Nearly 1 in 3 US physicians were born abroad

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At a time when immigration is a hot-button issue, the American health care system is highly dependent on professionals born in other countries, an analysis of U.S. census data shows.

In 2016, roughly 17 percent of professionals in 24 medical fields—from optometrists to chiropractors to veterinarians—were foreign-born, and almost 5 percent of them were not U.S. citizens, according to the analysis published this week in the Journal of the American Medical Association. The analysis could not distinguish between professionals trained in their country of origin and those trained in the United States.

The rates were even higher for the most educated providers. About one in five pharmacists, one in four dentists, and 29 percent of physicians—approaching one in three—were foreign-born.

Among one of the biggest occupational groups—psychiatric, nursing and home aides—23 percent were foreign-born.

"We rely very heavily in health care on those who were born abroad," said lead author Anupam B. Jena, an economist and physician at Harvard Medical School. "That tells you what would happen if we had a policy that restricted skilled immigration."

Controversy has surrounded the Trump administration's policies aimed at curbing from Mexico, and his ban on travel from six predominantly Muslim countries. But changes that are less well known have chipped away at legal immigration, including new compliance rules, documentation requirements, and visa restrictions for skilled workers and college students.

Jena's interest in the intended and unintended consequences of immigration policy is partly personal. He was born in Chicago, but his parents—a physician and a physicist—emigrated from India.

"People like my mom who are able to make it to this country and perform professionally, these are generally very skilled, very motivated people," Jena said.

Yet doctors trained outside the U.S. are so often perceived as less qualified or less competent that Jena and his colleagues did a study to evaluate the quality of the care they provide. The study found that hospitalized Medicare patients who were treated by international medical school graduates had lower mortality rates than patients treated by U.S. medical graduates.

For another study, Jena looked at the scientific contributions of foreign medical graduates by counting their journal publications, federal research grants, and clinical trials. The conclusion: Physicians educated abroad but working in the U.S. account for nearly a fifth of U.S. biomedical research scholarship.

Jena led the new analysis—which used data from an annual household survey conducted by the Census Bureau—to look broadly at the health care workforce. While studies over the past decade have reported that about a quarter of doctors working in the U.S. were born abroad, most other health care professions haven't been examined.

The fields with the smallest percentages of foreign-born professionals were audiologists (5.9 percent), veterinarians (7.3), nurse-anesthetists (8.4) and psychologists (9.5).

About 16 percent of nurses, optometrists, dietitians and dental assistants were born abroad. Asia was the most common region of birth, accounting for 6.4 percent of all U.S. health care professionals. Mexico and the Caribbean were next, accounting for nearly 5 percent.

"As the U.S. population ages, there will be an increased need for many health care professionals, particularly those who provide personal care like home aides, a large proportion of whom are currently non-U.S. born," the researchers concluded.

Jena speculated that current anti-immigration policies and sentiment may discourage from coming here, even if a move would mean better economic prospects.

"Skilled immigration isn't going to stop," he said. "But at the margins, there are always people on the fence. That's true for anything in life. Do we want them on the fence when they are contributing to the American health system?"

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Dec 05, 2018
I actually find this insulting as an American. Not only are these individuals foreign born, but more than likely a majority of them are also foreign educated.

You can call me cynical, but I really believe they are not here to bring healing to our populace but are here for our money.

I spent more than a few decades visiting hospitals and physician offices all over the southeast and noticed this phenomenon of foreign doctors twenty years ago-especially in the rural areas where, in order to get their special visas, they had to serve under served areas before they were "set free" to move to other parts of the country.

For the life of me, if we need more doctors (and we do), why are we not enlarging current medical schools and building new ones to accommodate our need for more physicians?

In closing, let me ask -- who needs better access to healthcare, citizens of India, Nigeria, Kenya, or Americans living in rural areas that are not too far away from large population centers?

Dec 05, 2018

One reason for the increase in foreign-born doctors is that medicine is becoming less attractive to Americans who might consider it as a career (and others quitting to do something else, or retire early).

With the outrageous cost of schooling, continual interference by government, a legal system that's a full-employment/welfare system for lawyers, with unlimited lawsuits and awards driving insurance cost to insane levels, etc., it's becoming so aggravating and expensive to become qualified, and to practice, that it isn't worth it. Few people are interested in devoting the amount of time and money that it takes to get started, be told what they must, and must not, do by government bureaucrats, and pay most of what they earn to insurance companies to keep lawyers from putting them out of business. Government policies, which are driving the cost of college and the ability to bring frivolous lawsuits, as well as their direct interference, are making it more bother than it's worth.

Dec 05, 2018
Your your sciences don't factor reality, such as how the government over regulates limiting the amount of potential doctors we can churn out year over year, the burdensome residency requirements. When a foreign born doctor comes to America they are forced into a residency program which takes from open spots for Americans to take.

Dont forget universal healthcare is failing in many countries and these doctors come out here so they can be paid a decent wage to become doctors. Notice your statistic also mentioned only 5 percent were non citizens then you went all irrelevant on us talking about Trumps Policies. The foreign born part means they came here legally and not illegally meaning Trump isnt cutting off a supply line of doctors.

Dec 05, 2018
And to continue:

Your article is talking about the scare that there are less America practicing medicine while trying to push for more foreign born doctors. Maybe we should follow trump's policies and give those opportunities for America rather then helping everyone else while America bleeds.

Dec 05, 2018
I personally research my doctors before using them. Almost without exception my doctors are American born. Doctors should face more scrutiny and be rated and classed and if they fail to be top ranked they should have to at least form quorums (eg, automatic second opinion). This way we dont need to isolate them by origin but by performance.

Dec 05, 2018
There wouldn't be such a big need for immigrant doctors if the AMA and affiliated medical schools hadn't artificially limited the number and size of medical schools in the U.S. for decades. We all know many capable individuals who were not admitted to medical schools due to the artificially high bars to admission. They would have loved to become doctors. (I'm not one of them). I'm very skeptical that all of these imported foreign doctors would have met the admissions criteria for medical school here if they were Americans. So don't cry about visas, tear down the anti-competitive obstacles to increasing the supply of U.S. citizens going to medical school instead..

Dec 05, 2018
The worst part about this is the way that none of them really even care about you. They will hand out narcotics like candy because they get a kickback. Most of them don't really speak the language and don't bother to communicate information properly. Every other race is encouraged to "find a doctor of their own race", but when whites try to do this, we are attacked, in our own country, and then receive subpar care, when it is US who are paying for everything in the first place.

Dec 05, 2018
Sure, meanwhile the medical schools are still turning away 95% of the qualified US born applicants in favor of foreigners.

When I went to grad school we had 100+ applicants each year and selected only 4 or 5. Medical school is even more selective. Top tier medical schools turn away hundreds of applicants for every one admission.

Are you trying to suggest that NONE of those hundreds of thousands of US born applicants that are turned away every year could possibly have completed medical training? What a joke...

The most sickening part is how much taxpayer money goes into these schools to train foreigners while qualified Americans are turned away.

Dec 05, 2018
Many of these doctors are subpar, and they do indeed kill patients. I often wonder if they do so deliberately, while practicing their own eugenics on Americans of certain races (and not just white).

Dec 05, 2018
Tons of disinfo here. 1. Thousands of Americans are getting their medical degrees outside of the United States because it's nearly impossible to get into an American medical school. You have to be the right age, have the perfect scores, the perfect resume and grades, and even if you have all of that, it's luck or who you know(letters of recommendation), that get you in.
2. The cost of an MD is at least 200,000$.

Dec 05, 2018
3. Good luck getting a residency in the profession you want to practice!!! Yep, that's even more difficult to obtain, and you spend years chasing it on top of the 8 years of schooling you just spent to get that MD.
4. Lets not forget about your licensing exams which can take years to get through if you don't have the right connections, and if you care about what specialty you will spend the rest of your life doing. People think you just become a doctor and it's a gravy train, it's 24/7 work for relatively little money compared to what you go through. All of the older docs will tell you this, it's over for the new ones coming up.

Dec 05, 2018
5. Now after all of that, you made it and finally get to start paying off the hundreds of thousands of dollars of debt, but wait, the government and insurance companies now control everything, so you spend all of your time jumping through hoops just to treat your patients. And watch out! Lawyers sue you for everything.
6. I can go on, but even the schools make it incredibly difficult to finish. If you have anything happen in your life, too bad, you have to start over! Even if you were doing well. The whole system is completely broken and it's going to get so much worse, but this is what the baby boomer generation built for us to inherit. So blame them. There are tons of people who are trying to finish medical school, not just foreigners. Most of them are American or Canadian and went outside the US because they weren't accepted anywhere.
Good luck.

Dec 05, 2018
The best teachers I ever had were French and Iraqi. I'm sure there are plenty of amazing teachers who are American, but 99% of the upcoming medical students won't get to see it. That's the system you created and all of that knowledge and technique will be lost. We have sabotaged our own future when it comes to medical schools, and we are in trouble.

-frustrated disillusioned American medical student

Dec 05, 2018
Anyone with a brain saw this coming. A country will not produce doctors, scientists, engineers at a high rate when the country is middle of the pack at best at science and mathematics. Our country is full of bumbling morons.. i mean my god, we elected trump.

Dec 05, 2018
Re: lisk
Who and where is this? Their peers and malpractice make this impossible, and they got into medicine to help people not hurt them. Plenty of easier professions if you just want to hurt someone then becoming a doctor. Government or police for example......

Dec 05, 2018
All of those amazing surgeons, all of those great primary care docs leaving by the thousands, all of their skills will be gone, and they won't be passed on because there are so few residencies available and so little money funding the next generation of doctors. So go complain about it. You could fix it if you wanted to.

Dec 05, 2018
This comment has been removed by a moderator.

Dec 05, 2018
Re: John Muir
New Orleans, LA. Good hospital. Mostly good to excellent doctors with good to excellent pedigrees who are in denial about malpractice by certain foreign-born surgeon(s). Meanwhile said overlookers pat themselves on the back for upholding diversity in medicine. Not saying this is what the killer sets out to do when he first starts. Probably just a psychopath in the ranks.

Re: John Muir again "You could fix it if you wanted to."
How can you fix it? So many students worry about testing well. They barely understand that it's a tradition they're meant to be inheriting. And many physicians don't understand that medicine is a culture with traditions that they are meant to be transmitting.

Dec 05, 2018
Biomedical research is inundated with foreigners because of the permissive immigration system. I've worked with hundreds of foreigners, some are great, most are average, some are incompetent crooks. They're a mixed bag like any group of US born workers would be.

The idea that foreigners are elite and far surpass Americans is ridiculous. 40 years ago medicine and academia was dominated by white men and America was the world leader in both by a wide margin. Now as these workforces get more 'diverse', we are losing our competitive edge despite spending much more than other countries.

There is clear statistical evidence that white men face an uphill climb to attain any competitive training position anymore, due to the national obsession with diversity, and the billions of dollars at stake for the universities making the decisions.

This was a known and intentional impact of Obamacare.

Don't act surprised. You didn't sleep through it.

Dec 06, 2018
A ton of misinformation in this thread. There are only enough American trained grads to fill 75% of residency slots. A full 25% go to foreign grads. It has been that way forever. Foreign grads most often are double trained by way of having to complete residency again in the US. Their US training is not always in the same specialty. Most of the foreign grads are also the best and brightest that their country has to offer or have families willing to help them get to the US. The thing that is grossly unfair is that they get into the US system with zero or very little educational debt. It does not take them 10-15 years of paying off student loans like the bulk of US grads, who end up delaying starting families, buying houses, etc. The thought that all of that training should be provided as service because politicians say healthcare is a "right" is complete bs. When the government starts regulating how much lawyers can charge for services, maybe things will change.

Dec 06, 2018
i'm surprised more americans havent raised questions about this; i can see maybe 10 percent or less foreign born dr's; this must be a business model just like h1-b's are used to displace american tech workers

Dec 06, 2018
Some of these medical professionals are not competent. Some have strange ideas about human anatomy.

And some are very good.

We run medicine as a monopoly keeping the ability to get into medical school very difficult so we end up with physicians that do not know how many kidneys a person has and where they are located.

Dec 06, 2018
Obamacare is causing thousands of early retirements, I'm not sure how it's causing an increase in foreign born docs.

Re: David1984
It's not even close to the h1b tech worker situation, but give our government time. They are already pushing legislation to make it easier to hire foreign nurses for less than Americans. Eventually it will be that way with everything, and we are not doing anything about the doctor shortage that's coming. It's going to get a lot worse before it gets any better. Think about how many retirees will be needing care in the next 20-40 years. It's going to be miserable.

Dec 06, 2018
I had intended on becoming a doctor in the US. I am American and my first day at the University I transferred in to should tell you all you need to know. The head of the Biology department assembled us in the main lecture hall and proceeded to tell us that everyone wants to be a doctor, give it up and forget it. Those were his words. I later discovered the medical school at the University I attended doesn't usually take its own undergraduates and the majority of the students were foreigners. It was very disheartening. I am now an Engineer.

Dec 06, 2018
The AMA enjoys a government protected monopoly over the number of physicians that are allowed to be trained and licensed every year. They intentionally keep the supply of doctors artificially low, and US physicians make more than doctors in any other country by a wide margin.

Meanwhile, many Americans are crossing the borders to get medical and dental care elsewhere for a fraction of the price.

For the AMA to bleat about current or future doctor shortages is the highest hypocrisy.

Dec 08, 2018
As the American (my family here since 17th century) wife of a FMG (foreign medical grad) and close friend of many other FMGs,--I feel many of the assertions stated here are not true. Don't judge physician skill based on country of orgin. My husband is from small E. Europe country, had same testing prior to attending the required Internship/Residency in US that every FMG completes. In board exams, he scored in the top 1% of ALL physicians in the US. I constantly hear from everyone what a phenomenal physician he is. I have found many foreign grads to be exceptional. We do tend to attract the best & the brightest. If they are not, their own native countrymen don't respect them, trust me. But even my husband thinks it's very stupid that in US we don't train enough of our own doctors. It is intentional, for reasons we can debate. Although its good to remember, we can attract super people who are very compassionate professionals, I'd also like to see US programs open up more.

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