Should the US stop the importation of Indian doctors?

[BlueCircle]

http://news.yahoo.com/special-report-why-indias-medical-schools-plagued-fraud-012140186.html


The article above highlights to very important issues:

1.) 47,000 Indian doctors are currently practicing in the United States obtained from a system plagued with fraud, deception, and of questionable quality.

2.) By importing Indian doctors, we are robbing an medically underserved country of much needed medical personell. This is highly contradictory to the humanitarian persperctive. We need to train more native born doctors IMO, not just import the rest.

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[deleted480308]

the humanitarian perspective does not call for stranding people in a place they don't want to be just because they are educated

 

[Gandyy]

Those are all mostly doctors who will be retiring soon though. Plus you still have to go through and complete a residency in the United States to practice in the United States.

If Residency Directors hardly give any spots to IMG's what makes you think they will give them to FMG's? Especially with the merger.

What I'm saying is that newer doctors coming in from countries with sub-par medical education still have to successfully complete a residency in the United States. Thats if they get them at all.

 

[chemist16]

I'm not sure how it works in India, but the article doesn't mention anything about licensing exams or exit exams. Either of those would go a long way towards fixing the problem in India, forcing schools to meet certain academic standards. Then again, there may develop a cheating infrastructure around the exam that would make it pointless. For an exit or licensing exam to work, it'd have to be administered by a third, uncorrupted party.

2.) By importing Indian doctors, we are robbing an medically underserved country of much needed medical personell. This is highly contradictory to the humanitarian persperctive. We need to train more native born doctors IMO, not just import the rest.

We're doing this in every sector. There is a so-called "brain drain" and talent drain from less developed countries to more developed ones. We have visas that are made specifically for researchers, doctors, lawyers, etc. I agree - this is morally wrong, but in the end, we are not one global nation. We are a conglomeration of nations, each existing to further the good of its own citizens.

the humanitarian perspective does not call for stranding people in a place they don't want to be just because they are educated

There's no moral basis for distinguishing between persons who are educated and ones who are not. In other words, I can just as easily say, "The humanitarian perspective does not call for stranding people in a place they don't want to be just because they are uneducated." But in reality, we do legally distinguish between such persons and I'm not sure there is a moral justification for that. From a purely utilitarian code of ethics, there is a basis for limiting the movement of one person or one class of persons if the great majority of society would benefit from it. Recall when Pele was declared a national treasure (though I'm sure one could argue if society really benefited from that).

 

[Lancer]

I'm not sure how it works in India, but the article doesn't mention anything about licensing exams or exit exams. Either of those would go a long way towards fixing the problem in India, forcing schools to meet certain academic standards. Then again, there may develop a cheating infrastructure around the exam that would make it pointless. For an exit or licensing exam to work, it'd have to be administered by a third, uncorrupted party.



We're doing this in every sector. There is a so-called "brain drain" and talent drain from less developed countries to more developed ones. We have visas that are made specifically for researchers, doctors, lawyers, etc. I agree - this is morally wrong, but in the end, we are not one global nation. We are a conglomeration of nations, each existing to further the good of its own citizens.



There's no moral basis for distinguishing between persons who are educated and ones who are not. In other words, I can just as easily say, "The humanitarian perspective does not call for stranding people in a place they don't want to be just because they are uneducated." But in reality, we do legally distinguish between such persons and I'm not sure there is a moral justification for that. From a purely utilitarian code of ethics, there is a basis for limiting the movement of one person or one class of persons if the great majority of society would benefit from it. Recall when Pele was declared a national treasure (though I'm sure one could argue if society really benefited from that).

Don't foreign doctors still need to pass the USMLE exams to be licensed to practice in the US before being able to go to residency?

If they can do well on the USMLE, I'd say that shows qualification

 

[chemist16]

Don't foreign doctors still need to pass the USMLE exams to be licensed to practice in the US before being able to go to residency?

If they can do well on the USMLE, I'd say that shows qualification

I mean how these poorly trained Indian doctors come to practice in India. In the U.S., the USMLE is quality control for sure. But do you know if there's an analogue in India?

 

[Law2Doc]

Don't foreign doctors still need to pass the USMLE exams to be licensed to practice in the US before being able to go to residency?
If they can do well on the USMLE, I'd say that shows qualification

No the USMLE doesn't show qualification. It's meant to be a bare minimum.

 

[Law2Doc]

... In the U.S., the USMLE is quality control for sure. ...

Not so much.

 

[chemist16]

Not so much.

It's quality control in the sense that people are kept to a certain standard. Sure, that standard may be very low, but at least there are standards. I wonder if there are any standards for practice in India and what ways people use to circumvent those.

 

[Law2Doc]

It's quality control in the sense that people are kept to a certain standard. Sure, that standard may be very low, but at least there are standards. I wonder if there are any standards for practice in India and what ways people use to circumvent those.

It's not on its own the standard. To get licensed you need USMLE AND some amount of residency training.

 

[chemist16]

It's not on its own the standard. To get licensed you need USMLE AND some amount of residency training.

How do foreign doctors get licensed to practice in the U.S.? It'd be kind of strange to have a 50 year old cardiac surgeon educated and practicing in the U.K. to come to the U.S. and do residency just to practice here.

 

[Law2Doc]

How do foreign doctors get licensed to practice in the U.S.? It'd be kind of strange to have a 50 year old cardiac surgeon educated and practicing in the U.K. to come to the U.S. and do residency just to practice here.

Strange perhaps but that's what most have to do. There are a few loopholes in some specialties but most of the time if you didn't train here you don't get to be a doctor here.

And that's why people who say -- "but I passed the USMLE" is just bunk. That's never been the end all be all hurdle.

 

[chemist16]

Strange perhaps but that's what most have to do. There are a few loopholes in some specialties but most of the time if you didn't train here you don't get to be a doctor here.

Interesting. Then that basically alleviates fears of unqualified Indian doctors practicing here then. All Indian doctors who are practicing here not only passed the USMLE but also redid residency here.

 

[Apollo1]

By importing Indian doctors, we are robbing an medically underserved country of much needed medical personell. This is highly contradictory to the humanitarian persperctive.

Not quite jingoistic, but shades of it.

If they passed all necessary exams and completed residency to the satisfaction of faculty, then they've earned their spots.

 

[Law2Doc]

Interesting. Then that basically alleviates fears of unqualified Indian doctors practicing here then. All Indian doctors who are practicing here not only passed the USMLE but also redid residency here.

Yep. There are a few loopholes -- I think in some fields you can skip residency and do multiple fellowships, but conceptually it's still the same. Plus to practice here you still generally have to sit for and pass a specialty board, which is a much more comprehensive test than USMLE. So i think the concern of Indian doctors coming here and taking jobs is a ruse. It's not happening.

 

[ZX10R]

For comparisons sake are you aware that 23,000 (MD +DO) student graduate each year? So every two years the US graduates are about the same number as total Indian transplants. I don't see this as a big deal because most of them get in by being someone or extremely smart.

 

[chemist16]

Yep. There are a few loopholes -- I think in some fields you can skip residency and do multiple fellowships, but conceptually it's still the same. Plus to practice here you still generally have to sit for and pass a specialty board, which is a much more comprehensive test than USMLE. So i think the concern of Indian doctors coming here and taking jobs is a ruse. It's not happening.

Well, I think that it is happening but not at a huge scale (http://content.healthaffairs.org/content/25/2/380.full). Sounds like over a thousand Indian-educated doctors migrate to the U.S. each year. If they can pass the USLME, residency, and boards, I don't see a problem with them practicing. That is to say, while I think that India is experiencing a brain drain of doctors, I don't think it's concerning to us here in terms of qualifications to practice.

 

[Gandyy]

Don't foreign doctors still need to pass the USMLE exams to be licensed to practice in the US before being able to go to residency?

If they can do well on the USMLE, I'd say that shows qualification

Yes you still have to pass the USMLE AND participate in a US Residency to practice in the USA.


MD>DO>>>>>>>>>>>>>>>IMG>>>>>>>FMG as far as obtaining a residency goes.

 

[Law2Doc]

Well, I think that it is happening but not at a huge scale (http://content.healthaffairs.org/content/25/2/380.full). Sounds like over a thousand Indian-educated doctors migrate to the U.S. each year. If they can pass the USLME, residency, and boards, I don't see a problem with them practicing. That is to say, while I think that India is experiencing a brain drain of doctors, I don't think it's concerning to us here in terms of qualifications to practice.

Numbers are so small it's not worth worrying about. Nobody from India is going to take your job. NPs might...

 

[Holmwood]

Well, I think that it is happening but not at a huge scale (http://content.healthaffairs.org/content/25/2/380.full). Sounds like over a thousand Indian-educated doctors migrate to the U.S. each year. If they can pass the USLME, residency, and boards, I don't see a problem with them practicing. That is to say, while I think that India is experiencing a brain drain of doctors, I don't think it's concerning to us here in terms of qualifications to practice.

Oh... that's a good point. What if the situation is getting worse because we sort of steal their highly competent docs? And they're just left with quacks. : O

 

[chemist16]

Numbers are so small it's not worth worrying about. Nobody from India is going to take your job. NPs might...

Well, if we take the above statistic to be correct - U.S. graduates ~20,000 medical students a year - then the Indian immigrant doctors make up 5% of new U.S. doctors each year. Not too concerning in terms of job prospects but this hasn't ever been about somebody taking your job. These same doctors who successfully immigrate here and pass the required exams to become a doctor are obviously the most qualified from their country. In a rapidly growing country with such poorly educated doctors, such a brain drain is concerning to say the least.

 

[Law2Doc]

Well, if we take the above statistic to be correct - U.S. graduates ~20,000 medical students a year - then the Indian immigrant doctors make up 5% of new U.S. doctors each year. Not too concerning in terms of job prospects but this hasn't ever been about somebody taking your job. These same doctors who successfully immigrate here and pass the required exams to become a doctor are obviously the most qualified from their country. In a rapidly growing country with such poorly educated doctors, such a brain drain is concerning to say the least.

Concerning to whom? India can impose whatever restrictions on its nationals as it wants. If they want to make it harder to get a med school education that one can take abroad they surely can. Really not our country's problem.

 

[chemist16]

Concerning to whom? India can impose whatever restrictions on its nationals as it wants. If they want to make it harder to get a med school education that one can take abroad they surely can. Really not our country's problem.

Concerning in a humanitarian sense. What's happening is you're taking the best and brightest a country can offer away from it. The only doctors who can come practice in the U.S. are the best and the brightest so all that's left in India are the poorly educated doctors. So the rich Western nations are getting better and better healthcare while healthcare in the poor, developing countries is getting worse and worse. If you think that moral responsibility is checked at national boundaries, then you're right, it's not our problem. But if you believe that national boundaries are completely arbitrary and provide no excuses for a lapse in moral responsibility, then you have a problem on your hands. Depends on your viewpoint.

 

[deleted480308]

Concerning in a humanitarian sense. What's happening is you're taking the best and brightest a country can offer away from it. The only doctors who can come practice in the U.S. are the best and the brightest so all that's left in India are the poorly educated doctors. So the rich Western nations are getting better and better healthcare while healthcare in the poor, developing countries is getting worse and worse. If you think that moral responsibility is checked at national boundaries, then you're right, it's not our problem. But if you believe that national boundaries are completely arbitrary and provide no excuses for a lapse in moral responsibility, then you have a problem on your hands. Depends on your viewpoint.

taking away an individual's freedom to pursue the life they want is not a moral imperative. If you are so concerned about india, go there

 

[Petrichor1]

ok here is where all arguments fall short: The doctors in India or any country in question still have to posit the step exams and they still have to be evaluated during internship. That by no feat is easy considering that this is a multi-lingual country that does not take its exams in their own language but in American english. The only brain drain that is occurring is for India to be losing its cream of the crop. I am sure that once residency placements become fewer by number and competitiveness increases in that arena too, international importation will cease subsequently. They learn that same material as medical students here and whatever they don't have in similarity they make up through residency and internship phase. You all are telling that the last 2 years (clinical terms in most medical schools) in an american medical school really make the difference between competency and incompetency when there is plenty more to learn? I have seen IMGs by a few numbers and they seem confident and are able to understand what is taught to them.

Concerning to whom? India can impose whatever restrictions on its nationals as it wants. If they want to make it harder to get a med school education that one can take abroad they surely can. Really not our country's problem.

It is interesting that India can impose regulations to prevent its graduates to go off internationally but if these doctors don't take loans out to study and are able to furnish their own education, why would a democratic country hold them back? Are we talking about dictatorship or communism here?

Also for what it's worth, this is concerning people from country with 1 billion people. So it would be the largest supplier of IMGs as no-brainer; especially since these doctors come from very educated families.
I have not had my education to believe in a yahoo article by the way. This was a thread made by a troll; good job. The proper resource is the following which compares apples to apples:
http://www.rand.org/content/dam/rand/pubs/occasional_papers/2008/RAND_OP212.pdf

 

[chemist16]

taking away an individual's freedom to pursue the life they want is not a moral imperative. If you are so concerned about india, go there

Where are you getting the idea that I want to take away an individual's freedom to pursue the life he/she wants, good sir? I've argued that under a purely utilitarian viewpoint that would be justifiable but I believe that every man has the right to choose his own destiny. In simpler terms, I'm not utilitarian. Your world is too black and white. You don't have to take away someone's right to move to keep him/her in place. You just have to incentivize staying. Clean up the medical profession there, make the job more prestigious, greater benefits for doctors, etc.

 

[chemist16]

It is interesting that India can impose regulations to prevent its graduates to go off internationally but if these doctors don't take loans out to study and are able to furnish their own education, why would a democratic country hold them back? Are we talking about dictatorship or communism here?

A government exists (conceptually) to further the interests of its people. Having your best and brightest leaving your country is not furthering the interest of your people. You're right - it is not the role of a democratic government to hold these people back. But it is the role of any government to act in the best interests of its people. So, don't hold your doctors back. Just give them more incentive to stay. That's the free market way.

(Also, a communist state is not necessarily authoritarian. In fact, communism refers only to a mode of economy, not a political philosophy).

 

[deleted480308]

A government exists (conceptually) to further the interests of its people. Having your best and brightest leaving your country is not furthering the interest of your people. You're right - it is not the role of a democratic government to hold these people back. But it is the role of any government to act in the best interests of its people. So, don't hold your doctors back. Just give them more incentive to stay. That's the free market way.

(Also, a communist state is not necessarily authoritarian. In fact, communism refers only to a mode of economy, not a political philosophy).

reappropriating the fruits of someone's labor is pretty authoritarian

 

[Petrichor1]

A government exists (conceptually) to further the interests of its people. Having your best and brightest leaving your country is not furthering the interest of your people. You're right - it is not the role of a democratic government to hold these people back. But it is the role of any government to act in the best interests of its people. So, don't hold your doctors back. Just give them more incentive to stay. That's the free market way.

(Also, a communist state is not necessarily authoritarian. In fact, communism refers only to a mode of economy, not a political philosophy).

I think the incentive of opening their own business and having a fee-for-service structure should be enough. I know plenty of doctors there that have pharma companies and own hospitals to say that incentives are plenty. The best part is that doctors actually have a normal work hour day and they get to relax with the family every single day; yes you heard me. So I don't know how much incentive is too little in this case. To say that the government doesn't try to give the best appropriations is superficial understanding. India has a competent pool of doctors and you will come across them in every city; it isn't deprived ya know; the article is just the indian style of sensational journalism; while it is true, no educated individual would go to the hospital that doesn't have good reputation. Sadly, the poor will. The US maintains its education standards and that is what India should focus on; they should provide great facilities for doctors to learn. This is what they need; they don't need to sell themselves to their own nationals. Rather they need to dictate their healthcare system with the utmost strictness at all levels to improve standards. The last thing they need to worry about is keeping their smart doctors, because let's be honest; as mentioned, people have various reasons to go abroad despite the best of appropriations by government. Do you not have doctors that leave the US to practice?

 

[Law2Doc]

Being a doctor is prestigious and well-compensated in India. But nowhere near the prestige and compensation to be gained by moving to the U.S.

The reasons Indians — including doctors — leave India are many and complex. It is no easy fix to convince doctors, or any Indian who can emigrate, to remain.

Well the same "easy fix " that caused DO to merge back with allo and threatens the existence of offshore schools is going to leave Indian grads with one less option in a few years. Problem solved.

Incentives are one approach to restrict exportation of talent, but many countries are less liberal with visas to study or train abroad and that works too.

But honestly in a country with a billion people a few thousand doctor exports won't really cause as much of a ripple as you guys are suggesting.

 

[Gandyy]

Well the same "easy fix " that caused DO to merge back with allo and threatens the existence of offshore schools is going to leave Indian grads with one less option in a few years. Problem solved.

Incentives are one approach to restrict exportation of talent, but many countries are less liberal with visas to study or train abroad and that works too.

But honestly in a country with a billion people a few thousand doctor exports won't really cause as much of a ripple as you guys are suggesting.

I am almost entirely sure that offshore schools will be nearly useless in 2020.

 

[Mad Jack]

Concerning in a humanitarian sense. What's happening is you're taking the best and brightest a country can offer away from it. The only doctors who can come practice in the U.S. are the best and the brightest so all that's left in India are the poorly educated doctors. So the rich Western nations are getting better and better healthcare while healthcare in the poor, developing countries is getting worse and worse. If you think that moral responsibility is checked at national boundaries, then you're right, it's not our problem. But if you believe that national boundaries are completely arbitrary and provide no excuses for a lapse in moral responsibility, then you have a problem on your hands. Depends on your viewpoint.

If the country they are leaving needs then so badly, they should find a way to compensate them adequately. It is not our responsibility to rob people of their opportunity because of the circumstances of their nation of origin, and such an idea is quite un-American.

 

[I'm On My Way Up]

But honestly in a country with a billion people a few thousand doctor exports won't really cause as much of a ripple as you guys are suggesting.

This

 

[700003]

Well the same "easy fix " that caused DO to merge back with allo and threatens the existence of offshore schools is going to leave Indian grads with one less option in a few years. Problem solved.

Incentives are one approach to restrict exportation of talent, but many countries are less liberal with visas to study or train abroad and that works too.

But honestly in a country with a billion people a few thousand doctor exports won't really cause as much of a ripple as you guys are suggesting.

I keep hearing this on SDN; that residency spots are becoming lesser and that foreign grads (whether US citizen or not) will have a tough time getting into a spot. But I'm so confused…is this really true? Or is SDN just exaggerating like it does sometimes? Because on the NRMP data, the foreign grad placements doesn't seem too bad right? It seems pretty steady, hovering around 50%. Isn't that good odds for a foreign grad?

Also, if you look at some schools residency students (like SLU and VCU from what I remember), they seem to have a lot of foreign grads in their Med/Peds, FM, and sometimes even more competitive specialities!

 

[Law2Doc]

I keep hearing this on SDN; that residency spots are becoming lesser and that foreign grads (whether US citizen or not) will have a tough time getting into a spot. But I'm so confused…is this really true? Or is SDN just exaggerating like it does sometimes? Because on the NRMP data, the foreign grad placements doesn't seem too bad right? It seems pretty steady, hovering around 50%. Isn't that good odds for a foreign grad?

Also, if you look at some schools residency students (like SLU and VCU from what I remember), they seem to have a lot of foreign grads in their Med/Peds, FM, and sometimes even more competitive specialities!

You have to realize that a few years ago there were many places that did pre-matching of offshore grads, so literally thousands were getting spots before the match. So the fact that the match rate stayed around the same but they lost all those prematch spots with the "all in" rule was a pretty big hit. Also the move from scramble to soap made it harder for offshore folks to land things after of the match. It hasn't dropped off as precipitously as some were expecting, but the losses are pretty real. Check out the various boards after each if the last few matches and you will notice a big difference. Also the recent DO capitulation pretty much tells their view of the upcoming allo onslaught. You can choose to believe what you want but a lot of us have seen a big difference over a relatively short time frame.

But most importantly, don't believe any info published by the offshore schools on their own websites. They aren't obligated to abide by any of the US consumer protection and truth in advertising laws so they often exaggerate or, frankly, just make things up.

 

[sinombre]

I keep hearing this on SDN; that residency spots are becoming lesser and that foreign grads (whether US citizen or not) will have a tough time getting into a spot. But I'm so confused…is this really true? Or is SDN just exaggerating like it does sometimes? Because on the NRMP data, the foreign grad placements doesn't seem too bad right? It seems pretty steady, hovering around 50%. Isn't that good odds for a foreign grad?

Also, if you look at some schools residency students (like SLU and VCU from what I remember), they seem to have a lot of foreign grads in their Med/Peds, FM, and sometimes even more competitive specialities!

Residency spots aren't decreasing, they're just increasing at a slower rate than the number of applicants is increasing (largely because the Balanced Budget Act of 1997 capped Medicare funding used for GME, which subsidizes roughly 90% of it IIRC)--so it is becoming increasingly difficult for non-US grads to match. I'm pretty sure the graph below has been posted on this forum hundreds of times, but it's pretty easy to comprehend.

Also keep in mind that US grads have been steadily increasing in recent years (in large part because of the 30% increase AAMC called for in the early 2000s). And because US grads typically get preference, it has been even more difficult for non-US grads to match.

 

[chemist16]

If the country they are leaving needs then so badly, they should find a way to compensate them adequately. It is not our responsibility to rob people of their opportunity because of the circumstances of their nation of origin, and such an idea is quite un-American.

Nobody's robbing anybody of their opportunities. In developing countries, there are more pressing needs than compensating doctors. That doesn't mean that the country doesn't need good doctors. Just means they don't have the resources to keep their talent. We are privileged. There's also no need to "rob" people of opportunity here. You don't need to deny them entry to the U.S. Humanitarian aid/loan packages could help those countries address crucial concerns (water sanitation, developing infrastructure, etc.) that free up resources for other things like healthcare.

reappropriating the fruits of someone's labor is pretty authoritarian

It's only authoritarian if some third party appropriates the fruits of someone's labor and then redistributes it to someone else against the first person's wishes. That's not the fundamental concept of communism. Communism entails simply working to the best of one's ability and taking only what one needs. There is no government and therefore no authority that appropriates the fruits of individual labor. What you're thinking of is socialism, not Marx's final stage of history, communism. I'm not debating whether such a utopia could exist - only that communism is such a vision. What you experience today as "communism" is not communism. The Soviet Union was an authoritarian socialist state. China is an authoritarian socialist state that is transitioning towards democratic principles. There has been no state in the history of the world that has reached Marx's vision of communism.

 

[deleted480308]

Nobody's robbing anybody of their opportunities. In developing countries, there are more pressing needs than compensating doctors. That doesn't mean that the country doesn't need good doctors. Just means they don't have the resources to keep their talent. We are privileged. There's also no need to "rob" people of opportunity here. You don't need to deny them entry to the U.S. Humanitarian aid/loan packages could help those countries address crucial concerns (water sanitation, developing infrastructure, etc.) that free up resources for other things like healthcare.



It's only authoritarian if some third party appropriates the fruits of someone's labor and then redistributes it to someone else against the first person's wishes. That's not the fundamental concept of communism. Communism entails simply working to the best of one's ability and taking only what one needs. There is no government and therefore no authority that appropriates the fruits of individual labor. What you're thinking of is socialism, not Marx's final stage of history, communism. I'm not debating whether such a utopia could exist - only that communism is such a vision. What you experience today as "communism" is not communism. The Soviet Union was an authoritarian socialist state. China is an authoritarian socialist state that is transitioning towards democratic principles. There has been no state in the history of the world that has reached Marx's vision of communism.

And there won't be....society needs the producers, and the producers who work harder than everyone else tend to want more in return

 

[WingedOx]

Also, if you look at some schools residency students (like SLU and VCU from what I remember), they seem to have a lot of foreign grads in their Med/Peds, FM, and sometimes even more competitive specialities!

Residency spots aren't decreasing, they're just increasing at a slower rate than the number of applicants is increasing (largely because the Balanced Budget Act of 1997 capped Medicare funding used for GME, which subsidizes roughly 90% of it IIRC)--so it is becoming increasingly difficult for non-US grads to match. I'm pretty sure the graph below has been posted on this forum hundreds of times, but it's pretty easy to comprehend.

Also keep in mind that US grads have been steadily increasing in recent years (in large part because of the 30% increase AAMC called for in the early 2000s). And because US grads typically get preference, it has been even more difficult for non-US grads to match.

As an example, IM program at my "local" state school was 100% FMG/IMG back when I was applying to med school. Today it's about half.

 

[Mad Jack]

Nobody's robbing anybody of their opportunities. In developing countries, there are more pressing needs than compensating doctors. That doesn't mean that the country doesn't need good doctors. Just means they don't have the resources to keep their talent. We are privileged. There's also no need to "rob" people of opportunity here. You don't need to deny them entry to the U.S. Humanitarian aid/loan packages could help those countries address crucial concerns (water sanitation, developing infrastructure, etc.) that free up resources for other things like healthcare.



It's only authoritarian if some third party appropriates the fruits of someone's labor and then redistributes it to someone else against the first person's wishes. That's not the fundamental concept of communism. Communism entails simply working to the best of one's ability and taking only what one needs. There is no government and therefore no authority that appropriates the fruits of individual labor. What you're thinking of is socialism, not Marx's final stage of history, communism. I'm not debating whether such a utopia could exist - only that communism is such a vision. What you experience today as "communism" is not communism. The Soviet Union was an authoritarian socialist state. China is an authoritarian socialist state that is transitioning towards democratic principles. There has been no state in the history of the world that has reached Marx's vision of communism.

By treating physicians different from other immigrants because of their profession, you are depriving them of opportunity. That's pretty straightforward. We can't just say, "you know, you're too important to be treated like every engineer and computer scientist, you need to go back to India."

As far as more pressing concerns, well, physicians will continue to leave until they become a pressing concern and force the state to act. That's economics. If you don't pay people enough or provide them with enough opportunity and they can go elsewhere, they will. Trapping Indian physicians in India isn't the answer- giving them a reason to stay is.

 

[chemist16]

By treating physicians different from other immigrants because of their profession, you are depriving them of opportunity. That's pretty straightforward. We can't just say, "you know, you're too important to be treated like every engineer and computer scientist, you need to go back to India."

As far as more pressing concerns, well, physicians will continue to leave until they become a pressing concern and force the state to act. That's economics. If you don't pay people enough or provide them with enough opportunity and they can go elsewhere, they will. Trapping Indian physicians in India isn't the answer- giving them a reason to stay is.

I have never advocated for physicians to be treated differently or for their movement to be proscribed by the state. Let me make that clear. You're arguing with a straw man. All of my posts above have clearly stated my position, which is to incentivize their staying.

 

[deleted480308]

I have never advocated for physicians to be treated differently or for their movement to be proscribed by the state. Let me make that clear. You're arguing with a straw man. All of my posts above have clearly stated my position, which is to incentivize their staying.

Are you implying that the US should incentivize their staying in india? or india should incentivize?

 

[Mad Jack]

Are you implying that the US should incentivize their staying in india? or india should incentivize?

Yeah, he's already stated that India can't incentivize them, so that either means we are or it just isn't happening.

 

[deleted480308]

Yeah, he's already stated that India can't incentivize them, so that either means we are or it just isn't happening.

so we offer such a good living here that we should outbid ourselves to get them to stay away? that's the dumbest thing I've heard all day and I know people voting for sanders

 

[chemist16]

Are you implying that the US should incentivize their staying in india? or india should incentivize?

Yeah, he's already stated that India can't incentivize them, so that either means we are or it just isn't happening.

What I'm saying is a bit more complicated. I think that the U.S., as a world leader (I'm not an isolationist, if you haven't noticed already 😉), should provide humanitarian aid to developing countries. When those countries don't have to spend so many resources on making sure people have the bare necessities of life, they can begin to improve the quality of medical care and incentivize their doctors, physicians, etc. But unless somebody gives them that aid, there's no way they're going to be able to provide incentives for physicians and scientists to stay (these incentives can even be minor things like elevating the prestige of the profession by cracking down on corruption, providing research grants) even if they were in dire need of those professionals.

so we offer such a good living here that we should outbid ourselves to get them to stay away? that's the dumbest thing I've heard all day and I know people voting for sanders

You're looking at it from the wrong perspective. It's a matter of whether you think we should provide humanitarian aid to poor, developing countries to take care of their citizens' basic needs. If you think we shouldn't, there's no point discussing this further or calling people names. If you think we should, then that's all I'm really saying.

 

[deleted480308]

What I'm saying is a bit more complicated. I think that the U.S., as a world leader (I'm not an isolationist, if you haven't noticed already 😉), should provide humanitarian aid to developing countries. When those countries don't have to spend so many resources on making sure people have the bare necessities of life, they can begin to improve the quality of medical care and incentivize their doctors, physicians, etc. But unless somebody gives them that aid, there's no way they're going to be able to provide incentives for physicians and scientists to stay (these incentives can even be minor things like elevating the prestige of the profession by cracking down on corruption, providing research grants) even if they were in dire need of those professionals.



You're looking at it from the wrong perspective. It's a matter of whether you think we should provide humanitarian aid to poor, developing countries to take care of their citizens' basic needs. If you think we shouldn't, there's no point discussing this further or calling people names. If you think we should, then that's all I'm really saying.

I think voluntary charity is wonderful....I think it's stupid that you would call yourself moral for deciding someone else gets my money regardless of what country they live in, that's not humanitarian aid...it's theft

 

[chemist16]

I think voluntary charity is wonderful....I think it's stupid that you would call yourself moral for deciding someone else gets my money regardless of what country they live in, that's not humanitarian aid...it's theft

Again, there's no need to throw insults around. It's childish. This is what the U.S. government does. Your tax money gets sent to other countries in the form of humanitarian aid and economic "loans" all the time. If you take issue with this, take it up with the government, not me. That I think there's a moral responsibility for helping others who are not within the completely arbitrary and silly lines called national boundaries is a personal opinion. Obviously I have a different moral code than you and there's no need to call another person's moral outlook "stupid" because it does not align with yours.

 

[deleted480308]

Again, there's no need to throw insults around. It's childish. This is what the U.S. government does. Your tax money gets sent to other countries in the form of humanitarian aid and economic "loans" all the time. If you take issue with this, take it up with the government, not me.

If you advocate and vote for it, my issue is with you. And I'm insulting the policy...

 

[Mad Jack]

What I'm saying is a bit more complicated. I think that the U.S., as a world leader (I'm not an isolationist, if you haven't noticed already 😉), should provide humanitarian aid to developing countries. When those countries don't have to spend so many resources on making sure people have the bare necessities of life, they can begin to improve the quality of medical care and incentivize their doctors, physicians, etc. But unless somebody gives them that aid, there's no way they're going to be able to provide incentives for physicians and scientists to stay (these incentives can even be minor things like elevating the prestige of the profession by cracking down on corruption, providing research grants) even if they were in dire need of those professionals.



You're looking at it from the wrong perspective. It's a matter of whether you think we should provide humanitarian aid to poor, developing countries to take care of their citizens' basic needs. If you think we shouldn't, there's no point discussing this further or calling people names. If you think we should, then that's all I'm really saying.

We can't even afford to keep our own citizens out of poverty, let alone prop up the medical system of a 1.3 billion person nation enough to compete with our own. Anyway, this isn't about India- they aren't our responsibility. This is about America, and how we deal with Indian physicians.

 

[chemist16]

If you advocate and vote for it, my issue is with you. And I'm insulting the policy...

Pretty sure it's your congressman/woman who votes for it. Think of how much the U.S. spends each year in foreign aid. It's not a huge part of our budget, but it's still on the order of billions (https://www.nationalpriorities.org/...ar-us-foreign-aid-about-one-percent-spending/).

I vote for such aid because I believe that developed nations have a moral duty to help less developed ones who are in need. I'm not saying throw a billion dollars at France. I'm saying invest in developing infrastructure (roads, hospitals, schools, etc.) in those countries. When they become developed, they will be your close partner. That's how policy decisions are made. That's my own ethical opinion. Are you familiar with Singerian utilitarianism? If you see a child drowning in a pond, you would dive in and save him/her. If there's a child drowning in a pond and there are a hundred spectators, you are still not relieved of the moral responsibility to save him/her if you can. The fact that that child is ten thousand miles away doesn't relieve you of that responsibilities. Again, these are my own beliefs - and I am not the only one with them.