You're making valid points, however:
.....For example, lets say a region of the country is drastically underserved, so the local politicians use their clout and get a few more funded residency spots for some of the hospitals in that region in the specialties needed. If the person who fills that residency finishes and then leaves the country the region stays underserved and the region is worse off because they just spent 6 digits a year training someone who was not part of the solution. ...
Regardless of immigration status, underserved regions have a problem retaining their doctors. In fact, there's a program in place to fill these vacancies with international physicians offering permanent residency/tax breaks as long as they stay in rural areas for >5 years.
....Residency is thus very different than, say, education. For education, you charge someone money to teach them, and so if they leave after they finish school, at least you got whatever you felt was fair value for their education in the form of tuition. And you can always add another spot if Y% of the people you teach up and leave each year. Residency is the opposite. The government and hospitals fund these spots, and the person taking the spot gets a salary, and the spots are limited to determined need. It's not possible to simply add a spot because someone isn't staying in the US. So someone who takes this spot not only provides a service and gets a salary, but really also becomes part of the "mission" to provide needed service to the community in that specialty post-residency. The specialty has already determined it NEEDS X more doctors to stay in the US and practice in that specialty. So anyone planning to leave means the patients of that specialty got shortchanged -- the demand is not met. And when the government and government funded institutions, whose job it is to ensure that their constituents get the medical care needed in the various communities, pull the purse strings, it is very reasonable that they choose to focus on people most likely to stay....
If this is taken to the extreme (many trained residents in the U.S. leaving the country), YES! You're totally right, this would be a big problem. I find hard to believe that the U.S. government doesn't account for people stopping practicing for various reasons (i.e. sickness, death, raising a family, even winning the lottery and retiring early...).
My point is: We're in a globalized world, and talent from other countries will benefit the system. I'm NOT saying that we should have priority over AMGs, but we should have the opportunity to learn and contribute to the system.
....As mentioned, foreign medical grads provided a great interval service for a while, as US med schools didn't meet US residency needs. This has been more or less corrected. It has nothing to do with better or worse applicants, just the notion that US med schools should be meeting US needs, and that citizens and PERMANENT residents should be filling these spots, because this is who is going to stay on. I expect the fall off of FMGs getting spots to continue to be fairly drastic from here on out, and expect the weaker offshore schools that focus on US residencies to have to close their doors in the not too distant future....
For many years, one of the biggest strengths of this country was the drawn talent from all over the world (entrepreneurs during the industrial revolution, researchers during the I/II world war, visiting scholars who will eventually make huge scientific contributions --check your Drs./Professors' last name, I can guarantee you some are from overseas).
Recent chances in the immigration policies have scared away many talented individuals, and the side effect is that offshore schools will become stronger than ever.
What you're proposing is to protect AMGs by "Regulations". But you'll missing some of the brightest individuals in the planet, what do people prefer? The "best American doctor" or the "best doctor" they can have?
....citizens and PERMANENT residents should be filling these spots....
I'm a permanent resident of the U.S. as an "alien" of extraordinary ability. My work has benefited the U.S. citizens and even the government has seen my value. BTW, this is the case for a large number of FMGs.
