This is correct. My mother (anaesthetist/GP trained in India, practiced in Britain for 25 years) retired at the age of 50 (ie., when we moved here) because she didn’t want to complete a third residency and standardized testing of some sort.
I believe what Rumor_Watkins is referring to is the ease of actually immigrating, not of going into practice- it’s much easier to get a work visa or green card with a high-demand qualification like an MD.
gitfiddle, your friend is manipulating the facts (presumably to suit her political arguments).
Doctors do come here in droves. They do not come here in droves because “they’re fed up with socialized medicine”. They come here because the overall standard of living is better and because physicians specifically make a lot more money here than they do in any universal-care system. I suppose they are fed up with socialized medicine in the sense that it doesn’t pay as well, though.
Offset this with the recent trend of Americans going overseas for both elective and non-elective procedures because physicians and other influences have driven up the cost of US medical care. It’s not exactly common, but certainly no longer unheard of, for regular people to go to countries like Mexico, India and Thailand for health care services.
The above is from an episode of All Things Considered on NPR. If you Google “Medical Tourism” you’ll find a lot of info on this trend.
Except those externalities aren’t germane to a doctor who is looking to increase his own amount of wealth while he’s living.
And considering that MDs who run their own private practices can easily find themselves with a good portion of their taxable income taxed at the highest marginal tax rates, I’d contend that the tax burden is WAY lower in the US than in Canada. I would also suspect that that study only looks at federal taxation - there is a large disparity in some states’ income taxes as compared to provincial taxation.
Top Marginal State/Provincial income tax rates:
Ontario: 11.16% on the amount over $73,698 (6.05% on the first $36,848 of taxable income)
New York: 6.85% on the amount over $20,000
Texas: 0
Basically, that study is probably accurate for a median earner. Probably not so much for the wealthy.
Yes, that’s what I meant, it’s easier to immigrate (no clue about the medical re-licensee process). Sorry for the confusion.
Partly. It’s mostly related to the AMA’s recommendation to limit medical school places, which means we’re currently about 100,000 doctors “short”, and will probably be short twice that number by 2020.
The population has risen by 50,000,000 since 1980, while the number of domestic MD graduates has stayed almost exactly level.
When demand outstrips supply, naturally prices go up.
If not for Medicare/Medicaid things would be even worse- they bear the majority of the cost of residency programs, and without them we’d have even fewer physicians.
Physicians will probably make a bit less under an American UHC system, but not that much less. Partly it’s because they’ll be able to spend a lot less of their revenues on billing and collections, but mostly because demand will still outstrip supply. In any case, part and parcel of any “socialized” medical system will have to be an increase in the number of med school places, which will reduce the cost of physician services “naturally” over time.
I agree that your analogy is flawed. Unlike gravity, the “pay gradient” isn’t the only thing moving doctors (or anyone else) around. I’m a medical student, and for moral, convenience, family, and somewhat nationalistic reasons, I plan to stay in Canada, or (if I travel) another socialised medical state.
If TV has taught me anything, it’s that doctors immigrating to the USA must first get a custodial job of some sort at a hospital, then save a patient’s life because of an incompetent intern or uncaring, busy senior physician. At that point, they can begin practicing medicine again.
The point of the analogy isn’t that “human migration patterns exhibit the same qualities as the gravitational effect upon water” it’s more “X may be a symptom of Y, but X was caused by Z, which is unrelated to Y” (yeah I put it in doctor-speak for you )
Basically, because there exists a big “demand puller” for doctor talent world wide called “the pro-doctor, anti-patient clusterfuck that is the US medical system”, you can’t really ever honestly examine the rate of doctor piss-offedness by discovering that doctors are flocking towards the big pull. A better way to see how fed up doctors are with their socialized system would be to compare rates of doctor migration between the socialized systems - the features of the US system are too asymmetrical to have any analytical use in assessing the relative merits of medical policy.
The follow-up was TiC - apologies if that didn’t come across well
The real issue driving this is not a lack of doctor in the USA but a distribution of said doctors. Americans who go through degreed programs and get an MD or DO (or even nurses or other medical professionals), who are Americans don’t want to practice in low income, urban ghetto or rural areas.
These areas found that while it’s tough to get doctors who were born and reared in America CAN get doctors from overseas to fill these areas.
This however creates a typical immigrant cycle where as the doctor from, say India, will come work in a poor urban area, till his contract runs out, become a citizen or permenent resident and move on to a nice area. Once again the area is underserved and then it “imports” another doctor from overseas.
That however isn’t a doctor thing that is an immigrant cycle that has existed since this country was founded with most professions.
Teachersare coming to the US in “droves” too (and alot more would if it were as easy for teachers to emigrate here as doctors), does that mean the public education system is a system that works perfectly in every way, and doesn’t need reform ?
An interesting observation: US citizens seem to be going overseas in droves to have elective surgery done. Myself, I’m going to have dental bonding done when I go to southeast Asia in december at $220 per tooth (US cost is a whopping $1400 per tooth). Gee, I wonder why those Thai dentists aren’t flocking to the states to get rich off of us cash cows.
This is why I don’t waste time looking for cites when I post on this board most of the time because no matter what you post or how relevant it is someone is always going to discount it without providing any rationale. Why don’t YOU find out how many peole leave the US to start their own practice? That cite supports the OP clearlyenough.
No it doesn’t, not without context. You can’t just throw out a number like “18%” and expect people to nod knowingly as if you have just said something profound. Is 18% a large number? A small number? No context, no relevance. You want the relevance? You supply the context, don’t just slide meaningless numbers over the transom and expect us to oooh and aaah.
I would say it’s reasonable to conclude from that 18% figure that physicians are more likely to come here from Canada than they are to leave here and go to Canada- and I’m on the other side of the debate from Cubsfan (I think). 18% is an awful lot, regardless of other traffic.
Your friend is quite wrong. EMTALA laws in this country protect anyone coming into an ER from questions about their payment until after they’ve been seen by a physician. Every hospital I’ve worked in has had a very strict wall between clinical personnel and financial folks in order to safeguard against these sorts of accusations.
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