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Greg Siskind on Immigration Law and Policy

PRESIDENT CARTER RESPONDS TO MY OP-ED PIECE IN USA TODAY

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OK, this was unexpected. And not that I would ever have thought something I wrote would have ever been on the radar screen of a former occupant of the Oval Office. But, with all due respect, I have to say, President Carter, I disagree with your conclusion.

    Greg Siskind's commentary "U.S. savior: Foreign doctors" presents one side of a tragic and selfish trend: our recruitment of scarce health workers from poorer countries. This is a crisis The Carter Center constantly faces in fighting diseases in Africa (The Forum, Tuesday).

    Cuba has a doctor for every 169 citizens. The U.S. ratio is 1-to-391, and Mozambique's is 2.6-to-100,000.

    A Japanese girl born today expects to live 86 years -- 44 years longer than one born in Zimbabwe!

    In nearly 10 years, Ghana has lost 604 of its 871 medical officers. Zambia has lost 550 of 600 trained there in the past 40 years. And just 360 of 1,200 doctors trained in Zimbabwe still practice there. Malawi has 930,000 people with HIV, but in five years it has lost 53% of health administrators, 64% of nurses and 85% of physicians, mostly to wealthy nations. American nursing schools rejected more than 32,000 applicants in 2006 because of limited facilities and teachers, and to meet this shortage Congress has moved to eliminate all immigration restraints on foreign nurses. The obvious solution is to increase the number of health workers both here and in poor nations.

The African brain drain argument really doesn't apply to the foreign physician population in the US. Less than 5% of the foreign doctors coming to the US for training are from African countries, hardly enough to even be noticed in sub-Saharan Africa. And a number of that relatively small number of doctors actually returns home. As for nurses, the story is the same. Fewer than 5% of foreign nurses coming to the US come from all of Africa. Complain about Europe if you want where the vast majority of African nurses are going (particularly the UK). But the African doctors and nurses mentioned by President Carter are not coming to the US.



As for where our doctors are coming from, about 1/3 of the doctors are coming from India and Pakistan, two countries that produce far more doctors than they intend to employ. And the overwhelming majority of our foreign nurses are coming from the Philippines, a country that has made nurses its primary export, supplying nurses to hospitals throughout the world. None of those countries is complaining about a health care worker shortage and many health care professionals in those countries plan on migrating even before they begin their studies.



But I cannot argue with President Carter's basic premise - the world needs to help developing countries with their health care infrastructure. We need to work to facilitate training and retaining more health care workers in countries that need them so that all countries - rich and poor - can have high quality health care.



And we can be creative in using immigration law to help. One example - Senator Richard Durbin has proposed giving nurses with green cards credit toward their five year US residency requirement for naturalization for time spent working in a developing country, whether it is their country or not.



But blaming physician and nursing immigration to the US for the health crisis in Africa is simply wrong on the facts.

>>

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Comments

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  1. AC's Avatar
    Greg,
    I certainly agree with your perspective in the article. Greg, any chance of the Schumer nursing amendment coming up again in near future ? Is there an organized opposition in the senate for that amendment? I would appreciate your thoughts.
  2. USC's Avatar
    "Greg, any chance of the Schumer nursing amendment coming up again in near future ?"

    The Senate goes away for its summer recess today/tomorrow. They come back in September. So you will have to wait till then, at the very least.
  3. Another Immigrant's Avatar
    There is a genuine point in what Carter said ,which Greg accepted that Developed countries should help in poor countries health care system.

    But I dont agree with the statement which Greg said below
    "None of those countries is complaining about a health care worker shortage and many health care professionals in those countries plan on migrating even before they begin their studies."

    They are actually complaining . I can say that for India.
    India's rural health care system is COMPLETELY broken.

    But the problem is, Indian Govtis not able to retain doctors because doctors genuinely cannot stay in rural areas taking all the troubles with the salary that Governament is offering. Starting salary per month is around 200 to 300$.

    So governament of India is toying with the idea of making doctors work for about 1 year in rural areas as part of the education to ensure that rural areas are getting some attension.

    only other way is to give very good perks to doctors which currently Govt cannot offer with their budget.

    i really dont see a easy solution for this problem.

    Being a doctor, paskal can tell more about this I guess






  4. Greg Siskind's Avatar
    I'd like to see something regarding complaints about a shortage of Indian physicians, because I had a conversation personally with the Indian Ambassador to the US at the Embassy in DC last summer about precisely this subject and he noted that India is training far more doctors than they could ever hope to employ. And that migration is factored in from the very beginning of medical school training. I don't have the data, but given how many Indian physicians are working in developed countries and given the patterns we've seen in IT and nursing, India's enlightened attitude is that it can produce a surplus of extremely smart people that can export their skills to other countries and this, in turn, aids in the development of their own country.
  5. USC's Avatar
    I agree with Greg. There are still a few individuals who go into a particular profession because they love that calling. However, there are many who base their careers based on the financial compensation that they will reap. I believe the same applies to medicine, engineering etc in India. I know from many conversation that quite a few people go into the IITs because they intend to use that as a stepping stone to immigrate to the US. The same applies to medicine in India. So, if the option of immigrating to the US were not available these folks rather than opting to practice in the rural areas would simply opt for another profession.

    We don't live in an ideal world. President Carter, is wrong on this one
  6. Another Immigrant's Avatar
    I am not denying what Greg said.

    I am just trying to say something here that Govt are actually complaining about the health care system in India because doctors are not willing to work in rural areas where half of population resides. It really does not mean that the problem is caused by people emigrating to US or some other countries.

    A paper below tells about the rural health care problems in pakistan.( This eaualy holds good for India as well I am sure)

    http://www.ayubmed.edu.pk/JAMC/PAST/16-2/umar.htm

  7. USC's Avatar
    "Greg, any chance of the Schumer nursing amendment coming up again in near future ?"

    See Today's Front Page NY Times story, linked below:

    http://www.nytimes.com/2007/08/03/washington/03immig.html?_r=1&oref=slogin

  8. In Immigration Limbo's Avatar
    USC,

    The story didn't say a peep about nurses, unless I missed something.

    President Carter says "American nursing schools rejected more than 32,000 applicants in 2006 because of limited facilities and teachers, and to meet this shortage Congress has moved to eliminate all immigration restraints on foreign nurses"

    Schedule A relief got voted down and appears to be about as dead as CIR for now. I'm not sure what he means when he says "congress has moved". And they definitely have not moved to "eliminate all restraints", as Schedule A relief would be limited in scope and per country caps would still be in place.

    If the Dems listen to Carter, and many probably will, they will have another justification for limiting legal immigration that has a better ring to it than out and out protectionism. Ugh, things just seem to keep going from bad to worse.
  9. USC's Avatar
    "The story didn't say a peep about nurses, unless I missed something."

    True. My point was that the article seems to imply that AgJobs & the DREAM act seem to be where the Senate is focused on.
  10. Greg Siskind's Avatar
    I don't think I've ever heard someone on the pro-nursing immigration side ever say a word against fully supporting nursing education in the US. The fact is that the nursing shortage itself has led to the undereducation of nurses in the US. There is a nursing faculty shortage along with a general nursing shortage and nursing schools are not able to educate all the applicants. Congress can address this, of course, by putting money in to subsidizing salaries for nursing faculty members. The private sector is stepping up as well. Yesterday, I believe Kaiser announced a $100,000,000 donation to fund a new nursing school in California.

    In any case, the nursing shortage is projected to be far worse than can reasonably be dealt with through immigration. So it is going to be necessary to educate more nurses in the US AND recruit more nurses from abroad. And that was one of the themes in my article that President Carter didn't seem to notice.
  11. Calouste's Avatar
    An interesting article in the Seattle Times today about how someone "outsourced" his elderly parents to India because they couldn't afford the cost of care in the US anymore.

    http://seattletimes.nwsource.com/html/nationworld/2003819509_indiahomes03.html

    I wonder if this is going to take off on a larger scale, moving the patients instead of the nurses.
  12. paskal's Avatar
    But the problem is, Indian Govtis not able to retain doctors because doctors genuinely cannot stay in rural areas taking all the troubles with the salary that Governament is offering. Starting salary per month is around 200 to 300$.

    So governament of India is toying with the idea of making doctors work for about 1 year in rural areas as part of the education to ensure that rural areas are getting some attension.

    only other way is to give very good perks to doctors which currently Govt cannot offer with their budget.

    i really dont see a easy solution for this problem.



    india produces more than enough doctors.
    young graduates have a horrible time trying to find decently paying jobs. barely 10% of graduates can get post graduate training of any kind. india exceeds the WHO criteria on doctor population ratios. The Medical Council of India has recommneded repeatedly that medical schools training any more than 100 graduates should cut down in size- but it's politically unteneble. doctors won't go to rural areas because there is zero infrastructure and facility there. no schools for your kids and no medicines for your patients- feels like a complete waste. most of us do a 3mnth stint in internship. the current proposal for a 1 yr mandatory service is the usual political sop- did it say anything about creating facilities, providing medicine or increased funds? nope doctors will go do black magic!
    whether it's the US or India- one problem is a constant - maldistribution.
    at least in the US they offer scholarships and incentive to serve. the fact that india has a broken health system is the result of spending less than 2% GDP on health and simply not caring to improve things- on the part of successive govts since independence. this has nothing to do with how many doctors are trained in the country- a number that continues to increase, even as the best students in the cities start to shy away from studying medicine.
  13. Another Immigrant's Avatar
    thanks paskal for the info.

    sometime back i read the articles where Medical council asked to cut down the size. I guess it is because medical colleges are located only in main cities and the seats in those are high numbered(?). if they plan to move them more and more towards secondary cities atleast then villages and towns near by will able to access the medical facilities for cheaper rates. i read in Andhra state they are opening 3 new medical colleges in interior places. Do you think does that help for rural people in soemway?
  14. EB3INDIA2004 's Avatar

    Very interesting view presented by President Carter. Conservative blame immigrants for all the problems in USA and Liberals are trying to blame immigrants for all the problems in the world.
  15. Ely's Avatar
    To support Greg's position I will add that many foreign physicians in the US continue their contact with their country providing medical advice, training and some times direct care to patients in these countries.
  16. TX's Avatar
    Greg,

    I'm not surprized that Pres Carter responded to your article. You are more popular then you realize. Keep up the good work. If you were an Immigrant wanting to immigrate to the US I think you would've easily qualified for EB1
  17. Peanut Farmer's Avatar
    Wow, you "got served" by a former President. First, congrats on the fact that someone paid attention to what you said and even though I don't agree with you I think you made a persuasive argument.

    President Carter is right, however. There are countries with desperate shortages of doctors and health care professionals. It would be wrong to rob them of their doctors when they are in such a crises.

    Now, I am just waiting for some idiot to claim President Carter is a racists because he doesn't agree with Greg Siskind. Isn't that how you guys operate?
  18. paskal's Avatar
    Hello again Roy. Please read the article again. Countries with desperate shortages send a small fraction of immigrant doctors to the US. Hyperbole aside, many of these countries do not even have employment for these doctors. Saying there is a shortage or that the medical system is broken does not mean that these doctors actually have the opportunity to serve meaningfully in sub Saharan Africa. Even in the very developed US, many designated under served areas that desperately need doctors do not have the facilities to hire them. Sometimes, things are not as simple as they look. I have the utmost respect for President Carter and his basic point is well taken. That does not mean it squares completely with reality.
  19. Greg Siskind's Avatar
    >>

    Wow, you "got served" by a former President. First, congrats on the fact that someone paid attention to what you said and even though I don't agree with you I think you made a persuasive argument.

    President Carter is right, however. There are countries with desperate shortages of doctors and health care professionals. It would be wrong to rob them of their doctors when they are in such a crises.

    Now, I am just waiting for some idiot to claim President Carter is a racists because he doesn't agree with Greg Siskind. Isn't that how you guys operate?
  20. In Immigration Limbo's Avatar
    I didn't think it would take long for the NumbersUSA, IEEE crowd to latch on to this. We are getting hit from both sides, OUCH!
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