Rural areas are being hit hard and staffed by in large part staffed by foreign-trained doctors:
“The consensus seems to be that if you have a first name like Mohammed, you can forget it,” Dr. Sanjay Chaube, a much-needed internist in Hurricane Katrina-ravaged Bay St. Louis, Miss., and one of more than 40,000 Indian doctors in the U.S.
David Catron has other thoughts.
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{ 16 comments }
So… foreign doctors are complaining that it’s hard to immigrate to the US and the reporter is saying that’s stupid because there is a huge doctor shortage in rural/underserved areas.
Solution: Pay US trained doctors more money to practice in rural/underserved areas.
And not the Health service corps. They only pay $20,000 per year towards student loans, and not even all rural doctors qualify because there are limited funds.
I’m talking about repaying a doc’s entire student loan debt for…i don’t know…5 years of service, while subsidizing insurance reimbursements so he can earn a solid national average type salary on a 50hr week. Or a doc who has no loans, allow him to earn an income $30K above average.
Few people want to live in the country because there isn’t as much to do and doctors have to take a lot more call due to fewer of them being there. The only way to entice docs into rural/underserved areas is to pay them more to go there. Money Talks.
So if your name is Mohammed, why not change it to Gary, John or for that sake George W.? Why not try to blend in? The difference between an immigrant and a colonist is that an immigrant tries to adapt the ways and culture of the host nation, while a colonist insists that the host nation adapts to him. And who wants to be colonized by moslems these days?
Doctor shortage is a myth. First off the rules for deciding which counties constitute “underserved” are incredibly liberal. They actually have areas of NYC listed as “underserved” whichh is a load of crap considering that NYC has the highest doctor/patient ratio of any city on the planet.
Secondly, read the bottom of hte article. It gives a story about a guy who tried to recruit foreign doctors to a rural area, but he said the docs who were already there blocked it because they said the foreign grad was going to take their patients.
Does that sound like a doctor shortage to you? Since when do doctor shortages produce doctors fighting over patients?
If there was REALLY a doctor shortage, the existing docs would have welcomed them with open arms so they wouldnt be overwhelmed by all the patients and could have a more reasonable patient load.
Foreign/International Medical Graduate practice demographics matches that of American graduates. If the place is undesirable to an American, it is equally undesirable to a foreign national, maybe even more so.
What the rural people get, at best, is a rotating complement of foreign docs paying off their J-1 obligation.
Yeah… lets restrict the supply and then ask those in rural/urban areas to pay the extortionist rates of the domestically trained. I think not. As far as providers protecting their turf from competition, that is the scenario being described by the third poster. We need to flood the market until the providers (especially procedure based) are fighting over the patients and reducing their charges to reasonable levels.
Anon 3:32
Those imported doctors come from countries where people were engaged in international trade and had created large urban communities while the northern European ancestors of most Americans were still naked. They know how to run their business in a crowed market while keeping charges high. I haven’t seen an immigrant doctor compete on price yet. They come here to make money. They go to the money-making locals like everyone else, even more so as they have no local loyalties in this country.
The rural health problem is overblown. I grew up a poor rural area of the delta. Now, the population density of the rural area is smaller, and the highway system means that what used to be an hour drive to the city is now 30 minutes–I can get from the old home place to an urban center faster than I can get across town. Anyone who set up a practice there would suffer because most would keep their doctor in town, just nagging this poor sap on weekends and at night.
Our old family doctor made ends meet but was able to run a lab without government regulation and dispensed drups without so many restrictions. He sold them in little boxes that he filled and increased his profits thereby. We paid cash on the barrelhead and were glad to. At one time, we had major health problems in the family that he treated without collecting. He was paid years later without any collection efforts by him. Medicare, when it came, allowed balanced billing. He charged by his conscience and let patients file their own claims.
The solution to rural health problems, if there is really a problem, is first to remove regulatory barriers that make it non-viable in the free market. Let doctors opperate and make money off ancillary services and dispensing, and let them set their own prices like other businesses, the government having only the right to decide what it will pay, with the difference being between the doc and the patient.
One reason for the death of rural medicine is that third party insertion has eroded the bond between the doctor, the patient, and the community to the degree that it is no longer as rewarding as it once was.
Anon:10:50 AM-
In X-Men 2 when Nightcrawler asks Mystique (the shape changing one) that if she could alter her shape to appear human – why didn’t she?
Her answer?: Cuz she shouldn’t have to!
We shouldn’t be asking their people to change their last names/culture to adjust to America’s culture…because like it or not they WILL be incorporated into America’s culture in time.
I agree with Anon 7:53. The “shortage” of rural docs often is a lifesyle problem. Three docs in a town of 5000 want a fourth and fifth to take less call, but the actual demand isn’t that great, so the grow their clinic then start dragging pt.s in, promoting practices…Marketing.Create demand.
But the 3 docs might feel better about covering the ER every third night if they made more money….
I thought when rural states like Mississippi got tort “reform”, this was no longer going to be a problem?
You mean that we were lied to? Shocking!
I thought the war on terror had caused a crisis in Kansas after some tornadoes recently.
In the article, mention was made of the one-way trade in docs. They come here, but we don’t leave to go to the other countries.
Actually, most of those countries, it would be difficult for an American doctor to go there. Licensure is very difficult for foreigners. The USA is relatively easy.
–Anon 3:32
“Extortionist Rates”???
How about fair market value. The supply of rural doctors is low, so cost should increase.
We could import foreigners for every job and pay them lower wages. What do you do for a living? Why don’t we import more people of your profession to decrease costs?
To 3:32:
Extortionist rates or fair market value? Importing doctors offloads the costs of education on the countries that they came from. That might sound good to you, until you get outsourced yourself.
The attraction won’t be to come here and work for peanuts, not ever. There are other countries that doctors from eastern Europe, Africa and Asia willing to pay as well, and in many cases with fewer professional annoyances.
I don’t see any barriers to going to rural areas except for the fact that those communities usually are relatively resource-poor, with fewer employment opportunities, poorer tax bases to fund public amenities, including schools and hospitals and generally lower incomes which also mean in many cases higher public assistance burdens and poorer reimbursement on average to private doctors.
Flooding the market won’t be possible. That isn’t the solution to this problem, or any problem where there isn’t a strong market to begin with.
“Extortionist rates”? “Fair market value”?
How about paying the same rate as the cities? Rural areas are paid LESS for the same medical service.
I moved from a rural area to a big city. For a mid-level office visit, established patient, Medicare pays about 20% more in my new practice, a nice suburb of a big city. The private insurers tend to follow Medicare in that payment pattern.
Thank you for reaffirming my hypothesis. There just are not enough providers in this country such that market forces dictate that providers must practice in rural and urban areas at the compensation levels offered in order to remain in practice. Perhaps one day the intellectual level of the populace will rise above that of cold fish and they will come to easily discerned realization that the current system serves, as primary beneficiaries, others besides themselves.
The last poster doesn’t get the idea that practice in many rural areas is just not feasable on any terms that relies on the ability of the local market to pay.
Even if you flooded the overall market so as to make city/suburban practice less profitable for the providers does not make the rural practice that could not support even a willing provider before suddenly able to afford that provider after. “No market” is in fact a prevailing market condition. That won’t necesssarily change by flooding other markets to the point of minimum profitability. All it will do is drive providers into other lines of work.
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