Posted by: bridget | 22 July 2007

War on Terror Worsens Doctor Shortage….???

Yes, that’s the new theory.  If we weren’t fighting the War on Terror, we would be able to import more doctors from overseas to serve in poor and rural areas.  There is a shortage of doctors in rural areas (such as the Mississippi Delta region and Appalachia); currently, the US government allows overseas doctors to obtain visas if they serve in such areas:

To help relieve the misery in the Delta, Appalachia and other parts of the country in dire need of physicians, the government lets foreign doctors into the country under J-1 visa waivers, dispensed through a variety of state and federal programs…. J-1 visa waivers allow foreign doctors to work in underserved areas for three to five years, with a shot at eventually obtaining permanent residency.

Reasonable enough.  After 9/11, the federal government changed the requirements for obtaining J-1 visas (concurrently with all other requirements for entering the United States). 

The number of physicians in training with J-1 visa waivers has fallen by almost half over the past decade, from 11,600 in academic year 1996-97 to fewer than 6,200 in 2004-05, according to the Government Accountability Office. And federal and state requests for J-1s for doctors dropped from 1,374 in 1995 to 1,012 in 2005.

Those statistics don’t actually tell us whether or not those onerous new restrictions are actually to blame for the decline in doctors, as it does not compare pre-9/11 trends and numbers with post-9/11 trends and numbers.  In fact, the data seem to say that the number of foreign doctors entering the US had been declining long before 9/11.  There are several reasons why American physicians (meaning any person trained, at least in part, in American medical schools) would not want to practice in rural areas or would be dissuaded from practicing medicine all together:

  • US-educated physicians have a strong disincentive to practice in rural areas.  Four years of medical school costs more than $200,000 at a private college (Harvard, for example, costs $58,500 for the upcoming academic year); after a student graduates, he must do internships and residencies and defer his loans.  By the time many doctors are able to practice, they have more than $300,000 in debt from tuition and interest.  Try paying that off while living in the Mississippi Delta.
  • Malpractice premiums have risen sharply over the past decade (which oddly coincides with the decrease in the number of physicians who have come from abroad to practice here). 
  • Rural and underserved areas have a high population of people on Medicare and Medicaid, both of which have a lower reimbursement rate than private insurers.  Whether foreign-born or American, it is difficult to encourage doctors to work for very little money. 
  • During the late 1990s, physician salaries decreased 5%, while salaries for other professions increased 3.5%.  (Number of people who desire to be physicians is a lagging indicator of such a decline; it takes several years for decreased salaries to discourage people from a path.)

Economically, the incentives to be a physician have decreased over the past ten years.  The starting costs are higher, salary is lower, and fixed costs (i.e. malpractice) are increasing.  It is not rational to cite, instead, national security concerns as the dominant factor in such a decline.


  1. I always wanted to be a doctor, but looking at the student loan estimates was pretty scary. What if I started as a ‘doctor wanna be’ but failed in the middle of it? That would leave me with a huge debt.

    Medical School costs and tuition are big deterrents.

    We should come up with a free medical school program :-).

  2. E.I. ~ You’re right: tuition and other costs are huge deterrents. I had considered being a doctor for years. My dad protested, pointing out the debt, the malpractice, and the managed care issues. I finally realised that it’s not worth it to go to school for four years, take on $200,000 of debt, and not be able to be financially stable until age 40. (Med school until late 20s; internships; residencies; paying off loans from early/mid-30s onwards.)

    Another big issue (which I should have mentioned and may so amend) is that medicine may become socialised. Will the government really pay doctors $250,000/year? (While that sounds like a lot, once you’ve taken off $75,000 – or more – for malpractice and another $30,000 for your loans, oh, and, of course, our taxation rate, you aren’t left with very much.) If that day does come, we’ll have to move to state-funded medical schools… and it won’t be cheap to start up a hundred med schools from nothing.

    I checked UConn’s med school website (mostly because it’s a good school that is pretty mid-range for public school costs). It is $26,000/year for tuition if you live in CT. With the addition of fees, books, and living expenses, it is $48,000/year. UCLA is about $2,000 more per year.

  3. Not looking at a trend before the supposed cause is something that occurs very often when reciting statistics. For instance, I know that in Colorado cigarette sales have declined since a smoking ban a year ago, but they didn’t bother to report what the trend was before then. Whether people aren’t good at statistics, or their ideological bias prevents them from such consideration, who knows.

  4. That’s the nice thing about going to engineering school, you can get your post-grad school paid for, and you may even get paid for it. Of course, I’m not making 6 figs either.

  5. Chance,

    Good point. A lot of people also don’t factor in the lag time: results are not instantaneous.

  6. Yeah, not sure why I left engineering. ;) Great starting salary, they pay for master’s (sometimes MBA, too)….

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