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Home Publications Blogs Beat the Press Why Do Calls for Immigrants Never Include Doctors?

Why Do Calls for Immigrants Never Include Doctors?

Friday, 13 June 2014 05:22

The Washington Post had a pitch for allowing more high-skilled immigrants into the country, arguing that by allowing more foreign software engineers into the country we would create more jobs. While there may be some possible gains here, it is worth noting that the wages of stem workers have been flat since the late 1990s. (Also, it would be easier to be sympathetic to the demands of the tech industry if they had not conspired to hold down their workers' wages.)

However it is striking that with all the efforts to bring in more immigrants to work in tech jobs no one ever talks about bringing in more immigrant doctors. The potential gains to the economy are enormous since our doctors receive far higher compensation than their counterparts in other wealthy countries. (The linked comparison understates the actual difference in physician compensation since more than 70 percent of our doctors are specialists, whereas the share in other countries is closer to 30 percent. The greater use of specialists has little obvious benefit in outcomes, it more likely indicates rent-seeking as specialists can enforce rules requiring their services for procedures for which primary care physicians are fully qualified.) 

The fact that we see so much discussion of easing immigration to bring in more software engineers as immigrants and none on doctors presumably reflects the power of the tech sector in getting items on the national agenda and the power of the physicians' lobbies in keeping items off the national agenda.

Comments (21)Add Comment
written by djb, June 13, 2014 6:12
Let specialists do specialist work but they should not be paid more than primary care....primary care does most of the work anyway
written by djb, June 13, 2014 6:25
That would eliminate the profit motive for unnecessary procedures
written by Last Mover, June 13, 2014 8:20

As any economist knows, the reason 70% of doctors in America are specialists is so they won't become structurally unemployed.

Unlike other workers, doctors are able to fill these slots because of the much higher wages offered in shortage conditions to fulfill these needs and eliminate the shortage.

This allows sock puppets to claim doctors have jobs and earn their pay through appropriate skills provided on demand. For rest, well, if you can't find a job it must be because you don't have the skills to match those ridiculous low wages offered for them.
written by Larry Signor, June 13, 2014 9:10
"...growth remains slow and 10 million people are looking for work but can't find a job, the nation could use an influx of highly skilled immigrants."

This can't be right. How could an "influx of highly skilled immigrants" be a more efficient solution than training some of the 10 million Americans looking for work? Seems like increasing "highly skilled" immigration is a recipe for hysteresis, unless WaPo is trying to tell us we are at NAIRU? WaPo also seems to think all of the highly skilled immigrants will become job creators as opposed to slothful Americans. When will the media stop beating up on labor?
Wonkblog reports immigration policy to suppress wages is really good job creating.
written by jaaaaayceeeee, June 13, 2014 9:12
Jim Tankersley argues that immigrant entrepreneurs create more jobs (links to McKinsey and National Journal), don't lower wages, and that we have tech shortages.

Dean already covered this false narrative:
I would bet most H1Bs and green cards go to skilled folks like doctors., Low-rated comment [Show]
written by skeptonomist, June 13, 2014 10:09
The percentage of foreigners in STEM fields seems to be about the same as for medicine:


(about 20% of physicians and 25% of US health-care workers are foreign). Hospitals and HMO's want to bring in foreigners to keep costs down while the AMA wants to keep the number of physicians down. Is there a bloody war of lobbyists on this? Anyway non-salaried physicians' pay does not really go according to supply-and-demand, but what-the-traffic-will-bear. People don't shop around by price among physicians. This is not really something in which free markets operate and countries which keep health-care costs down don't do it by having more free-market competition.
Regulatory Barriers to Medical Professional Immigrants
written by sherparick, June 13, 2014 10:16
Here is a good source for discussing these barriers. http://immigrationimpact.com/2...-medicine/
written by joe, June 13, 2014 10:47
why do you want a race to the bottom? There's nothing wrong with worker protections.
H1B and Visas to skilled folks? Not so much.
written by Tircuit, June 13, 2014 10:51
Pete -

Having worked for years at immigration firms representing SV firms, I can testify that the visas are not going to folks with different skills than those possessed by workers already here. It's a scam.

Immigrants simply work for less money, job security, etc. and help keep tech industry wages low. Here's how it works: Microsoft wants a cheap programmer and has candidate in India. Their law firm writes ad for programmer position and advertises it with keywords matched to resume law firm also writes. There are no interviews for position. Visa is granted because job was posted in newspaper to show that Microsoft tried to hire locally and immigrant resume qualifications perfectly match job requirements. Viola! "Specialist" is created, gets visa, and job! Complete scam. If there was a shortage, tech wages would be much higher.
Tircuit....i was aggreeing with Dean, more immigation at the high end., Low-rated comment [Show]
written by liberal, June 13, 2014 12:42
pete wrote,
Best to return to the pre 1880 regime of open borders. Most immigration restriction, then and now, is simply racism.

LOL. Yeah, sure.

You've never met a policy that pushes downward pressure on wages that you don't like.
For being a jerk
written by Sorry, June 13, 2014 5:52
Anyway, there are no huge corporations with more lobbying power than the doctors themselves. Engineers have no lobby. They're just a commodity with no respect.
Re: engineers have no lobby
written by John Wright, June 13, 2014 11:45
I went to www.bls.gov and looked up their estimate for
the electrical and electronics engineers job growth over the 2012 to 2022 time period.

The BLS estimated the number of Electrical/Electronic engineers employed was 306,100 in 2012 and expect the number employed to reach 306,100 + 12,600 or 318,700 in 2022.

So the total number will increase by about 1260/year over the 10 year period.

Now some EE's will retire and others will leave the profession, so the incremental need for engineers will be larger than the 1260/year.

However, given that H1-B visas numbered 117K in FY2010, 129K in FY2011 and 135K in FY2012, (http://en.wikipedia.org/wiki/H-1B_visa) if a small percentage of H1-B visas went to electrical engineers, the small 1260/year job growth the BLS estimated may not be filled by domestic engineers.

One might cynically suggest the political part of the government is recommending engineering (part of STEM) careers when the demand (through 2022) for domestic EE's in the USA is almost stagnant (and may be de-facto negative due to H1B visas) because it offers some hope to a discouraged population of unemployed/underemployed.

Maybe Tom Friedman will soon recycle another column about the need to train for a STEM career to re-boot one's job prospects?

Crowded Field
written by deanx, June 14, 2014 5:03
As a EE and systems engineer I can assure you that there are ample candidates in this field. Entry wages have declined and much of the work can be, and is already offshored.

Meanwhile working conditions for IT employees have sharply changed. Engineers are often no longer treated as 'professionals', recieve no support staff, and as the Internet became globalized are simply expected to be availble 7*24.

IT workers were redefined as a whole class by the Bush administration to be FLSA Exempt and there is no concept of 'overtime pay' anywhere in the industry. Everytime I here the media demanding importing of foriegn workers ... the first place I think we need to start is with Journalists.
written by Captain Incentive, June 14, 2014 7:19
Speaking of immigration and bad media coverage, who could have guessed that the Obama administration's announced decision to not deport minors and work toward legal status for their families would lead to an attempted influx of minors?
The effects of a "public" oligopoly: importing MDs to help keep incomes high
written by Rachel, June 14, 2014 9:36

We don't train enough doctors, which means excessive salaries, degraded helath care for many, and fewer opportunities for working class kids of all races. But by importing a large chunk of doctors we can fill the most obvious and least-well-paid vacancies, so as to prevent any pressure to deal with our failed system.

Thus the folks at NPR seem to feel no qualms about the claim that doctors (along lawyers and financial advisors) are so highly paid because they are "artisans." No need to notice the deeply flawed markets from which these people profit. No need to notice that most advanced countries have significantly more MDs per 1000 than we do.

But the computer industry is a private oligopoly. There's no public pressure to keep some engineers rich. So here we have hypercompetitiveness: high levels of imported labor, relatively low salaries and little job security, for the people who also have to cope with overpriced medical, legal and financial services.

written by JDM, June 14, 2014 6:29
why do you want a race to the bottom? There's nothing wrong with worker protections.

The problem is the fact that the worker protection is only for certain workers. You could honest debate the position that strong barriers for worker protection is good, and and you could argue that strong barriers for worker protection is bad. But instead we see over and over (and this is what Dean has consistently called out) that the debate among employers and in our news media is simultaneously for weak barriers for most workers and extremely strong barriers for a select few occupations. This is not an honest, intellectually consistent, position.

We need to have honest debates based on facts in this country; we can't have them if the press reports these things in an intellectually inconsistent manner, dishonestly, and doesn't present economic numbers with appropriate context. This is Dean's central thesis at this blog, hence the name.
"The STEM Crisis is a Myth"
written by Chris G, June 15, 2014 8:10
"The STEM Crisis is a Myth" by Robert N. Charette and related discussion at the IEEE website -

written by Ron Alley, June 15, 2014 9:31
One reason may be that immigrants comprise a substantial portion of physicians and nurses in many communities. They are capable professionals. However, many patients report difficulties in communicating with immigrant medical professionals. Perhaps, the reaction to proposing more immigrant physicians would create more opposition than just not mentioning encouraging foreign trained physicians to immigrate.
Shortage looms
written by Jim Hannley, June 16, 2014 2:05
A recent report http://beforeitsnews.com/opini...84184.html shows that by 2020 it is estimated that there will be a shortage of 45,000 primary care physicians and 46,000 specialists. It would seem that this shortage will have to be filled and it is more likely that it will be filled by existing (foreign) doctors than by producing more homegrown ones.

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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.