We don’t plan for native-born workforces

The 19th Century saw foreign workers brought into the U.S. through private sector workforce recruitment, such as Chinese workers on railroads, to fill jobs otherwise filled by native-born Americans. American food processing companies in the 1990s recruited undocumented workers at staff their factories. But there has been little of the reverse, that is, a concerted hiring of native-born American workers to staff positions that otherwise would be filled by immigrants.

An example of a possible “Hire An American” policy to recruit native-born American doctors for rural medical care.

Today, one quarter of all practicing doctors are foreign-trained (the great majority being foreign born). In rural areas, and in low income areas, the percentages are higher. What would it take to design and implement a strategy to make them more native-born?

There is no federal agency nor any major research/policy institute which routinely examines native born / immigrant workforce dynamics. There is no tried and tested method of designing such a strategy. And no one in Washington is talking about building this capacity.

And, for purposes of staffing rural physician slots with more native-born doctors, building such a strategy is very difficult. Let’s look at the forces that would complicate a plan, for instance, to financially incentivize graduates of American medical schools to locate for extended periods in rural areas”

1. Labor shortages and surpluses come in waves and both influence and are influenced by immigration.

2. There is a lot of internal sorting / shifting within occupations. For instance, native born doctors tend to concentrate in higher compensated specialties and live in relatively more amenable locations.

3. There can be a lot of sorting / shifting between occupations — for instance, using nurse practitioners a lot more for primary care than physicians. In my dozen years in Vermont, I am far more likely to see a nurse in primary care than to see a physician.

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