lowering their rates. Offer more salaried positions. The lowest paid primary care physicians should get the help to lower their costs without trying to extract any costs savings from them.

Correction to Last Sentence of My 12:59A Comment
written by jerseycityjoan, December 06, 2013 12:04
"The lowest paid primary care physicians should get the help to lower their costs without trying to extract any costs savings from them."

Should be:


"The lowest paid primary care physicians should get the help to lower their costs without trying to extract any RATE REDUCTIONS from them."


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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.

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