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Greg Siskind on Immigration Law and Policy

HEALTH CARE REFORM NEEDS IMMIGRATION REFORM

Rating: 2 votes, 3.00 average.

I've written an op-ed piece for the Memphis Commercial Appeal with my colleague Elissa Taub on the need for reforming the laws governing the immigration of doctors and nurses.

The 2,700-page health care bill approved by Congress certainly
doesn't lack detail in describing how it plans to extend coverage to 32
million more Americans. But its failure to address one basic question
could very well doom its chances for success in expanding access to
health insurance: How will we handle a significant increase in patients
-- a number equivalent to the population of Canada -- when we already
are experiencing a drastic shortage of doctors and nurses?

The Council on Physician and Nurse Supply estimated the United States
was facing a shortage of 200,000 doctors and 800,000 nurses before
health care reform. Undoubtedly, the shortage now will be
substantially worse. And without more doctors and nurses, the only
obvious solution will be to ration health care -- something that is
quietly happening already in small-town America.

The shortage can be blamed on a variety of factors -- a rapidly
aging population, the retirement of a large number of baby boomer nurses
and doctors, a decline in the average number of hours worked by
doctors, an inadequate number of nursing and medical schools as well as
shortages of faculty members, and the availability of new technology and
treatments that mean more Americans are likely to seek out the services
of a health care professional.











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Comments

  1. George Chell's Avatar
    Cutbacks in University spending during recession will mean fewer US doctors and nurses, which means either more malpractice suits as nurses work overtime, due to the death of patients or importing more people professionals from abroad. I believe tha antis would have rather have their parents dead!
  2. George Chell's Avatar
    One writer says...

    "Simple solution: Abolish the unconstitutional O'care, seal the borders, get the government out of the relationship between individuals and medical professionals and let the free market prevail."

    I think we should try seal the border strategy with Arizona first as a pilot program. Why are the pro-Arizona folks get so upset when we suggest that we should boycott Arizona. That is essentially what they are saying..seal the borders. Indeed we should try it with sealing the Arizona borders.

    Free market does not prevail when we seal the borders!
  3. Jim's Avatar
    The US better hurry up to attract back doctors and nurses. Don't forget that there is a worldwide shortage of doctors and nurses. UK's NHS recognizes this and is asking their Gov't to open up further for more Indian doctors and Filipino nurses. It doesn't help that their own domestic nurses are migrating to countries like Australia and Canada for the last few years as well because they get overworked back home.

    And some countries may be closed right now but when they open up their process is much, much easier and FASTER than what the US immigration process. Everything else equal, the US looses on just the shear efficiency of other country's immigration process.

    This is one comment from a recent article in the Oxford Times:http://www.oxfordtimes.co.uk/news/8250876.Foreign_workers__vital_to_Oxfordshire_/?ref=rss

    "Joe Cooke, Oxford says...
    11:24am Fri 2 Jul 10
    Don't know about Oxford University but I know the NHS could not cope without nurses from the Philippines and doctors from India. We should let these people work here and clamp down on people who come here without jobs."
  4. Adi's Avatar
    Truth remains that we cannot open more schools to teach nurses and doctors here in this country. There is shortage of faculty to teach students and not many qualified people are willing to sacrifice their money making careers and go teach, which are generally low paying jobs. You cannot pay more or else tuition fees will have to be raised and student loans will be unbearable. Short term fix is import workers and long term work on producing more faculty to teach in schools.

    Lot of nurses quit their jobs with in 3-4 yrs of work. This adds to severe shortage. Just wait till economy bounces back and most nurses that came into workforce go back to retirement. You will see hospitals shutting down or cannot open new floors due to lack of nurses.
  5. Jim's Avatar
    "You will see hospitals shutting down or cannot open new floors due to lack of nurses. "

    They are going to blame illegals for this eventhough studies have repeatedly said the illegals are least likely to use ERs and since they don't have insurance cannot just walk in too see a doctor.

    What irks me is they try to hide their racism and discrimination by making up excuses and when there are studies proving otherwise they dismiss it.

  6. Adi's Avatar
    "What irks me is they try to hide their racism and discrimination by making up excuses and when there are studies proving otherwise they dismiss it."

    And that is why we need leaders who can see through all this crap and make right decisions for the country. It very unfortunate that Obama cannot bring back 14 senate republicans that supported immigration in 2007. Serious lack of leadership. Anyhow its time that they allow certain urgent bills to pass and work on undocumented later.
  7. Guest's Avatar
    http://www.dailypennsylvanian.com/node/59534

    http://www.workingnurse.com/articles/Why-Nursing-School-Grads-Have-Trouble-Finding-Jobs

    http://www.nursingtimes.net/graduate-unemployment-up-80/993018.article

    http://health-careers.suite101.com/article.cfm/new-graduate-rns-and-the-nursing-shortage

    Fact, there is very little turnover in RN positions, Fact new graduates can not find employment.

    Fact Foreign Nurses currently fail the NCLEX at at 60% rate.

    Hospital admissions are down, many hospitals are closing, surgery is down, with health care reform spending is down.

    Why do you feel the need for reform?
  8. Jim's Avatar
    "Fact, there is very little turnover in RN positions, Fact new graduates can not find employment.

    Fact Foreign Nurses currently fail the NCLEX at at 60% rate.

    Hospital admissions are down, many hospitals are closing, surgery is down, with health care reform spending is down.

    Why do you feel the need for reform?"


    I can find more articles and more data that says otherwise and it far outnumbers those you have cited.

    There is little turnover now because those who have retired or about to retire did not push through with it. You think they will live forever or will never retire?

    Foreign nurses passing nclex at 60% rate. So what!? Those who did pass are the ones who are getting in and not those who failed. Is that difficult to understand?? I'll be more concerned on domestic nurses quitting within 3-5 yrs than worry about the passing rate of foreign nurses as those who failed are not getting in anyway.

    How many American nursing students even finish the course? And how many are BSNs w/c some hospitals now prefer than an ADN??

    Hospital admissions are down?? Sure, I can believe that. It would be foolish if you think it will remain that way specially
    once 32 million will be insured a a couple of years.


  9. Jim's Avatar
    "the U.S. Department of Health and Human Services, the *nationwide shortage is estimated at 150,000* registered nurses. In 10 years, that number will multiply to *800,000*. The aging baby-boomer population is driving these large numbers. In California, today's shortage of 20,000 nurses will reach between 50,000 and *80,000 in only five years*. And by the way, *California is ranked last in the nation for registered nurses per capita.*"

    http://www.allbusiness.com/education-training/education-systems-institutions-colleges/14136077-1.html


    Nursing shortage gets worse as universities fail to accommodate demand:
    http://gazetteonline.com/top-story/2010/03/17/nursing-shortage-gets-worse-as-universities-fail-to-accommodate-demand


    So, where will the US get the needed nurses?? And the 800,000 projection is the projection before HC reform passed. Can't wait to know what the new projections would be if they add the extra 32 million who will be getting insurance in 2014. 4 short years from now.

  10. George Chell's Avatar
    "Nursing shortage gets worse as universities fail to accommodate demand."

    I completely agree that we need to train Americans. But, it is interesting that the antis led by Kirkorian, Camarotta and Stein have not been protesting budget cuts at the university levels which would lead to even more shortages down the road. Instead the racist Kirkorian protests increases in foreign students at US universities. The goal I think is more and more sinister. The antis want to killl off the seniors, the weak and the infirm...it is the stated goal of their here Richard Lamm, the former governor of Colorado...who in 1986 or aorund there implied that seniors should drop dead.
  11. Adi's Avatar
    "budget cuts at the university levels which would lead to even more shortages down the road."

    Even if budget is increased (and it should be increased), there is severe shortage of faculty to teach nurses. Faculty positions are generally low paying and not everyone is good at it. Not many professionals even prefer working at universities. Obama's solution: Train more domestically. I cannot believe he said it, without checking his facts.

    Just year and a half back, hospitals were in deep trouble due to lack of nurses. Just because some people have put off surgery, and some nurses came back to workforce, it does not mean future is not grim for nursing care. Anyone who does not believe in this shortage, has very short term view of things and is ok with people dying in hospitals. It has to be very comprehensive approach which includes long term solution of training more nurses, faculties, funding for schools etc and short term solution of bringing in foreign nurses. If this shortage is not solved, nursing costs will rise through the roof, hospitals will not be able to accommodate more patients, ER waiting times will increase both at front and back door which increases costs and lower quality of healthcare, more errors will occur at hospital floors which in turn will increase costs and lawsuits, more and more nurses will quit due to overload and making shortage worse and increasing costs etc. Just look at aggressive programs of Canada, middle east and Australia immigration for recruiting nurses and you will get an idea, on how wisely they are investing in their health care future. They have very good idea on how they will control the costs and serve their population.

    I did also notice that in private (and rich) hospitals, RN performed all the tasks, while in public and not so rich hospitals had lot of work done by LPNs or nurse's aids (which can only add to the errors and costs). Situation was worse in nursing homes, where condition of older adults was just horrible due to lack of nursing staff. I cannot see anyone ok with the situation of nursing shortage especially if their own relative or loved one is admitted in these conditions. If nothing is done now, situation will only get worse and will ultimately end up being a crisis. I wish our leaders solved problems before they became crisis.
  12. Geroge Chell's Avatar
    "Even if budget is increased (and it should be increased), there is severe shortage of faculty to teach nurses. Faculty positions are generally low paying and not everyone is good at it. Not many professionals even prefer working at universities. Obama's solution: Train more domestically. I cannot believe he said it, without checking his facts."

    All lip service! State universities facing massive budget cuts not seen since World War II and where are all the folks at CIS and FAIR protesting budget cuts..just a bunch of racists who want to keep America white!

  13. Jim's Avatar
    Would like to share an almost similar blog from Carl Shusterman:

    http://blogs.ilw.com/carlshusterman/2010/02/universal-health-care-without-nurses.html

  14. Jim's Avatar
    "Even if budget is increased (and it should be increased), there is severe shortage of faculty to teach nurses. Faculty positions are generally low paying and not everyone is good at it. Not many professionals even prefer working at universities. Obama's solution: Train more domestically. I cannot believe he said it, without checking his facts. "

    Like to add that even if somehow salaries for nursing faculty positions gets increased (even higher than other faculty positions from other professions) there aren't just no qualified people to do it.

    At least 60% of new grads are 2-yr associate degree holders only and study shows that the probability that ADNs upgrading their degrees to Bachelors and specially Master's is very low. Only those with Master's degree can teach Bachelor's while BS holders can only teach associates. And all these fast-track new grads (less than 2 yrs) are all ADNs.

    Then there is the normal quitting time of 3-5 yrs.

    In short, there is a spiral downwards. Also, it just happens that majority of foreign nurses (at least those from the Philippines) have a 4 yr Bachelor degree holders.

    And the topic not usually talked about is other degrees from UK, Australia do not meet US standards because transcript evaluations from CGFNS and the different Board of Nursing in the US would always ask them to add more theoretical and/or clinical hours before being approved. Yet no one complains.

  15. Guest's Avatar
    To be a US nursing instructor you must have a Master's Degree in Nursing and 5 years of clinical experience. In the Philippines requires a BSN and no clinical experience. If the US lowered it's standards and allowed BSN nurse to be instructors there would be no shortage of instructors( and all the unemployed American BSN would have a job) .

    Canada has determined many of the Pinoy BSN graduates are equivalent to a practical nurse. In the Philippines high school ends at grade 10 or a US Sophomore, that is how you get 20 years old with a BSN . In the US of a high school grad and ASN has the same education as a foreign BSN and most US students have some job skills which a foreign grad does not.

    Why is a BSN from the Philippines trained by BSNs with no experience in a no American Health care system better than an American Nurse who has been trained by experienced MSN prepared nurses?The US grad has 89 -90 % chance of passing the NCLEX exsam rather then a foreign graduate who fails the NCLEX more frequently than they pass
    ?

    US has close to 1 million LPNs who in less than one year can become a RN if needed. These nurses live in the USA, know American Health care are would have the same number of years of education are a foreign RN.

    Health care reform does not equal demand for more RNs
    ( Inpatient and long term care where foreign grads work). The 32 million people uninsured are getting emergent care but not insured for routine services. What will be in demand is Primary Care Physicians, NP, and PA who can provide primary care in the out patient environment. Medical schools should enroll more students, primary care needs to pay primary care physicians better wage. There is going to be a demand for NP and PAs to help direct the projected 32 million people to access the health care system the need for more RNs is not guaranteed and presently there is an over supply of RNs.


    Lastly, are the foreign nurses prepared to support one self coming to the USA? Last I heard Medicare is not reimbursing hospitals for the cost of recruiting nurses (so the foreign nurses need to be self supporting). Are Americans willing to pay to set up house for foreign nurses while Americans themselves are loosing their housing?
  16. More information about the over supply of RN's Avatar
    http://www.economicmodeling.com/2010/06/25/digging-deeper-into-data-on-registered-nurses/
  17. Australia migration's Avatar
    Health sector need lots of nurses for support this sector. I think this is right way to settle in Australia for those who has done nursing registration.

    I am willing to do.
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