Working Immigrants

The past ten years have seen an increase in migration of doctors, as well as medical students. One quarter of practicing physicians in the U.S. are foreign born. Among countries (see table below) that percentage varies greatly. Advanced countries in general are experiencing a doctor shortage – not just the U.S.

The OECD reports that between 2010 and 2016, the proportion of foreign-born doctors across these OECD countries rose by 3% to 27% in 2016. The trend for nurses is similar with the percentage in 2016 at 16%.

Between 2000 and 2010, the proportion of foreign-trained doctors registered to practice medicine in Ireland rose from 13.4% to 33.4%.

Half of all medical students in Ireland are international students, nearly a third in Romania and a quarter in Poland. Many medical schools, such as in Central and Eastern Europe, have programs in English. (Go here.)

Noted medical writer and Atul Gawande’s parents are from India. Here is there background: Atmaram Gawande was born in 1934 to a family of seven brothers and five sisters in the village of Uti, Maharashtra, in western India. After graduating from the Nagpur Medical College in 1962, the elder Gawande moved to New York City to train in general surgery, where he ended up meeting Sushila, a paediatrician who he would go on to marry. Sushila herself had moved to the US from Ahmedabad, Gujarat.

In 1973, a few years after Atul and his younger sister Meeta were born, the Gawandes decided to move to Athens, Ohio, a small town that was looking for doctors. In Athens, Gawande senior went on to become a well-known urologist at the O’Bleness Memorial Hospital, serving over 25,000 local patients.

From here.

The United States needs more primary care physicians, including family physicians. Projections based on current trends show a deficit of 52,000 primary care physicians by 2025.

There are about 120,000 family medicine doctors in the U.S. Each year about 5,000 newly educated medical doctors enter an accredited family medicine programs.

Since 2009, the overall proportion of US medical students entering family medicine increased from 9.0% to 12.6%. That was largely due to a rise in graduates in osteopathic medicine. However, the number of non-citizens graduating from foreign medical schools rose from 2000 to 2009, then appears to have declined. They constituted 10% of new family medicine entrants in 2000, 21% in 2009, then dropped to 8% in 2017.

It is unclear if any future increase in the total number of new family medicine doctors can happen without foreign graduates returning to higher numbers.

From here.

The Democratic sweep in this Tuesday’s elections in Virginia invites a look at immigration trends in the state and the possible impact of voting by naturalized citizens. Well-educated foreign-born, naturalized adult citizens have likely grown from perhaps 4% of eligible voters in 2000 to 8% in 2017. This is due to many more foreign-born adults, their higher education profile, and to naturalization trends.

Surge in foreign-born adults: foreign-born persons age 25 + rose from 6.4% of all persons 25 + in 1990, to 10.6% in 2000, to 18.6% in 2017. In absolute numbers, the foreign-born pop 25 + doubled 2000 – 2017 while the U.S. born population grew by 16%.

An increasing share of immigrants have naturalized and are eligible to vote. I infer that the 18 + population of naturalized citizens rose 250% from around 200K in 2000 to around 500K in 2017, while the vote-eligible U.S. born rose by only around 15%.

Note that the most recent figure is for 2017, i.e. would not reflect any greater proclivity to be naturalized during the Trump administration, as a risk management step.

Foreign-born adults are better educated than U.S. born in a state that is a leader in education. In 2017, 43% of foreign-born Virginians had at least a bachelor’s degree, compared with 38% of U.S. born adults in Virginia. Virginia is one of the best-educated states in the country).

From here.

What is the American presence in Mexico? A huge problem in coming up with estimates is that we really want to know two flows: U.S. citizens and non-U.S. citizens who circled back. The U.S. does not spend much time tracking “circular migration.” There may be a million U.S. citizens living in Mexico, and several million Mexicans who have circled back.

So, there are American citizens living there, and also persons who lived in the U.S. with a Green card. And there are unauthorized persons who returned, often it appears with a U.S. born child. There seems to be some agreement that a relatively small number of retirees who retired in Mexico after working in the U.S.

The State Department says 1.5 million American citizens live in Mexico. The Migration Policy Institute estimates that there are 899,000 U.S. born persons living in Mexico. The 2015 Mexican census puts the number of U.S. Citizens in Mexico at 739,000.

The Migration Policy Institute also surmises that very many of the total, whatever it is, includes includes approximately 1 million U.S.-born persons who moved, mainly to Mexico, over the 2010-15 period, and the majority of them were children, mostly it appears of unauthorized Mexicans who had lived in the U.S. and born children there. (10% of the Mexican workforce in about 2005 were in working in the U.S.)

The Mexico’s Ministry of the Interior estimates there could be 430,000 to 600,000 U.S. citizen minors living in Mexico, the great majority of them U.S. born children of Mexican households who had returned from the U.S.

Retirees: Only a very small percentage of American citizens living in Mexico are retirees. Retirement communities in Mexico – 10,000 are estimated to live in San Miquel de Allende, 35,000 in Puerto Vallarta, and 20,000 near Lake Chapala in central Mexico (according to the U.S. Embassy.) Only 58,000 who receive Social Security checks. (this number is not broken dwn between U.S. citizens and Green Card holders.) This number is equivalent to roughly 3% to 6% of American citizens living in Mexico. Compare that with 306,000 U.S. citizens living in Canada, and 111,000 persons receive Soc Sec checks there.