Increased migration of doctors and medical students

December 6th, 2019

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 farm worker crisis

November 26th, 2019

The number of foreign farm workers entering through the temporary H 2A visa program jumped from 77,300 in FY 2011 to 257,700 in FY 2019, a 230% increase. In 2005 there were less than 50,000 visa holders. The five leading job titles were general farm workers, berries, tobacco, fruits and vegetables and apples. Jobs that require year-round employment, such as diary work, are not serviced by this visa.

Agriculture Dept data suggests that 600,000 of the 800,000 crop workers today are either visa holders (about 250,000) or working illegally (about 350,000). Farm workers are hard to count, thus the figures are approximations.

Put this into historical context: in 1950 there were 7.6 million family farm workers and 2.3 million hired workers. In 2000, the number of family workers declined by 75% and hired workers by half.

According to the Agriculture Dept’s official website, “the share of hired crop farmworkers who were not legally authorized to work in the United States grew from roughly 15% in 1989-91” about 50% today. Only a quarter are U.S. born.

Thus the farm workforce has become increasingly dependent on hired (and unauthorized) foreign workers. The average wage of crop workers is about $13 an hour.

The Farm Workforce Modernization Act of 2019, HR,5038, which on 11/21/19 was approved by an 18-12 vote of the House Judiciary Committee, is intended to normalize substantially all farm unauthorized workers into legal temporary status.

Are visa overstays a problem?

November 21st, 2019

“…in the past 10 years, visa overstays in the United States have outnumbered border crossings by a ratio of about 2 to 1, according to Robert Warren, who was for a decade the director of the statistics division at the agency that has since been renamed U.S. Citizenship and Immigration Services, and who is now a senior visiting fellow at the Center for Migration Studies, a New York–based organization.” (The Atlantic)

from the Department of Homeland Security’s report for FY 2018:

An overstay is a nonimmigrant who was lawfully admitted to the United States for an authorized period, but remained in the United States beyond his or her authorized period of admission. During FY 2018, there were 54.7 million non-immigrant entries non-citizen entries into the U.S. with expected departures in FY 2018. The overstay rate for this inflow was estimated at 1.2%. [this means about 700,000 persons.]

For visitors from countries not needing a visa, the rate was 1.9%. For those with student visas, 3.7%; for visitors from Mexico, 1.4%.

Note that this is just for FY2018 entrants with an expected departure in the same fiscal year.

Sanders’ immigration policy

November 19th, 2019

The Sanders campaign issued a statement on immigration. Below are the “key points” as summarized by the statement.

The statement follows the typical style of immigration statements by national politicians, which is to focus on (for inclusivists) very narrow, headline-oriented changes to accelerate existing flows of immigrants or (for restrictivists) to enforce headline-oriented proposals in current law enforcement.

Both types of statements fail to address (1) employer enforcement of laws, (2) overall goals for immigration, (3) how to resolve major issues such as farm labor and high-tech workers, and (4) oversight in Washington. There is still not a single agency in Washington tasked to monitor and access the economic and social trends in immigration.

“Key Points” : Institute a moratorium on deportations until a thorough audit of past practices and policies is complete. Reinstate and expand DACA and develop a humane policy for those seeking asylum. Completely reshape and reform our immigration enforcement system, including breaking up ICE and CBP and redistributing their functions to their proper authorities. Dismantle cruel and inhumane deportation programs and detention centers and reunite families who have been separated. Live up to our ideals as a nation and welcome refugees and those seeking asylum, including those displaced by climate change.

Miller on Confederate memorabilia

November 15th, 2019

The Southern Poverty Law Center’s Hatewatch obtained copies of 900 emails between Stephen Miller and a Brietbart editor, Katie McHugh, sent in 2015-2016.

The SPLC writes,White nationalist Dylann Roof murdered nine black churchgoers in Charleston, South Carolina, in June 2015. Roof’s attack triggered a national conversation about racial hatred in the United States. In response, Amazon.com and other retailers made efforts to pull the Confederate flag from their websites and stores.

Miller sought to create a counternarrative to this news through Breitbart, the emails show. He emailed McHugh with the subject line “defies modern comprehension” on June 23, 2015, following the news about the retailers, and highlighted a statistic about the deaths of Confederate soldiers with a link to history.com:

Miller, June 23, 2015, 3:10 p.m. ET: “‘22.6 percent of Southern men who were between the ages of 20 and 24 in 1860 lost their lives because of the war.”

McHugh told Hatewatch that she and Miller spoke on the phone about the subject of Amazon yanking Confederate flag merchandise after the email. Miller appears to refer to that call in his next email and suggests that McHugh write about how Amazon was selling “commie flags.”

Miller, June 23, 2015, 3:31 p.m. ET: “That’s a really, really, really good point.

Have you thought about going to Amazon and finding the commie flags and then doing a story on that? I think you’ve hit on something potentially profound.”

On August 17, Trump tweeted: “Sad to see the history and culture of our great country being ripped apart with the removal of our beautiful statues and monuments.”

Regions vary in immigrant experience

November 12th, 2019

The Center for Immigration Studies reports and adds nuances to the dramatic differences among regions in immigrant experience, by tracking households who speak a language other than English at home.

In 1990, the distribution of foreign born in the U.S. was very roughly the same as in 1920: mainly California, the Northeast, and old industrial cities in the Midwest. Since then, immigrant populations spread out. States with the largest percentage increase in those speaking a foreign language at home from 1980 to 2018 are Nevada (up 1,088%), Georgia (952%), North Carolina ( 802%), Virginia (488%), Tennessee (459%), Arkansas (445%), Washington (up 432%), South Carolina (398%), Florida (393%), Utah (383%), and Oregon (380%).

A few states account for the great majority of non-English-at-home speakers. The states with the largest share of their populations speaking a foreign language at home in 2018 were California (45%), Texas (36%), New Mexico (34%), New Jersey (32%), New York and Nevada (each 31%), Florida (30%), Arizona and Hawaii (each 28%), and Massachusetts (24%).

Family medicine doctors — immigrants needed

November 10th, 2019

 

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 Virginia elections and the rise of the educated naturalized immigrant

November 7th, 2019

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.

How many Americans live in Mexico?

November 7th, 2019

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.

Iowan attitudes about unauthorized immigrants

November 4th, 2019

The Des Moines Register poll of Iowans in February 2018 reported strongly positive support for normalization of legal status among unauthorized immigrants. This poll is fairly consistent with other polls on the issue of how the U.S. should treat unauthorized residents, when the questions are slanted towards a positive response. 65% called a pathway to citizenship for all undocumented workers currently living in the country “a worthy goal.”81% said eventually extending citizenship to “Dreamers” — the group until recently protected by the executive action known as DACA — is a worthy goal.