Trump, Immigration, and Healthcare providers

Today MCM is honored to bring you a guest post authored by the Sedgwick Institute’s Rick Victor, PhD.  Rick is the former CEO of the Workers’ Compensation Research Institute, and a colleague and friend as well.

The post begins below; emphasis was added by MCM.

Trump Immigration Rhetoric and Actions

Risk Higher WC Costs and Slower Return to Work

The Trump immigration actions and rhetoric will significantly worsen the doctor shortage. The Association of American Medical Colleges (AAMC) reports a deficit of 8200 primary care doctors in 2016. It predicts a shortage of nearly 95,000 doctors by 2025. As of 2010, 27% of US physicians were foreign born – 230,000 physicians. Fortunately for US patients, that number has increased each year. Given the large number of baby-boomer physicians who will retire in the next decade, we increasingly rely for our care on foreign born doctors.

The Trump travel ban, rhetoric and recent actions to detain and deport immigrants are creating direct impediments to immigration of needed medical personnel, and a hostile environment for many healthcare workers who consider immigrating to the US for training or jobs. It is in our self-interest to encourage the best and brightest come to the US rather than embracing public policies and rhetoric that repel them.

Seven thousand US physicians were born in the six countries covered by the Trump travel ban. These doctors provide 14 million patient-visits each year. Especially affected are patients in Michigan (1.2 million visits), Ohio (880,000 visits), Pennsylvania (700,000 visits) and West Virginia (210,000). In areas with current doctor shortages, the doctors born in these 6 countries provide 2.3 million patient-visits each year. [The Immigrant Doctors Project used US government data to create a map showing the adverse effects on each local area in the US https://immigrantdoctors.org/.

The negative impact of the Trump travel ban on our healthcare system is much broader than this. First, the rhetoric and initial actions have created substantial uncertainty (and inhospitality) for immigrants from many countries, not just the six listed in the travel ban. The best and the brightest of these have many options other than the US.

Second, both those currently working and training in the US and those considering immigration for training and/or better living conditions are also affected. For those currently training in the US, they wonder if they leave the US to visit family, will they be allowed to returned. When their training is completed, will they be allowed to stay? For those considering training or relocating to the US, they are making a multi-year commitment – mid-course disruption would be very costly to them. The uncertainty created by the recent rhetoric and government actions make the decision to come to the US an increasingly risky one.

Third, we rely heavily on non-physician healthcare workers – 1 in 6 of US healthcare workers are foreign born (nearly 2 million). Forty percent of foreign born healthcare workers are from Asia and the Middle East.

Each year, the US healthcare system depends heavily on immigration to meet the growing demand for healthcare services in the US. Between 2006 and 2010, the number of foreign born US healthcare workers grew from 1.5 million to 1.8 million – adding 300,000 new immigrant healthcare workers.

The US healthcare system relies heavily on foreign born doctors and other healthcare workers. Each year, its reliance grows. The demands on our healthcare system are growing substantially with the aging of the population. Current doctor shortages are predicted to growth dramatically, even if the past patterns of immigration continue. The Trump rhetoric and actions on immigration will impair the flow of healthcare workers immigrating to the US. We will all be worse off as wait times grow and access to needed services becomes more difficult.

Foreign born doctors have choices about where they work. Opponents of single payer models of healthcare financing often cite the longer wait times for patients in single payer systems like Canada and Britain. How ironic if US immigration policies end up reducing wait times in Canada while increasing our wait times.

14 thoughts on “Trump, Immigration, and Healthcare providers

  1. Is a fundamental problem in here in our country simply that US citizens’ work-related expectations are so high that they aren’t willing to make the effort – either through years of training or years of just plain hard work – to be effective, valuable workers in the existing job market? Or am I just far, far too cynical?

  2. From what I have heard it is a temporary ban while they ensure that appropriate vetting processes are in place. Plus, I would have to believe that physicians in the US make better money than in other parts of the world. Wouldn’t the lure of money ultimately overcome any extra hassle? I’m not necessarily a big fan of the President but I’m not sure it’s productive to blame him for every ill we face. It’s quite possible that the millennial lust for quick and easy solutions and free access to everything is more of the problem since struggling through and paying for 8 years of post graduate training may be too much for them. Why blame a ban that so far hasn’t happened?

    • Hi Brian – thanks for the comment.

      I believe Dr Victor’s perspective is that the ban is just part of the issue; the hateful rhetoric is equally if not more damaging, especially as it has incited incidents against people of color.

      Re the “vetting”, this is just nonsense. The background checks, security checks, and other research into potential visitors that have been in place for years is incredibly detailed and thorough.

      sources

      http://www.politifact.com/california/statements/2017/feb/03/tom-mcclintock/americas-refugee-vetting-already-robust-not-haphaz/
      http://www.npr.org/2017/02/03/513311323/former-immigration-director-defends-u-s-record-on-refugee-vetting
      http://www.politico.com/magazine/story/2017/01/i-went-through-americas-extreme-vetting-214703

      • Thanks Joe. I assume that if there are appropriate checks in place that the ban would be short lived? I don’t know. I do share your concern about rhetoric. I belong to a faith that has been driven from places, condemned, maligned and even had an insulting Broadway play made about it, all in this country. So I understand the harm of hateful rhetoric. But it comes from many sides and seems to be how we now deal with conflict in this country. I also think it is important that we have honest dialogue about the problems we face and work together to solve them. I don’t see so much of that in politics because both sides are afraid the other will get the credit. I also think that many of the problems we face pre-date Donald Trump and we need to get past the election and start working on solutions. That might mean we have to work with people we don’t always like or respect. That doesn’t mean we can’t be likeable and respectful, ourselves. One thing I wish Rick would have addressed is how many doctors per year immigrate from countries where the ban, if implemented, would impact. How significant would it really be? And what can we do to recruit young people in this country to travel the hard road and become doctors?

        • Brian – I agree that Trump is the result of a poisoned atmosphere and electorate – his hateful rhetoric about Mexicans and Muslims has given many the idea that this language and way of thinking is somehow acceptable. Unfortunately our country’s history is replete with examples of this awful behavior.

          I don’t think the data on physician immigration is available; knowing Rick he’d have it if it was. The proxy is the current number of immigrant healthcare providers which at least provides a sense for their impact, and the shortage statistics going forward for possible future effects.

          thanks for the thoughtful comment.

  3. I’m sorry Richard and Joe, but this is just more liberal hype trying to make something an issue that really is not. This will have ZERO impact on workers’ compensation and there is no factual basis for you to claim otherwise. You might as well claim the immigration order will slow efforts to cure cancer, or solve world hunger, because there is a chance someone delayed entry to the United States due to additional vetting holds the key to these issues.

    You are blaming Trump for the physician shortage that has been around for years and will continue into the future. The cause has been well established previously. Medical schools in the US did not increase capacity to meet the growing needs of our aging population. Thus, more physicians trained by medical schools outside the United States are needed to treat patients here. Yes, the problem lies in the education system, not immigration policy.

    The travel ban is TEMPORARY. Why can people not grasp that simple fact. These are all countries identified by the OBAMA administration as being high terrorist risk and lacking a centralized government for adequately vetting travelers. The travel ban is there to allow time to develop adequate methods to deal with this situation long term.

    If there are really thousands of practicing physicians in the US from those countries (which I am skeptical of) then this temporary travel ban has ZERO impact on their ability to continue practicing medicine in the US. Those people moved here long ago, and are very likely already naturalized citizens.

    There is ZERO basis for the statement “The Trump rhetoric and actions on immigration will impair the flow of healthcare workers immigrating to the US.” Really? This TEMPORARY freeze of people coming here from Somalia and Syria will impact healthcare? Could there be a few individuals impacted? Yes. Will this have a fundamental impact on the US healthcare system? No.

    Finally, foreign born physicians have a choice to where they immigrate. And the choose the US because of the high quality of life and significantly higher income potential for physicians than other countries. This TEMPORARY ban will not have a significant impact on this.

    • Mark – thanks for the comment. A couple observations.

      1. This is NOT liberal anything. I don’t know why you find it necessary to label Rick’s position as such. Facts aren’t liberal or conservative or anything else. They are just facts.

      2. This is NOT just about the travel ban. As Rick pointed out, the vilification of immigrants itself is leading many to rethink the US as a destination.
      sources
      https://www.ft.com/content/d8d3402a-1540-11e7-b0c1-37e417ee6c76
      https://www.usatoday.com/story/news/world/2017/03/29/trumps-travel-ban-could-cost-18b-us-tourism-travel-analysts-say/99708758/

      3. In contrast to your claim there is “ZERO” basis for Rick’s statements, there is a wealth of data pertaining to this issue, including research on the thousands of physicians from these countries. I suggest you read the article referenced below for more detail.
      http://healthaffairs.org/blog/2017/03/06/the-immigration-ban-and-the-physician-workforce/

      • I do not think this country is anti-immigrant. There are elements in the media pushing that narrative but that does not make it true. This country was build by immigrants. Almost all of us are here because our relatives immigrated here. We are a country of immigrants.

        Personally, I don’t think I have had an American born family physician since I was a child. Foreign born physicians are an essential part of our healthcare system. No one is questioning that. Immigrant physicians are not being kicked out of the US because of a temporary travel ban from certain countries. It is unsubstantiated hype to say this temporary travel ban will lead to significantly increased physician shortages in the US.

        • Mark – Again, you misstate what Rick said, Trump’s rhetorics AND the immigrant ban are the issue – not the travel ban itself.
          The cites I provided support that view.

          Further neither he nor I suggested foreign born physicians are being “kicked out”, rather that some who are not citizens may be concerned they will not be allowed back in if they leave. There’s been many examples of this occurring before the courts suspended the bans.

          Finally, if you read the cites you will see Rick is asserting that the ban/rhetoric MAY impact physician immigration. Lastly, as you will see from the cites I provided, it is NOT “unsubstantiated hype.”
          Again, I suggest you read the Health Affairs article.

  4. I am straying a bit from Dr. Victor’s post but wanted to respond to some of the comments.

    The US needs immigrants and will need more of them in the future. The US birthrate is at its lowest point since 1909 (the year recording keeping began) with just 62.2 births per 1,000 women aged 15-44. (https://www.cdc.gov/nchs/products/vsrr/natality-dashboard.htm) We need immigrants and youth to stimulate our economy. I am uncomfortable with rhetoric and think it is harmful in the US and abroad.

    I find it demoralizing that we continually beat up millennials as lazy, selfish, and entitled. Like it or not they are the future and someone raised them (you?) I suspect there are a combination of factors resulting in less American born citizens becoming doctors – with debt being a big one. The median education debt for a physician was $190,000 in 2016. (https://news.aamc.org/medical-education/article/taking-sting-out-medical-school-debt/)

    We need immigrants and millennials for a vibrant economic future. Blaming them for all the problems is probably not the best way to engage.

    • Thanks Jennifer – this is an important comment. My 2 physician daughters have huge educational debt; it’s an enormous disincentive for young physicians who might otherwise consider primary care (which includes occ med). Think about how long it’s going to take to pay off big debt at office visit fee schedule reimbursement for a WC patient. Mark Walls is correct that this is not a new problem, but incorrect regarding the prevalence of immigrant physicians. For a wonderful perspective on this, read My Own Country by Abraham Verghese. On the supply/demand issue, it’s more complicated than just medical school capacity, which has increased – it’s also residency slots, among other factors such as poor public policy around this issue.
      The rural areas of the country, as Rick correctly notes, are the ones most often served by immigrant physicians, and will be impacted. I have no insights into how “temporary” the travel ban might be, but I agree with Joe that the rhetoric is influential beyond the actual ban. I do think that it’s hard to predict how much this will impact WC – which already uses a lot of nurse practitioners on the front lines – but it’s an issue worth some continued attention.

  5. Allowing Obamacare to collapse isn’t the political trump card the president assumes
    At the heart of Trump’s comments is his continuing disinterest in building coalitions that extend beyond the people who already like him. He can’t executive-order his way through everything, and some of his policy choices will require him to reach beyond the people who already stand with them. This health-care fight is a good opportunity to do so, an opportunity that the president doesn’t seem to be embracing.

  6. There are also dozens of nurses that work in the metro Detroit area that come across the Canadian border. While this particular issue was resolved, it is worrisome that any visa volumes might be reduced.

    Limitations on nursing class sizes also needs to be addressed. There should be no reason these jobs can’t be filled by Americans from nursing schools. As a Baby Boomer I know we are all going to need a lot of care.

    http://www.freep.com/story/news/local/michigan/2017/03/19/canadian-specialized-nurses-visas/99390430/

  7. Just caught this posting. Has anyone commented on the impact of US immigration on health resources in those countries that often paid or heavily subsidized the training of their own citizens, who then split for the US for the obvious reasons? At the same time we export charity and resources to address developing world health issues, we short-change many of the same countries by removing their skilled professionals. While it is not our job to stop this impact on other countries, it is something to think about. And I certainly can’t fault a colleague who wishes to move for better opportunities, whether quality of life, economic or others.

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