Foreign trained doctors in the U.S.

February 24th, 2018

Among the 12.4 million workers employed in health-care occupations in 2015, 2.1 million (17%) were foreign born. The foreign born accounted for 28% of the 910,000 physicians and surgeons practicing in the United States, and 24% of the 2.1 million nursing, psychiatric, and home health aides (go here).

Physicians who were trained outside the U.S.

About 25% of practicing physicians are graduates of foreign medical schools. Of these upwards of a third are American citizens who obtained their medical degree from a foreign medical school. A recent study reports the “evidence suggests the care these physicians provide is as good as or better than that provided by graduates of US schools. They are substantially more likely to practice in rural and poorer communities and are overrepresented in primary care specialties, including family medicine and pediatrics. Shortages of US physicians are predicted to increase, both in primary care in certain specialties over the coming decades” (go here).

To gain access to practice in the U.S. foreign medical school graduates must pass tests by a gatekeeper special commission, and also enter residency programs, even if they have done them before. This is a major disincentive to immigrate. The Educational Commission for Foreign Medical Graduates (ECFMG) was created 60 years ago and “represents the interests of the organized medical profession.”

According to the Commission, of the roughly 10,000 certifications it gave in 2015, the last year reported, 30.9% of certificates were issued to U.S. citizens, and 18.9% were from India or Pakistan, and 7.9% from Canada. The American citizens appear to be educated in one of about six Caribbean islands, Grenada and Dominica being the largest.

Foreign medical school graduates have a very high percentage of practicing physicians in some state: New Jersey (40%), New York (38%), and Florida (35%).

 

Arrests of undocumented immigrants in Boston are up 50%

February 21st, 2018

Arrests of undocumented immigrants in the Boston area rose more than 50% in the last fiscal year, according to federal data, signaling that President Trump is pushing to fulfill a campaign vow on bolstering enforcement. This is according to the Boston Globe.

With his administration shifting priorities away from targeting criminals to going after anyone in violation of immigration laws, arrests nationally have grown 30 percent in the same period. Still, the total number of arrests was far lower than during President Barack Obama’s first term.

US Immigration and Customs Enforcement officials in the Boston area arrested 2,834 immigrants who were in the country illegally during the 2017 fiscal year, which ran from October 2016 to September, compared with 1,858 arrests in the previous fiscal year. The increase was largely due to a surge in “noncriminal” arrests, a figure that more than tripled from 343 to 1,106, the data showed.

Lilian Calderon was detained by ICE as she attempted to apply for legal permanent residency, according to the ACLU of Massachusetts and Rhode Island.

Calderon, 30, was brought to the country from Guatemala when she was 3 and is married to a US citizen. The couple, who have two young children, had just finished an interview with immigration officials that confirmed the legitimacy of their marriage — the first step in changing her immigration status — when Calderon was arrested and brought to a Boston detention center.

“ICE continues to focus its enforcement resources on individuals who pose a threat to national security, public safety and border security,’’ ICE officials said in a statement in response to questions about the increase in arrests. “However . . . ICE does not exempt classes or categories of removable aliens from potential enforcement. All of those in violation of the immigration laws may be subject to immigration arrest, detention and, if found removable by final order, removal from the United States.”

Outsourcing hospital jobs to India

February 20th, 2018

 

Boston area Partners HealthCare will outsource some expensive, back-office jobs to India, according to the Boston Globe. About 100 employees are being let go by Partners HealthCare. Their jobs are being outsourced to India.

Partners is the 73,000-empoyee parent company of Massachusetts General and Brigham and Women’s hospitals. Like other Massachusetts health care providers, the organization is required by state law to keep its spending growth to 3.1% a year.

“We need to do things to improve productivity in health care,” said Partners’ chief executive, Dr. David Torchiana. “I don’t know of another . . . sector that doesn’t outsource call centers and back-office functions.” The large hospital network is several months into a three-year plan to slash $500 million to $800 million in costs.

Technology, financial services, and health insurance companies for years have outsourced jobs that can be done remotely on a computer by reliable, cheaper workers in countries including India and the Philippines. Industry analysts say hospitals are now moving in this direction — though cautiously.

A survey of employers in 2016 by the consulting form Deloitte found that outsourcing across industries was growing, despite predictions of its demise. And a survey of 400 US hospitals last year by a health information professional association found that about 25 have sent coding jobs overseas.

In the early 2000s, hospitals explored hiring radiologists in India to interpret imaging tests. The experiment largely “died a natural death,’’ in part because US rules require physicians to be licensed in the same state as their patients, said Dr. Sanjay Saini, a Mass. General radiologist. There are less-stringent rules for coders. Hospitals decide what certification and experience coders must have.

Immigration bills — today’s voting

February 16th, 2018

 

The Senate today (2/15) voted on four immigration bills, and fall failed to gain 60 votes. (Source: Vox).

The Common Sense Caucus proposal (led by Sen. Susan Collins). The plan had gained the endorsement of Democratic leadership and was technically sponsored by Minority Leader Chuck Schumer.

•Provided a path to citizenship for 1.8 million undocumented immigrants who came to the country as children
•Offered $25 billion for border security
•Prevented DACA recipients from sponsoring their parents for legal status

It failed 54 to 45. Democrats almost unanimously backed the plan, along with eight Republicans. But the rest of the GOP conference and a handful of Democrats blocked the bill.

Coons-McCain Bill by Sens. Chris Coons and John McCain (R-AZ).

• Provided a path to citizenship for 1.8 million undocumented immigrants who came to the country as children
• Offered no money for Trump’s border wall, though it did include some border security measures

It failed 52 to 47, with Democrats almost united in favor and Republicans mostly voting against it.

Toomey amendment to Coons-McCain bill. The second vote, on an amendment from Sen. Pat Toomey (R-PA), did not actually address DACA or border security. The Toomey amendment would have penalized so-called sanctuary cities that refuse to enforce federal immigration policy, by withholding federal funding from those municipalities.

It failed 54 to 45. Republicans and a few Democrats supported it, but most Democrats were opposed.

Grassley Bill. This one was closest to the White House’s preferences

• Provided a path to citizenship for 1.8 million undocumented immigrants who came to the country as children
• Offered $25 billion to fund a southern border wall
• Substantially curtailed family immigration and eliminated the diversity visa lottery program in such a way that would gut the legal immigration system

It failed, 39 to 60. Democrats opposed the bill en masse, joined by a notable number of Republicans, while most of the GOP conference and a couple Democrats supported it.

ICE arrests expand to ensnare long term, peaceful residents

February 12th, 2018

The Washington Post reports that ICE is using wider latitude on whom to arrest for immigration violations. “The agency made 37,734 “noncriminal” arrests in the government’s 2017 fiscal year, more than twice the number in the previous year. The category includes suspects facing possible charges as well as those without criminal records.

“Critics say ICE is increasingly grabbing at the lowest-hanging fruit of deportation-eligible immigrants to meet the president’s unrealistic goals, replacing a targeted system with a scattershot approach aimed at boosting the agency’s enforcement statistics.

“ICE has not carried out mass roundups or major workplace raids under Trump, but nearly every week brings a contentious new arrest. A Virginia mother was sent back to El Salvador in June after her 11 years in the United States unraveled because of a traffic stop. A Connecticut man with an American-born wife and children and no criminal record was deported to Guatemala last week.

“In addition to arresting twice as many immigrants who have not been convicted of crimes, ICE also arrested 105,736 immigrants with criminal convictions, a slight increase. That figure includes people with serious or violent offenses as well as those with lesser convictions, such as driving without a license or entering the country illegally.

“ICE’s caseload far exceeds the capacity of its jails. In addition to the 41,500 immigrants in detention, according to the most recent data, the agency has a caseload of roughly 3 million deportation-eligible foreigners, equal to about 1 in 4 of the estimated 11 million undocumented immigrants nationwide. More than 542,000 of those are considered fugitives, meaning they did not show up for their immigration hearings and were ordered deported, or they failed to leave the country after losing their cases. Nearly 2 in 3 were not considered a priority for deportation under Obama. They are now.”

Republican point system for ranking immigrants

February 4th, 2018

Senators Tom Cotton and David Perdue proposed in February 2017 an immigration bill which would introduce a system to prioritize green cards on the basis of merit. The Reforming American Immigration for Strong Employment (RAISE) Act would according to the sponsors “lower overall immigration to 637,960 in its first year and to 539,958 by its tenth year-a 50 percent reduction from the 1,051,031 immigrants who arrived in 2015.” A summary of the bill is here.

The bill includes a points system for merit-based green cards. Britain, Canada and Australia have point systems. In 2008, the Labor government introduced Britain‘s first points-based immigration system heralded by ministers as being based on the Australian system. It replaced a labyrinthine scheme which saw 80 different types of visa granted.

The Australian Labor government elected in 1972 decided migrants would be granted a visa based on their personal attributes and ability to contribute to Australian society – most obviously, through their occupational status. The points system – formalised in 1989 – has gone through several versions, and was most recently updated in July 2011. Canada was the first country to introduce a points-based system, in 1967.

The RAISE Act point system, in Section 5, would keep economic based visas at the current level of 140,000 and require an applicant to reach 30 points to be eligible for a green card. For example, a high school degree (foreign or U.S.) is 1 point, a U.S. professional degree is 13 points, and a foreign PhD in STEM is 10 points. Age 26 – 30 is 10 points, but age 41 – 45 is 4 points. English proficiency provides 6 to 12 points based on proficiency. If you have $1.35 million or more, you get from 6 up to 12 points. A high wage job offer provides 13 points. There is little or no room in this system for artists, authors, farm workers, and most health workers.

 

Digging into the Trump plan to cut immigration

February 1st, 2018

The Migration Policy Institute published an analysis of the four point White House immigration plan of January 25. It wrote:

The Trump administration has proposed drastic cuts in legal immigration, unlike any seen since the Immigration Act of 1924, as part of its price tag to legalize the DREAMers

Family reunification:

Under the plan, Americans would lose the right to petition for their parents, adult or married children, or siblings to join them, allowing them only to reunite with spouses and minor children. [These account for 317,000 green cards issued in FY2016.] And legal permanent residents, who have had more limited ability to reunify with relatives, would no longer be able to petition for their adult children. The effects would be greatest for parents of U.S. citizens, who received 59 percent of the green cards [174,000 in 2016] in the categories slated for elimination under the White House proposal.

According to the State Department, as of November 1, 2017, there were 3.7 million individuals waiting in the categories listed for elimination.

Lottery:

The White House also is seeking to eliminate the diversity visa lottery, and repurpose those 50,000 green cards to reduce the family and employment-based backlogs. The lottery…is currently used primarily by nationals from countries in Africa, Central and Western Asia, and Eastern Europe.

Overall impact:

Together, these family-sponsored and diversity categories proposed for elimination made up one-third of all new green-card holders in fiscal year (FY) 2016. These cuts align with those proposed by the Trump-endorsed RAISE Act—whose authors estimated their bill would eventually lead to a 50 percent reduction in legal immigration.

While family-based and diversity visa applicants are not selected on the basis of high educational attainment, recent Migration Policy Institute (MPI) findings show that nearly half of all recent immigrants, through all streams, have a college degree—a significant increase over earlier arrivals and the U.S.-born population. Paradoxically, the ultimate effect of the White House’s proposed legal immigration changes would be to reduce immigration of highly skilled workers.

Republican initiative to boost skilled immigration

January 30th, 2018

What about boosting skilled worker immigration?

Two immigration lawyers write, “In stark contrast to the Trump Administration’s xenophobic wish-list is the Immigration Innovation (“I-Squared”) Act of 2018, introduced by two Republican Senators, Orrin Hatch (R-UT) and Jeff Flake (R-AZ). The bill does not address Dreamers, but rather focuses on employment-based visas. Although imperfect, the bill serves as a proper starting point when discussing sensible immigration policy. Specifically, the bill acknowledges the utility and benefit of foreign skilled workers, especially in the IT field.

“Hatch and Flake have both realized that these workers not only benefit US industries, but also help create jobs for American workers. In a global economy, all forms of capital, including intellectual capital, flow to their optimum destinations according to the laws of supply and demand. We can, if we think and act anew, transform immigration policy from an endless source of controversy to a flexible weapon in our economic arsenal so that everyone profits. I-Squared does provide the opening salvo.”

Polling results support compromise deal in midst of agreements, disputes

January 28th, 2018

A Harvard-Harris poll on January 17-19 of 980 registered voters found a rare high degree of consistent support for an immigration package being proposed by the White House.

Voters were asked, “Would you favor or oppose a congressional deal that gives undocumented immigrants brought here by their parents work permits and a path to citizenship in exchange for increasing merit preference over preference for relatives, eliminating the diversity visa lottery, and funding barrier security on the U.S.-Mexico border?”

Every category of political leaning and demographics said it would support the deal by a majority of between 60% and 75%. Liberals like it by 63%; conservatives, by 68%.

When asked, not about a deal, but about specific features, 77% said yes to Dreamer access to citizenship. Even conservatives agreed by 64%.

As for giving more weight to education and skills, 79% said yes, with Republicans at 87% and Democrats at 72%

However, there is wide disagreement about the preferred number of permanent immigrants per year. The respondents were not told the current rate of about one million. Conservatives want a level of well less than 500,000, even below 250,000, while liberals want between 500,000 and million. College educated persons and those earning $75K or more tend to be more open.

The lottery system is unpopular by 32% in favor, 68% opposed.

16% of Republicans think that border security is adequate, compared to 60% of Democrats.

Deal on immigration reform?

January 28th, 2018

Ross Douthat in the NY Times points to possible negotiation between the White House and pro-immigration forces among Democrats:

“Especially since last week, Trump and Miller actually made an interesting offer: an amnesty and even a path to citizenship for DACA recipients and other Dreamers, more generous than what many restrictionists favor and with no promise of the new E-Verify enforcements conservatives often seek, in return for a shift (over many years) to a skills-based policy and a somewhat lower immigration rate. [The White House “framework” of January 25 would reduce immigration from about one million to about 700,000 a year.]

“If you’re committed to the view that restrictionists can and must be steamrolled, you’ll respond to this offer the way many Democrats have — call it a “white supremacist ransom note,” punt on policy, and use the issue to rally your base in 2018.

“But if you think that lasting deals are forged when all sides are represented, you might consider making a counteroffer: for instance, the same rough blueprint but with more green cards for skilled immigrants, so that Miller gets his cuts to low-skilled immigration but the overall rate stays closer to the status quo.”