Has anyone estimated the number of "foreign doctors" the United States already has?

[MissMarple]

It seem like we have quite a few without having nationalized health care. Also, our medical schools are not graduating many more doctors than they did thirty years ago. Our population goes up, our number of doctors does not. It seems to me that if the so called "free market" were in play we would have a few new medical schools or at least increased capacity at our current ones. Isn't that how it is supposed to work? :shrug:

If the wing nut xenophobes want all true blue American doctors you'd think they would at least call for more money for our state medical schools to increase capacity. But, no. In their view, public education is a bad thing, it needs to be privatized. It's that "free market" thing again. Ah huh.

[MissWaverly]

1. then there's the cost of higher education

that ever escalating buzzsaw for those who wish to go to college and then on to med school.

[DesertKart]

2. so what's your solution?

it seems as though you're advocating nationalizing the medical schools, but I can't read your mind.

I don't see why foreign doctors are a bad thing, it should help bring costs down.

[MissMarple]

21. Not nationalizing, just educate more doctors. And foreign doctors are not a bad thing.

I just think we should have a system that lets more of our best and brightest be physicians. Too many kids who would be great doctors can't get in the school door. Rural health and primary care are two areas that are crying for doctors. But the money isn't there. Many of our doctors graduate with high student loans, they gravitate to the higher paying specialties.

My point about the so called free market, is that it is an ignorant rallying point for conservatives.

[DesertKart]

26. Yeah, but how would you do it?

It's nice to say "we should have a system" etc etc, but how would you change the system to get more kids to become doctors?

[ThomWV]

3. The lack of medical education in this country has nothing to do with lack of qualified students

Or lack of qualified teachers. We have now, and have had all of my lifetime, a planned and controlled lack of Doctors in this country. All we are missing is medical schools. There is no reason at all that we could not crank out medical doctors like we do engineering degrees other than that the AMA controls with precision how many medical doctors enter the workforce in this country.

[etherealtruth]

37. So true ...

I don't think many people understand how many truly qualified students can't get into medical schools for exactly the reason you state

[MichaelHarris]

4. I don't know

but don't walk too close to them, they may blow up.

[MissMarple]

22. Funny.

:rofl:

[OmmmSweetOmmm]

5. I remember years ago my sister-in-law's brother wanted to get into medical school here and it

was impossible. There were quotas back then (25 years ago)and it was also helpful if you were politically connected. He wound up going to the UK, accepted at Oxford's Veterinary Medical School and became a Vet.

As Michael Moore said in SICKO. this is all very deliberate on the part of the medical industry.

[DesertKart]

7. So you actually believe that there's a conspiracy stopping people from going to medical school?

Come on now.

[OmmmSweetOmmm]

8. There is a quota. Why is that so? Why do we have Americans going to other countries

to become doctors? Why aren't we building more medical schools? Our population is Increasing and yet the amount of doctors we produce is static. Does that make any sense to you?

[DesertKart]

9. I've never heard of that.

Can you point me to somewhere that shows there is a quota imposed on the number of doctors taught?

[OmmmSweetOmmm]

15. There is a quota in the sense that there is no expansion of medical schools, therefore limiting the

amount of students that they can take. This was the case of what I was told 25 years ago and Michael Moore brought this up in SICKO. I have to work right now but will look for sources when I can.

[FlaGranny]

17. The quota isn't an "official" one.

Each university allows a set number of medical students each year. For the most part they accept the best students, but many, many highly qualified students get turned away each year. Instead of expanding the opportunities to study medicine and accepting all qualified students, many are turned away. Any way you look at it, that's effectively a "quota."

Then, on top of that, graduates of foreign universities, some with much lower standards, are allowed to come here to practice medicine.

[DesertKart]

18. So, what's your fix?

[FlaGranny]

27. You want me to

come up with a fix for the problem? Okay, I'll try. 1) Incentives to American universities to provide enough slots for every prospective medical student who qualifies. 2) UNIVERSAL SINGLE-PAYER HEALTH CARE.

There. That should fix the problem. Besides, we deserve at least as much as every other industrialized, rich nation, don't we?

[DesertKart]

29. I agree with #1

American universities need to see it in their best interest to expand their medical training programs.

#2 however will result in the exact opposite of what you want.

Government subsidies almost always have the exact opposite effect that was intended. It all starts out great, but socialized systems tend toward disaster because of their inherent inefficiency.

1) Subsidies cause people to use more health care. If someone else is paying the bill people have less incentive to not go to the emergency room when they're feeling under the weather. The government doesn't need to make sound financial decisions because they've got the taxpayer paying the bill. Look at the Tenncare disaster for proof.
2) More health care usage leads to increased demand
3) Increased demand leads to increased costs
4) Increased cost leads to a)imposed cost structures or b)health care rationing.
5a) Price limits drive providers into other areas of health care, to other countries (like Canadian doctors are now), or to not become a doctor in the first place and it eliminates research incentives.
5b) Health care rationing leads to people not getting the health care they need

The problem with our health care system is definitely not that there isn't enough government intervention. The problem is that there is already too much.

[ljm2002]

33. So, if universal health care leads to increased cost...

...then why is it that we in this country pay more for our health care, and get less in return, than any other industrialized nation? Just look at Canada for a start -- their administrative overhead is a fraction of ours (see cite below), yet no one there has to wait until they're sick enough to need emergency care before they can get any care at all.

The arguments you make are theoretical in nature, and are pushed by the privatization fanatics. They do not reflect reality.

While it is true that *some* people will abuse the system, the fact is that the great majority of people have better things to do with their time than seek unnecessary medical care.

===

http://www.rwjf.org/reports/grr/036617.htm

From the Robert Wood Johnson Foundation web site:

"Administrative costs for health care in the United States significantly exceeded those in Canada in 1999. Researchers at the Cambridge Medical Care Foundation found that administrative costs per capita were $1,059 in the U.S. and $307 in Canada; these costs accounted for 31 percent of health care spending in the U.S. versus 16.7 percent in Canada. The Robert Wood Johnson Foundation provided $139,381 to support this study from July 2000 to January 2003."

[DesertKart]

38. because of government anti-competition rules and subsidies.

Believe it or not, Medicare and programs like it are driving up our medical costs. You should read up on it. Lots of wiki links on these topics.

[ljm2002]

60. "Believe it or not,"...

..."Lots of wiki links"..."You should read up on it."

Pardon me if I find your unsupported assertions less than convincing. Rather the opposite in fact.

Oh, and welcome to DU. :eyes:

[FlaGranny]

34. Spoken like a true conservative.

All the talking points are there. Kind of interesting. You want us to just keep accepting our third world medical system system. It is first world quality only if you have an employer who pays for your insurance or if you are wealthy. Other people do without.

If our system was the same as the Canadian system, where would the Canadian doctors run away to? Haiti? Because we're the only non-third world country that doesn't want to provide health care to everyone.

I went many years with NO health coverage until I was old enough for Medicare. Say what you like. I've heard all the lame arguments.

My health care for more than 10 years was the same as what the poorest in Haiti receive - none, nothing, zilch. Half of my neighbors are Canadians, so I know enough about the Canadian system to know that your conservative talking points are nonsense. What percentage of Canadian doctors are fleeing, anyway. It's a wonder anyone can see a doctor or go to the hospital in Canada. I sure do feel sorry for those poor Canadians. Nah. Truth is I am very envious of my Canadian neighbors. They shake their heads in disbelief about our non-health care system.

Go to the emergency room? You've got to be kidding. As a working person who was not wealthy, I could not afford to go to the emergency room. I wouldn't have been able to buy groceries and if I didn't pay I'd be sued and have my credit destroyed. If people could afford to go to a doctor, they would not wind up in emergency rooms in the first place.

Geez, go annoy a Pat Robertson, or somebody.

[DesertKart]

36. fiscal conservative and social liberal

If you choose to ignore what history teaches so that you may benefit (temporarily) by taking money from others, that's your choice. Luckily most are not as easily fooled as you.

[FlaGranny]

43. That doesn't deserve a civil answer. n/t

[DesertKart]

46. You're right, sorry

I don't know you well enough to make judgements about you. However your opinion is biased based on your life experiences and it seems you are, in my opinion, willing to take money from others to benefit yourself. That's not my idea of what America is about.

[MissMarple]

49. There is a different way to look at that.

It is a more progressive more group oriented way. If we view our selves a casually associated group of rugged individuals and each must make his way alone, your comment makes more sense. But if we view ourselves as part of a group whose long term well being depends on working together, that we are only as good as we treat the least of us, then some sort of group responsibility must come into play. If we have too many of the "least" of us, that will undermine our social stability. Both views have a part to play, but if either dominates that can cause trouble. For me, progressive goals and actions should be pragmatic. And, then, they can also be the right thing to do.

[FlaGranny]

52. That also does not deserve a civil answer, but

I will give you one. I have never taken a dollar from anyone in my entire life. I put 50 years into working, earning a living, raising a family, and paying taxes and contributing to society in other ways as I could. I am willing to take money from others to benefit myself? Geez, turn it around will you. I'm willing to pay taxes to BENEFIT OTHERS, fer chrissakes.

[DesertKart]

62. Your taking money from others to benefit yourself right now.

You are in a socialized health care system by using Medicare. I'm paying for your medical care, but I don't want to. Read my signature.

[FlaGranny]

87. Okay, friend, will it make you happy if I drop dead? I'm

sure it would. Wouldn't want you to spend a buck you might have used to buy a new DVD. I'm truly sorry for you. You must feel like a poor, downtrodden, and picked upon soul. It takes pure self interest to feel that way. I pity you that. By the way, I haven't cost you anything yet. I have not collected enough Social Security yet to match what I've paid in and I do pay a monthly premium for my Medicare and have I'm healthy enough not to have had to use it. So, I'm not feeling to sorry for you yet because I still haven't cost anyone a cent and I've spent 50 years paying my share. Do you want to spend 50 years paying your share?

Perhaps you'll be in luck and I'll die before I start costing you anything. You're a good American.:sarcasm:

[ikojo]

74. It sounds as if you believe in a ME America

rather than the WE America Michael Moore advocates at the end of SiCKO. I believe in the WE America.

If WE can pay for stadiums for the rich sports teams owners then WE can provide access to healthcare for ALL regardless of age, gender or socio-economic status.

[MissMarple]

45. I agree with #1, as well, #2..not so much.

This is an answer to your #26 post. But single payer, universal health care...I just don't think that will fly too well in the U.S. I do think, however, that we can provide much better health care to people in the U.S., we just don't have the political unity. A hybrid system may have more of a chance, and American ingenuity may be able to come up with a system or groups of systems that work better than what we have now.

The suburban hospitals that are being built now are way over the top in providing luxurious surroundings and gourmet meals. I think that is so interesting. Urban hospitals are closing in Denver, the suburbs seem to to be on the winning side of the "free market". So I think some kind of subsidy will be necessary. How they decide to do that I have no clue, but I do believe that viable solutions are out there. It isn't just an either, or issue. But to find them, put some in place, and work out the kinks will take some effort to work together. Right now, America is just too polarized. That has to change.

[FlaGranny]

50. That kind of system may

help, but a hybrid system would still leave those who can't afford insurance in a second rate system. I thought I saw a recent poll that the majority of Americans are interested in a single payer system. Just about anything would work better than what we have now, though, wouldn't it?

The obvious reason that city hospitals are closing is lack of funding. A good percentage of their patients are uninsured and pay nothing for their medical care. The hospitals are not receiving the funds they need to stay operational. The funds they receive are not nearly enough to cover the care they provide. They have to, by law, treat a certain percentage of indigent patients free of charge if they receive any government funding at all (not-profit hospitals, that is). So the poorest of us DO receive free care already. The lower middle class do without even though our taxes help support what funding there is. Taxes of the poor cover some of this also. But, the upper middle class, and the wealthy have few worries.

I have worked and paid taxes full time since the age of 17 - 50 years. I spent somewhere around 15 years of that time with absolutely no insurance and without seeing a physician for anything. The last 5 years before I became eligible for Medicare I was uninsured. I could have had COBRA coverage for my husband and myself at $2000 a month but could not afford that. Without the COBRA neither of us was eligible for ANY coverage at all due to "pre-existing" conditions. I would have been happy to pay a reasonable amount. It is not right that the poor are forced into emergency rooms for very expensive (but free for them) care because they can't afford to see physicians. This is a very costly and ineffective method of care. It is not right for someone to postpone treatment for a breast lump due to having no insurance until it is too late and they die (an actual case I am familiar with). This person was no deadbeat. She was a hard working, tax paying individual who is DEAD (in her 40s) from a disease called "lack of insurance." She could have gotten care if she tried, but she was too proud to ask for charity care I think. Not all people can earn the salaries of the professionals in our society and afford to pay thousands a month to insure their families. It's just not possible. What do we do with them? We let them die.

Lets take doctors' offices. That's another disaster caused by insurers. When I was a kid, I went into the doctor's office and sat down and waited. The doctor would come out and call the next patient. There wasn't a secretary or a nurse in his office and he dispensed all medications to you right out of the medicine bottles that lined the shelves on his wall - extremely efficient and also affordable for my parents. Go into any office now and how many employees do you see? Even a GP usually has at least 3 full time, and always 1 full time insurance person. A larger practice, double the amount of employees. When I worked for a GP years ago, I was it. I did the insurance papers, I was the receptionist, answered the phone, made appointments, and I assisted the doctor when required. It was all he needed. I wouldn't be at all surprised if at least 25% of any given physician's income goes to deal with insurance issues - in addition to them getting ripped off by malpractice insurance. Just in doctors' offices, single payer insurance would save millions upon millions. Hospitals pay large staffs to deal with insurance coverage matters and collections. And how big a cut does the insurance industry take? I've forgotten, but when you get right down to it, I'll bet at least 25 of all dollars spent on health care in this country ends up in the hands of insurance companies and does not one damn thing to provide care to anyone.

You can see this is a subject I get pretty heated up about. I've seen too much of it and it pisses me off.

Don't duck - YOU didn't piss me off. ;-) I'm just calling it the way I see it and talking about it gets my dander up.

[MissMarple]

66. So what happens to the insurance companies?

Do they just quietly fold up their tents and send everyone home? I think slower changes might be a better way to go. And Americans do like their choices, well, many of us like our choices. I also have a bit of a problem with the second rate argument. That is what we have now, and worse. Keeping people healthy with appropriate, available health care is a goal. And it one we should strive for. But in the near future, I don't think any ideal result will be a reality.

It drives me crazy, too. :)

[FlaGranny]

88. Insurance companies?

Good lord. They're worth BILLIONS. They only need to reinvest in new moneymaking ventures. Of course, the employees would get the worst deal, but then, that wouldn't me much different from what the employees of other businesses have been dealing with for years. Perhaps put them to work for new companies that will be starting up in the renewable energy field. Okay - I'm a dreamer. ;)

[OmmmSweetOmmm]

69. Here's an article. It discusses how there was a conscious restriction on the amount of

new doctors. Although the article is from 2005, I haven't heard of expansions to medical schools. I also doubt that Michael Moore wouldn't have referenced this in SICKO if it was an incorrect fact. He has become meticulous with his facts.

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

[mainer]

90. Check out my post below. The quotas were against women.

and it's an historical thing, prior to Title IX.

[FlaGranny]

13. I have worked at hospitals and

doctors' offices and in the medical/health care field just about my entire working life. When I started, in 1958, it was very rare for a doctor to be non-American. It was just as difficult to get accepted in a medical school then as it is now. Over the years, it has remained difficult to get into medical school. The countries many of these foreign physicians come from do not have standards as strict, and yet physicians from these countries are welcomed into our system. It doesn't make a lot of sense. I have always felt that something is not quite right about this system of encouraging foreign physicians and discouraging Americans. I wish I knew the reasoning behind these unofficial "quotas." This seems to have really begun maybe about 30 years ago. They used to say the admission standards were so strict to make sure that only the best got accepted, but now we allow just about anyone with a medical degree, no matter whether they are "best" qualified, and no matter where they were trained, to practice medicine here. The only reasonable explanation I can think of to restrict admissions to American schools is that other fields of study are cheaper for the universities. Everything revolves around money.

[sandnsea]

20. US doctors will demand more money

As will US nurses, etc. It's better to bring in people from other countries to force the labor costs down. Which is fine, I suppose, except the profits will go to the stockholder and not to the patient. That's the piece of the puzzle that working schmoe just is not getting their head around.

[FlaGranny]

24. What you say may be true

especially for doctors who are employees and there certainly has been a push in that direction. Insurance companies have more to say about a physician's income than the physician does. Reimbursement rates are not helping doctor's get rich, foreign or American (they both have to deal with the reimbursement issue). The only physicians making more money are the ones with a large rich clientel, like plastic surgeons (both American AND foreign), who don't have as much reliance on insurance reimbursement.

[entanglement]

25. AFAIK, foreign doctors have to pass the USMLE like everyone else

in addition to an English proficiency test. Congress has recognized that they play an important role in delivering health services in rural America. You'll also find foreign / naturalized doctors conducting research at prestigious medical schools nationwide. So I don't really see the problem (is it an immigration issue for you?)

[FlaGranny]

32. That's a rather interesting reaction.

Are you aware that a large percentage of students who are highly qualified and who could just as easily have passed the examinations are turned away? Our universities have extremely high standards. Some foreign graduates come from universities with lower standards. Most can manage to pass the examinations, but sometimes with lower grades and sometimes with a "C" rather than an "A".

Instead of accepting all students who are qualified, enough limits are put on students applying to American universities to cause a supply and demand problem, which must then be filled with applicants who have graduated from foreign universities which may or may not be up to the same standards as graduates from American schools.

The entire issue isn't really about whether the student is American or foreign. All our universities accept students (medical and otherwise) from all over the world. The point is, graduates of foreign universities (quite a few of them Americans) are the one's getting the lion's share of licenses to practice medicine. Do the applicants, American or otherwise, who have been rejected for medical training in the US (some of whom are well qualified and some of whom are not) have the same quality of education that they would have gotten in an American school? Are some of the applicants rejected by American schools for lower qualifications being accepted by schools with lower standards? Again, I want the physician with the A grade, rather than the B or C grade.

Of course, most Americans have the advantage of language, whether they have graduated in the US or in any other country. I can tell you right now though that I have absolutely NO IDEA how some of the foreign speaking doctors have passed an English exam. I'm in a position to know - I have to try to figure out what they're saying every single day. Unfortunately, many patient's cannot do the same. I might say the same thing about many native English speaking doctors - they also need to pass English proficiency examinations and be able to make themselves understood. The language issue is definitely a major problem, both English and English as a second language, in my line of work.

Immigration is not the issue at all here. We're talking about a broken educational system for people who want to get an education in an American university. Those applicants are not exclusively American.

My favorite actual quote from an "English as a second language" physician: "The patient was a blood vomit. One opportunity only." Many other things he said were a lot harder to figure out, but also harder to remember. I guess he must have passed the English proficiency exam. Kinda makes you wonder about the medical licensing exam.

And, again, no, this is not an immigration issue.

[entanglement]

35. I see

If I understand you correctly, then, you're (1) ok with foreign doctors who graduate from one of our universities (2) opposed to foreign and American doctors who obtained their degrees from medical schools you consider below par (3) for English proficiency exams for everyone, American or foreign.

[FlaGranny]

42. No, I'm for American universities

to stop artificially limiting enrollment in their medical schools and I'm for applying equal standards for admission to American universities no matter where the students are from. I'm for preventing students from having to go to lower standard universities in other countries to get their degrees. And, no, I don't have anything against foreign universities, many of which are the best in the world. To add to all that, some of these foreign students come here because they can make more money in the US because of our for-profit system. I would like to discourage that incentive. I'd rather have doctors who aren't concerned about profit.

[DesertKart]

44. Show me proof that universities are limiting enrollment based on anything other than available

spots for students. It makes the most financial sense for universities to maximize their enrollments.

[MissMarple]

47. The University of Colorado has added 20 students to the number they can accommodate.

I believe they have linked with a hospital in Grand Junction, on the other side of the state. I don't know how this is working out, but it is good to see.

[FlaGranny]

51. Answer me then, what

business in it's right mind limits customers because of lack of space. As a fiscal conservative, the thought should be appalling to you. A good business person expands his capacity to deal with demand. How in the world can a university maximize their enrollments by limiting them?

[DesertKart]

63. I don't understand what you're asking

A business should expand it's capacity as long as it makes fiscal sense. When it no longer makes sense economically you shouldn't. I am very interested in what is stopping these universities from expanding their medical training. I don't know. I certainly don't believe as many here seem to, that it's some kind of conspiracy by the AMA/corporations to limit the supply of doctors.

[knitter4democracy]

56. There's a quota system set by their accrediting board.

There is definitely a movement within the ranks to keep the numbers of physicians artificially low. There hasn't been a new med school in decades, and yet, with the baby boomer generation starting to retire, the demand is high. Fewer doctors means higher salaries.

[DesertKart]

64. Where can I read that?

[knitter4democracy]

77. AMNews.

It's in there all the time. There's quite a debate going.

[MissMarple]

48. Profit helps the world go around. It will always be a factor.

It's like in teaching, women who used to go into teaching are now accountants, executives, doctors and lawyers...and such. We would get better teachers, men and women, if they were paid more comparable salaries. The U.S. reaped a benefit for too long by grossly underpaying its teaching professionals. When more opportunities appeared for women, idealism and "teaching just because you love it" couldn't compete.

There are doctors who are more like saints than Beverly Hills plastic surgeons, but the rural areas, the inner cities, and primary care would be better off if their doctors were paid more. In rural Colorado medicaid is paid in the negative numbers, a local hospital director told me recently. Practices everywhere are closing to new Medicare patients. If you are in health care, I'm sure you know this. Money will always count, but it shouldn't count so much.

[knitter4democracy]

54. We accept foreign med school diplomas but not residencies.

They have to do a residency here in their field in order to practice. Getting a job after residency, with the fewer J-1 visas available and the bigger hassle with those now making employers not want to deal with them, is not easy unless you're outside of the urban centers where it's hard to get doctors to come and practice.

We've had some friends have trouble with that.

There aren't enough doctors going into primary care, since it's the lowest paid of all the specialties (with pediatricians and FPs making the least), so residencies take foreign grads to fill their slots and meet the need. Those doctors then stay in the area, if they can, as many do (if they don't go on to a fellowship).

[knitter4democracy]

53. The AAMC sets the quote numbers. Yes, there's a quota.

We also have foreign grads in our med schools, btw.

The quota's there to keep doctor pay up. Hubby's an internist, and that's what he was told when he was in med school ten years ago.

[OmmmSweetOmmm]

61. Thank you.

I really didn't want to do research to show the "social Liberal" that there were quotas.

[DesertKart]

65. Your husband "hearing" it in med school is no kind of proof

I think it's probably a myth that's been repeated enough times to the point that it's now being taken as fact.

[knitter4democracy]

76. That's possible, but then why are there limits to admissions?

Every med school has a certain number of slots, and yet, there are always more lockers, more desks, more resources available than there are students. Why?

[MissMarple]

78. Could it be not having enough attendings?

I believe Colorado added about 20 additional students by linking with a hospital in Grand Junction. Third and forth year students would work there. Even with that, CU still would be incredibly difficult to be admitted to.

[knitter4democracy]

82. It depends on the school.

Some have plenty of resources, and others don't. I know that Michigan State sends med students to all of their residency programs all over the state in order to meet their requirements. That's how they can have as many as they do.

[MissMarple]

83. Out of curiosity, how many do they admit each year?

CU, I believe, is around 120 for first year students.

[knitter4democracy]

84. They just increased by adding another campus.

It used to be 107 (close to Hubby's class size at Case Western) and now is 156. Thank goodness--we need about 5,000 doctors by 2010 in Michigan.

[Nikia]

12. All U.S medical schools are very selective

That is a fact. While I can see why we don't want someone who barely graduated from college going to medical school, there are people who could be good doctors who are not getting accepted.

[ikojo]

73. There is a cap of how many are accepted at

medical schools.

[ikojo]

72. The daughter of a friend of mine is thinking of

going to medical school outside the US.

[mainer]

89. Absolutely there were quotas. Title IX changed it.

Prior to around 1975, there were indeed quotas against women, limiting some med school classes in certain schools to around 25% or even lower. Then Title IX kicked in, the quotas vanished, and POOF! Women suddenly started getting in. My med school class was about 40% women (in 1975).

Now, it's over 50% female in some medical schools, I've heard.

The point is, many, many highly qualified women were denied admission while men got in with lower grades and lower MCAT scores. But that is no longer the case.

[whistle]

6. 20% at least considering all of the foreign born Hispanic doctors

...maybe the number goes as high as 30% foreign born and trained if Canadian medical praticioners are considered also. In fact a lot of American doctors who were not able to entire medical schools in the U.S. left the country to be trained elsewhere.

At this point there are not enough doctors based on the latest data from 2004:

--------------------------------------------------------------------------------
Below is total employment for the Physicians and surgeons occupation

Industry 2004 employment Projected 2014 employment Change, 2004-2014
Number Percent distribution Number Percent distribution Number Percent
Total employment, all workers 566,543 100.00 702,369 100.00 135,826 24.0

[MissMarple]

28. Thanks

I believe there is one medical school on Dominica that was created to fill the need that American schools are not. But that is just anecdotal. Perhaps the links the wingers were trying to make between terrorism and foreign doctors will back fire. I certainly hope so.

[whistle]

75. That is correct, but a lot of foreign doctors have been trained in Canada

...and come to the U.S. to practice, every nationality. I do not believe it is an issue of quality care, I think the compromise in services is all about health care insurance and for profit heath care and administrators and over-work and under staffing. Exactly the issues addressed by Michael Moore's film, at least the parts I've seen and heard about. I've not seen the whole film yet.

America also has a large component of quacks that many people turn to. I wish these practitioners could be more highly regulated

[malaise]

10. I read an article last year

with stats showing that six of ten doctors from developing countries are in the US, UK, Australia and NZ. Put simply out governments who subsidize higher education are training our young people for the lazy indifferent US government. Doctors now migrate for higher wages which are a direct result of policies coming from the Washington consensus - IMF and World Bank.

Many US doctors for for the HMOs and Pharma companies while draining our human resources. It's a fugging mess all around.

Tangentially, more than half of the US immigration problems are a direct consequence of policies from the said Washington consensus.

[Nikia]

11. Over half of the doctors in my hometown were foreign born

By the time that I graduated from high school 10 years ago. Most of them were Indian.

[SoCalDem]

14. The AMA curtails enrollment in US medical schools

and of course the cost is prohibitive to all but the most wealthy, in most cases.

There are some determined and lucky ones who still manage to buck the system, but I think it's more "cost effective" to hire foreign doctors who will willingly work for less at the beginning.

We have pacificare, and almost exclusively see Pakistani/Indian doctors at the clinic.

When they send out the directory of physicians every yearm the "anglo" names literally jump off the page at us.

The doctors we have seen are fine doctors, but the communication is difficult at best, since English is not their first language.

[DesertKart]

16. Can you show me where somewhere that shows the AMA curtails medical school enrollment?

The cost is prohibitive because the training is expensive. That's what school loans are for.

[SoCalDem]

19. Not Fox or newsmax, but here ya go..One source

http://query.nytimes.com/gst/fullpage.html?sec=health&res=9A0DE2DF173AF93AA15755C0A960948260

and another

http://www.google.com/url?sa=t&ct=res&cd=19&url=http%3A%2F%2Fwww.michigandaily.com%2Fnews%2F2005%2F04%2F08%2FNews%2FMedical.School.Will.Not.Boost.Enrollment-1430134.shtml&ei=cNaPRs-PCpX-gwPp4c31CA&usg=AFQjCNHokGIdpY13EJYOAS_E381JLA84PA&sig2=O_zoC8HQauhdFU9HTN5j1w

[DesertKart]

23. Interesting, but certainly no quota

Those articles were interesting, but not very relevant honestly.

The first one was an Op-ed piece published over 20 years ago about an unnamed and uncited report (I looked for it).

The second one never mentioned the AMA once and blamed that particular school's limitations of enrollment on the lack of mentor availability during the clinical experience portion of the course.

[knitter4democracy]

57. They do it through their accrediting group.

Well, it's not officially AMA, if I remember right, but there's a kinship there.

The cost is prohibitive. We owe more for Hubby's med school loans than we do for our house. The costs during med school were constant--$800 books, $300 pieces of equipment he had to have to do clinic, $50/mo. parking and on and on. We were really tight, and if my mom hadn't sent us a bit every month, we wouldn't have made it. We come from middle class families. Most of Hubby's class was from rich families or the upper middle class.

[MountainLaurel]

30. The irony is

That often times the foreign doctors end up in areas where the xenophobes are often most prevalent: rural and economically-depressed areas that can't get American-born health care workers to live there. For instance, growing up in WV probably half of all the doctors I saw until I was 18 were not U.S.-born.

[yurbud]

31. yeah, but I got an appendectomy in my alley for $5. Aint that America?

[dogday]

55. Pretty soon it will be "Do it yourself kits" for appendectomy and

other surgeries for sale at a drug store near you.....

[shadowknows69]

39. Should be interesting to say the least

I fear for some of our doctor's safety. There are a lot of Pakistani, Indian and Iranian doctors in our town. Not that your average right wing idiot would notice. They'll just see terraists.

[Horse with no Name]

40. The only doctors in my town are foreign

The foreign doctors in the town next over are predominantly foreign.
When I worked in Dallas there were a significant number of foreign docs.
When I still was running my company (which included transcription), one of my clients was Cornell University and MANY of those docs were foreign.
Methinks we should be careful about throwing out the baby with the bathwater in this moment of pure xenophobia...but freepers do what freepers do...RUN...BE AFRAID...etc etc.

[Princess Turandot]

41. Foreign Med School grads (FMGs) make up about 25% of US physicians..

It was just in the NYT this week:

"Foreign citizens or American graduates from foreign medical schools accounted for more than 228,665 of the 902,053 practicing physicians in the United States in 2005 — just over 25 percent, according to the American Medical Association. The Congressional Research Service said their presence “in many rural communities of the United States has allowed states to ensure the availability of medical care to their residents.”

http://www.nytimes.com/2007/07/07/world/europe/07britain.html

Large urban hospitals often have large residency programs which employ FMGs because some of them have a hard time competing for the number of American grads that they would need; not everyone wants the 'excitement' urban hospitals provide. The residents are needed to provide the hands-on care to Medicaid patients in particular, especially in outpatient clinics. For example, NYS has most if not all of its Medicaid patients in Medicaid HMOs but contrary to the usual notion of an HMO having a doctor assigned as your primary care physician, the HMOs contract with hospitals to provide care through the clinics because there are not enough private MDs to send them to. (Before the HMO model, the patients already were getting care in clinic.)In 2007, there were 21,800 first year slots for residencies in the US; 15,206 were filled by US grads.(Per the folks who organize the med school-residency matching system: http://www.aamc.org/newsroom/pressrel/2007/070315.htm)

The Medicare program has been a factor in recent years re: the number of MDs in the US (foreign or otherwise) because they pay hospitals for what they define as their portion of the costs of the teaching programs. The direct costs are residents' salaries and fringe benefits and payment to physicians for their teaching eforts, usually via a hospital stipend. They have two components of their payment; the 'direct med education' payment is the larger of the two and is a per resident per year payment (based on a formula that I won't bore you with) multipled by the Medicare utilization at each hospital. Near the end of Clinton's second term they decided to try to limit the cost to Medicare of med education so they froze the number of residencies that they were paying for at the hospital level. They have no ability to influence the number of students studying medicine but by limiting the available jobs for med school grads, they had an impact. The only way that a hospital could increase the number of residents in a department was to take the slots from another department. I think they made some sort of accomodation on this a few years ago but I don't think it increased the number of residencies by any significant amount.

The costs of Post-Graduate Medical Education is another factor in the high cost of care here. In addition to the direct costs, hospitals with teaching programs have higher costs for patient care believed to be caused by the inefficiencies of residents as they learn their profession. Medicare ponies up an indirect medical education payment for their share as well. (Other than a few states which have systems to provide monies from med education via the Medicaid system, the other insurers make no specific contribution for this.)

[knitter4democracy]

58. Hubby's residency story:

When he was applying to residency programs (internal medicine), he applied for a couple of the academic programs affiliated with his med school's hospital. I went along on one dinner, and most of the people in the room were native grads. There weren't enough residents there to answer questions, the program screwed up our reservation, and they ended up not filling all their slots on match day, so they went with foreign grads to fill. The program was known for being inhumane and awful to work for.

The community-based programs he applied to were far nicer and had the same mix at the dinners of native and foreign grads. Keep in mind, not all native grads are white. Anyways, he went with the program that had the most freedom in putting together his rotations and the most support for us as a family. His program filled all their slots every year. He worked side-by-side with native and foreign grads, and they were, for the most part, great doctors (there was one native grad he thought was a slacker, I remember).

The reality is, the quota system is hurting the entire system. We need more doctors, especially here in Michigan where we're about 5,000 doctors short of the need. Btw, if anyone was considering Michigan for a job, let me know. I know people. ;)

[supernova]

59. May have something to do with tuition

International and out of state students pay more $$$ to the university than in-state students typically do. International students pay the most of all.

If you are a university pres you're going to be looking at who can afford to pay the most to the school.

Having said that, I don't have a problem with international doctors as long as 1) I can understand them clearly 2) they understand and listen to me as well 3) There professional acumen is up to snuff. 4) They can get along with an uppity woman patient who wants to be a coequal partner in her own care and decisions. ;-)

[BlooInBloo]

67. Why the quotes? Are they not *really* foreign? Or not *really* doctors?

[nolabels]

68. The hospitals are full of papered emigrants........

at least that is the way it looked on my recent two days there. The doctor was a foreigner and his fill in was also.

I will be glad to get back to work in a few weeks. My coworkers are 92% emigrant / minority but we all get along good because nobody is shy about rubbing elbows or getting their hands dirty. Most of the people in that hospital were offish till they figured out i was a humble worker like them.

I am not convinced about anything that has do with race, social / economic class or any other human attribute, but the ideals of it all sure do seem bigoted when they have to be used to qualify someones potential :shrug:

[treestar]

70. The AMA keeps quotas on doctors, just like the quotas we have

on foreign laboreres.

The idea is to get the government to protect those who are already in from having to compete.

American doctors can't make as much money if they aren't protected from competition. That's what immigration quotas are for. To protect the $$ Americans can make. If more doctors would make it cheaper for you, the consumer, to get medical care, that's too bad. It's the ones already "in" who deserve to be rich, rather than that you should get cheaper medical care.

If they can't do it via immigration, they will do it via tests and boards.

Lawyers and accountants and nurses haven't figured this one out yet. Or haven't been able to get the people to agree that others should be restricted that they make more $$.

You, the people have fallen for it. Americans doctors or nothing. That group that dies or stays sick because of it should just God Bless America that foreign doctors are not allowed per the market. :sarcasm:

[mainer]

86. There are plenty of foreign doctors here

So how can you say we're keeping them out? In rural parts of Maine, the whitest state in the country, many of the doctors are from India. No one's keeping them out -- in fact, Maine is struggling to KEEP them here. But the climate and the rural lifestyle doesn't seem to be so attractive to ANY doctors, foreign or otherwise.

[ikojo]

71. My job at the insurance company is to load

physician demographic information into a database so it can download into the claim's system. I can tell you that there are MANY doctors from India and the Middle East.

In many countries higher education to the bachelor's degree level is free or of little cost. Not everyone goes on to college though. I had a Malaysian roommate and she was tested in the sixth and eighth grades. After those tests she was directed to a course of study in the sciences. She was sent to the US in the early 80s to learn English and get a degree in Chemistry (paid for by the government). Upon obtaining her degree in chemistry she was to return to Malaysia where she would work for the government.

I don't know if she ever got her degree or returned to Malaysia though, because I had to quit college when it became too difficult to pay for the tuition, books, food and rent.

[treestar]

80. If on the J visa she'd be required to go back, I believe

The AMA may indeed find it is getting underpriced, too, with this form of "outsourcing." Maybe Americans can go to foreign medical schools. Many of them are in English anyway. They might have to take a test here, and the AMA could try to figure a way to make them flunk it, but knowledge is knowledge, how far can they go?

Just another example of how we have to comepte with foreigners and there's no way out of it.

[Hamlette]

79. some guy on CNN just said 25% of US docs n/t

[MissMarple]

81. Thanks, usefull. n/t

[mainer]

85. Medical schools are extremely expensive to run

I think that's the bottom line -- not every university can afford to support one. You need affiliated hospitals, a medical faculty, a residency program (to supervise those green medical students) anatomy labs, malpractice insurance, etc., etc. These things can't be done on the cheap, and universities are struggling as it is just with their current curricula.

It makes almost more sense to bring in foreign medical grads.

Yes, there IS a doctor shortage in many parts of the country. Where I live, which I think is a very desirable area, we have a shortage of a number of sub-specialties.

I've heard as well that the number of applicants is down. The ratio of female/male is over 50/50, so we're graduating more women doctors which is good. But you also have to ask yourself -- if the men aren't as interested in being doctors anymore, that may be an indication that the practice of medicine isn't nearly as attractive as it used to be.

[northzax]

91. excellent point

any schmuck can start a law school, you need a couple of rooms, some books, an internet connection and a few J.Ds to teach. yes, it's more complicated than that, but give me $5,000,000 and I will start you an accredited law school. law schools are cash cows for universities, they are easy to scale up (eh, what's the real difference between having 50 people in a lecture and 60?) they are cheap to run, and expensive to attend. Med schools, on the other hand, have intensive capital needs (labs, tutors, cadavers, hospitals etc) and cost rougly the same amount to attend. you can't have every class in medical school have 60 people in it, especially once you get into practicums, no one wants 50 interns in their hospital room poking and prodding you. you can learn the law from a book, you could probably establish a pretty good online law school, listen to the lectures, read the readings, have online discussions and take your finals. we don't have the technology to do that for medical schools yet, you can't learn medicine only from a book, at some point you need humans.

Second off, teaching hospitals are incredibly expensive. you have all the regular expenses of a hospital, charge less, and have to teach people at the same time. Take the DC market, there are three teaching hospitals in town (Georgetown, GW and Howard) along with 4 other, non-teaching hospitals (Children's, Washington National Hospital Center, Sibley Memorial, Providence) and two Military facilities (Walter Reed, VA) and a few specialty ones (National Psychiatric, National Rehabilitiation) can the city really support another teaching one? does someone want to plow a couple of hundred million dollars into finding out?