Now that President Trump has signaled his support for the RAISE Act, many Americans are being forced to think about the merits and pitfalls of our legal immigration system. One key problem that has received no attention is how the large-scale immigration of foreign physicians has contributed to the atrophying of U.S. medical schools.
Specifically, America’s universities can no longer train enough medical practitioners to meet the nation’s health care demands—America relies on the immigration of foreign professionals to maintain its health care system and standard of living.
In a sense, we rely on imported physicians like we rely on foreign oil.
Before beginning, let’s be clear: there are more physicians per capita in America than at any other point in the nation’s history. The same goes for nurses, physiotherapists, and mental health professionals. This is good. But it’s also worth examining how we got here: was the process organic, or artificial? Do we, as a country, actually have the educational infrastructure to train that many professionals, or are we living in a consumption bubble?
Unfortunately, we are in bubble territory. In 1982-1983, America graduated roughly 16,000 physicians. This number has barely budged since. In fact, in 2015 America graduated just 18,705 physicians—that is, 17 percent more. During the same period, America’s total population increased by 39 percent, from 231.7 million in 1982, to 322 million today.
In a closed system, we would have expected to see the physician-patient ratio deteriorate over the last few decades—but the opposite has happened. Why?
According to data from the Migration Policy Institute, nearly 17 percent of America’s 12.4 million healthcare professionals (including physicians, nurses, dentists, and therapists) are immigrants. They more than make up for America’s training deficit. Out of interest, the percentage of foreign-born surgeons, as a sub-category, is even higher, at 28 percent. For nurses, it is 24 percent. The data is unambiguous: America’s healthcare system needs immigration to function.
Why does any of this matter? The legal immigration of physicians, and medical students, is clearly a good thing, since it provides us with a better quality of life. This is true. But, too much of a good thing can also be harmful. Immigration is causing two large problems: First, the displacement of American students with more profitable foreign students, and, second, systemic atrophy.
The first challenge is relatively straightforward, and doesn’t warrant much discussion. Essentially, there are a finite number of spots in U.S. medical schools, and an increasingly large percentage of those spots are allocated to foreign students, who are often charged extra (and are therefore more profitable).
This denies a large number of American students access to good educations and lucrative professions—all because of profit-incentives. This is, in fact, the main reason why native-born Americans are being locked out of professional programs; it’s not that Americans are dumb; it’s that foreigners out-bid them. My point is that America’s higher education system should work in our national interests, that is the promotion and education of American talent, rather than fleecing wealthy foreigners.
On the second point: America’s medical schools are atrophying, and our health care infrastructure is now wholly inadequate to keep pace with increasing demand. In the time before mass immigration, if America’s population increased, America needed to train more physicians. That meant more investment in universities and education, in better training programs, and so forth.
Immigration provided a shortcut, and because of this our education system is 40 years behind. First, it is relatively small—we should be graduating roughly 30,000 physicians annually to maintain our current physician-to-patient ratio. Second, training programs are becoming dilapidated relative to other Western or even developing countries—there is a strong preference for, say, Canadian or Filipino nurses in U.S. hospitals because our own programs are relatively poor or lack capacity. This is a rather biting fact, but it is a fact nevertheless.
Immigration may be a shortcut to better healthcare, but it’s also a short-term solution. In the long run, we will need to invest in ourselves, and end the addiction to immigrant labor. Until then, we are simply injecting fragility and dependency into the healthcare system.