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Graduate of the University of Oregon, Married for 4-1/2 years to my High School sweetheart. I am currently residing in Cleveland while I attend med school.

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    Monday, February 09, 2009

    RE: Sacha

    Sacha left some lengthy comments on my previous post, and I felt responses would be more appropriate as a new post. I'm not that interested in addressing all Sacha's points, considering my original post was an off-the-cuff opinionated response. Regardless, I thought some deserved attention.

    You're putting in a lot of hard work to get that medical degree. Then you will work very, very hard as an intern and resident. What if graduates of foreign medical schools could be brought in to work at lower wages?


    They can. Unfortunately, many residency programs, as well as the USMLE create artificial barriers to their successful employment (medicine is little more than a union). This summer and past fall I worked with an Iranian-born surgeon who attended medical school in the UK. Despite scoring a 99 on his american licensing exams, he is having trouble finding employment. It certainly is a boon for American born students who don't have to meet the same benchmarks, but it hardly seems like its in the best interest of their patients.

    Suppose that the medical field operated in a less restricted market, and more foreign-trained physicians could enter the field. You're right that if they worked for less pay, then physician reimbursement would drop, and health care costs would be (slightly) reduced, without a reduction in quality of care...in fact, more likely an improvement in quality of care. It certainly wouldn't help me, as an individual with a clearly invested interest, but it would certainly be of benefit to society as a whole. And if the reimbursement rates dropped, then smart people who otherwise would have been doctors will go into other professions: dentists, lawyers, PhD's, engineers, etc... where they will be more lucratively rewarded.

    Besides, since when is competition a bad thing? By your same train of logic, we should prevent the importation of foreign produced products. If Honda weren't allowed to sell cars on US soil, clearly General Motors would be better off. Without needing to worry about producing quality products at an affordable price, they would be virtually guaranteed people to purchase their products. Sounds great.

    Also, in your original blog post, you talk about how "An engineer who designs a new products creates jobs: secretaries, product testers, factory workers, people to market the product..." really? I don't think an engineer gets his/her own secretary, and the product testers and factory workers are likely located in Malaysia or Taiwan. It may create marketing jobs, but do we really need more people to go into the "sales" profession?


    My father is an electrical engineer (and he has had his own secretary in the past, incidentally). Just to cite a concrete example, several years ago he designed a new, state of the art product. Sales went up. People in the factory (located in the US, fyi) couldn't work enough overtime to meet demand, and the company hired more people to help build the products. Furthermore, the company hired 2 additional engineers to help with R&D. At his current employer (also with factories in the US), things aren't much different.

    The same is true for numerous other professions. A surgeon can't exist in isolation. Consider a simple total-joint-arthroplasty. There are multiple nurses and tech's in the OR with the surgeon, not to mention those in pre-op and post-op. An anesthesiologist is required for the procedure. People are employed to clean up the room after the surgery, to manufacture and sell the prosthesis, people paid to bill for the procedure, people involved in the supply chain that got the prosthesis to the hospital...and secretaries to schedule the surgery, schedule the blood donation, coordinate the OR schedule, etc....

    3 Comments:

    Anonymous Sacha said...

    "This summer and past fall I worked with an Iranian-born surgeon who attended medical school in the UK. Despite scoring a 99 on his american licensing exams, he is having trouble finding employment."

    Unless you are going to allege discrimination in hiring the Iranian-born doctor, then it appears that the market for physicians isn't very good right now, so it doesn't seem to be a good idea at all to bring in more physicians.

    It's not just a matter of you as a person not wanting competition. It is a matter of whether people based in the U.S. will go through with very expensive and difficult medical training when the country starts allowing in significant numbers of foreign competitors who are willing to work for less in the U.S. when there is probably a shortage of phsyicians in their countries of origin. Physician's wages are already considered low in certain specialities. I have read and heard accounts that for general practicioners, the financial return is not that good.
    Once word gets out that a medical degree is not worth it financially, shortages of doctors become a self-fulfilling prophecy. Furthermore, I have been informed by a doctor and have read articles that the best minds are already not going into medicine because the financial return is not adequate given the effort and expense of aquiring the credentials.

    7:47 AM  
    Anonymous Sacha said...

    Continuing with medicine, I'm all for it if a person can meet the standards of a profession, speak English, and then enter the United States to practice the profession. I'm the one who mentioned the USMLE in the first place.

    But you say, "Suppose that the medical field operated in a less restricted market, and more foreign-trained physicians could enter the field"

    It's unwise to put life and limb at risk by seeing doctors educated in nations where the quality of medical education is unknown-- unless those doctors have passed a rigorous examination that assesses their fitness to practice medicine in the United States.

    With regards to your father, that is a specific case of a person who is a good enough engineer designed a new, state-of-the-art product. He had a secretary. Factory located in the U.S..

    Unless everything I am reading is dead wrong, your father's experience is simply not typical. Also you said it was "several years ago." I'd love to know exactly how long ago it was. Outsourcing has accelerated significantly in the past 10 years. I have to go out of my way to buy American, and it sometimes it is impossible.

    Do you understand that you need to reason from part to the whole, known as inductive reasoning? Just because your father had a certain experience, does not mean the whole engineering field is like that.

    "By your same train of logic, we should prevent the importation of foreign produced products."

    Dead wrong. I wrote, "We have signed international agreements on free movement of goods, capital, and some services across borders. We do not have free movement of labor across national borders at this time, and I thnk that is for good reason."

    To re-iterate and clarify, a reasonable amount of immigration is good. Immigration to the point where it reduces the value of a hard-earned technical degree is not good. Immigration to the point where it really hurts the working class is not good. And all that is what is happening in this country today.

    What you did in your reply post is apparently NOT read the articles I supplied.

    You as much as admit it: "I'm not that interested in addressing all Sacha's points, considering my original post was an off-the-cuff opinionated response."

    You are just basing replies on your personal experience, and failing to reason that the full reality may not be in accord with the limited number of datapoints that you have.

    Here is the website that contains the Rob Sanchez Job Destruction Newsletter:

    http://www.zazona.com/shameh1b/H1BFAQs.htm


    Massive immigration is about nothing more than lowering the wages of ALL employees, to the benefit of employers and the detriment of the continued existence of the United States as a cohesive nation. You have been informed of the situation.

    If you want to continue with your head in the sand, all I can say is, you have been warned.

    8:26 AM  
    Blogger The Gentle Cricket said...

    "I have been informed by a doctor and have read articles that the best minds are already not going into medicine because the financial return is not adequate given the effort and expense of aquiring the credentials."

    So, we have a need to fill a position, which is financially unappealing to domestic-born students, as well as skyrocketing health-care costs..Yet you argue that perfectly qualified foreign-born physicians, who can pass our licensing exams in the 99th percentile should be excluded? If there's a shortage of physicians, why not fill the shortage with qualified physicians from Canada, India, the UK, China, or wherever? That makes no sense. For a decade there were no domestic television producers...should we have banned Sony from selling televisions in the US? Should we now ban Japan from importing soybeans? If we have a demand that exceeds domestic supply, why not import the good, especially if its at a cheaper price?

    I'm not advocating Massive immigration or open borders, as you seem intent to imply. Rather, its my opinion that smart immigration policy would allow greater yearly citizenship for professionals, who will create jobs for the middle class and the poor/unemployed.

    "It's unwise to put life and limb at risk by seeing doctors educated in nations where the quality of medical education is unknown-- unless those doctors have passed a rigorous examination that assesses their fitness to practice medicine in the United States."

    No one is arguing otherwise, and, in fact, to practice in the US you must pass USMLE (or certain equivalents). Yet, as I highlighted before, that hardly guarantees your ability to get residency placement. Instead, various residencies restrict acceptance to american-born applicants (thus, you place your life and limb in the hands of those who are not the best and brightest).

    The first example I listed of my father was ~8 years ago. He is still with his current employer, which I also cited. Guess what? When they are approached by a customer for a specifically designed product, my father (or another engineer) designs the product. Of course, someone else took the order. Someone else builds the prototype. Someone else does the product testing, and then many people work to mass produce them, bill the customer, etc... Alternatively, I worked for a surgeon in private practice. He had 7 full-time employees and two part-time employees. Guess what happened to those 9 people when he retired? They lost their jobs. This is so common sense that I can't believe I even have to say it.

    "We do not have free movement of labor across national borders at this time, and I thnk that is for good reason"

    I'm not arguing for free movement of labor across borders. I'm stating that our immigration policy should encourage the immigration of highly-trained professionals, those that can contribute to the growth of industry.

    "What you did in your reply post is apparently NOT read the articles I supplied."
    I most certainly did not read them. The problem with social science questions like this is that for every article in support of topic A, there is another in opposition to topic A. I've read plenty on the subject of immigration (from both economic and social science perspectives) to formulate an opinion, so I don't need to read articles published on a website with a clear agenda.


    Just for fun, you state: "You are just basing replies on your personal experience"...but you also say..."Furthermore, I have been informed by a doctor and have read articles that the best minds are already not going into medicine" and "I have to go out of my way to buy American". That sounds an awful lot like personal opinion and experience.

    You also state "Just because your father had a certain experience, does not mean the whole engineering field is like that."...but you also provide the following: "Check out this video of an immigration lawyer counseling companies on how to recruit H-1Bs while avoiding hiring qualified American workers".

    Sacha, just because one immigration lawyer acts irresponsibly, doesn't mean the entire field is like that!

    6:11 AM  

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