See the Future of Health Care Jobs Once the Government Admits they MASSIVELY Underestimated the Cost of their Entitlement Program

Do you understand that what passed both the house and senate are totally freaking different from the British?

We are a sick, unhealthy nation of morbidly obese children and adults, and with all of the baby boomers about to come of age not only for Social Security but Medicare and Medicaid, what did you really think was going to happen.

I have known for twenty years or more that the money that was supposedly set aside for our seniors was not going to be adequate to fund the increased demands on a system that had already been robbed by Ronald Reagan and the Republicans.

Can any tell me what happened to the Social Security Trust Funds which were supposed to be in a " LOCK BOX"?

In case you didn't know it the Republicans spent them on covert military options.

jhawkins wrote:

"Lets put all this aside, because it is totally irrelevant to the original story above.... the government was forced to control costs by lowering labor costs by bringing in less trained lower paid foreign workers"

It seems you are upset with the other posts because they point out the fact that the recently-passed bill does not put us in a socialized medicine situation like the one they have in the UK, as opposed to the fact that cost-cutting in any type of health care system may require bringing cheaper foreign workers into US healthcare jobs.

You are telling them to go back and read your article, which I have done. This is what seems to be the main problem addressed in your article:

"Several of the people involved in the march were completing their fourth year of training only to find that the job they had been expecting was now being made available at a lower wage to workers from over seas that had only completed a two year program. The government, to save money had decided to not only lower the entrance requirements to gain a work Visa, but also lowered the requirements to become certified to perform various levels of medical duties....

What had triggered the protest march was a change in rules announced by the British government mandating that the in person interview be eliminated from the hiring process and the Visa status be removed from consideration for certain medical positions.....now it would be based purely on transcript...... a transcript with credentials which require half as long to earn overseas."

Am I correct in this summary of your objections to the posts by btco and others?

I have a much longer post to follow, but first I want to be sure that this is indeed your concern, so that I can stick to the relevant issues.

Now that we have established your true concerns...

...the point of the writing is to question why anyone in the health care profession would support the currently proposed health care bills...... they are about to be hung out to dry.

...the health care workers and the American tax payer are destined to take the biggest hit and the publicity associated with all the "new jobs" that will be created is greatly over blown.

...I submit the following:

The photo you have chosen to accompany this seed is not from a protest about foreign workers taking UK slots. It is from the MMC protest in 2007. Here is a better shot of one of the protest signs seen in your photo.

Note the website mentioned: www.remedyuk.org . You will find the "about us" section discusses a number of things that led to the protest, including the fact that this group is mad about the MMC and MTAS programs in the UK.

Under the MMC, the NHS wanted to limit the number of non-European doctors taking training slots there, giving UK grads the first chance at these jobs, followed by other European doctors, and finally giving the leftovers to non-European grads.

This is diametrically-opposed to what you have claimed in your article, i.e. that allegedly less-highly trained and cheaper foreigners are somehow displacing UK citizens from these training slots.

In other words, the people protesting in your picture are from a group who thought limiting UK training slots to UK grads was unfair to both European doctors trained outside of the UK, as well as other foreign doctors. They wanted both EEU graduates--who come from many countries other than England, Scotland, Wales and Northern Ireland--and other foreign grads to be able to apply for training slots on the same footing as UK grads, especially if they were already partially finished with training in the UK (more explanation below.)

You see, once upon a time, the UK deliberately invited non-UK docs to apply for training positions in the UK because they had a shortage of junior doctors. It had absolutely nothing to do with paying these people less than junior doctors born and trained in the UK. It was about getting the manpower they needed to staff the hospitals and clinics.

The NHS is now trying to reduce the glut of physicians they have created through these old policies, filling the limited number of open training slots with UK grads whenever possible.
They are not replacing UK-born physicians with "cheaper" foreign ones, or less-highly-trained foreign ones. They are stuck with more med school grads than they can accommodate with the available training slots, so they have decided to shorten the time it takes to become a consultant while training in the UK, so that more new grads and junior doctors and can find positions as house officers, registrars, and consultants. This is not about giving people with less training obtained outside the UK positions as consultants, or even as junior doctors.

Some links: http://aphrabehn.wordpress.com/2007/03/09/a-patients-guide-to-modernising-medical-careers-and-mtas-part-1/

http://imgprotest.blogspot.com/ (note the "protest" here is about sending the IMGs home, not about giving them jobs because they will work for less)

http://www.workpermit.com/news/2006_08_16/uk/arab_doctors_outraged.htm (again, non-EEU doctors are now less welcome than EEU ones, and non-UK doctors are less welcome than those from other EEU countries--the opposite of the claim in your article. Also an interesting note about how more Arabic doctors are seeking training in the UK, as the post-9/11 changes in the US made them less able to train here.)

http://ghostcabinet.blogspot.com/2007/06/its-all-about-patient-safety.html http://www.wrp.org.uk/news/2022 (both links include references to the "My training, Your healthcare, Their mistake" banners shown in your photo, and both discuss the shorter training that consultants will have under the new rules--again shorter training in the UK, not overseas)

http://www.remedyuk.org/index.php/Campaigns/Was-MMC-a-Trojan-Horse-for-the-Subconsultant-Grade.html

http://www.timesonline.co.uk/tol/news/uk/article707786.ece

http://news.bbc.co.uk/2/hi/6372895.stm

***
Now, it is possible that the protesters you met on your trip to London around the same time as this controversy (2006-2007ish) were from a different group than the one in your photo. If so--and if possible--I would appreciate more information about the specific protest you witnessed, the types of banners they carried, and the groups they represented.

You may have found solid proof that cheaper and less-qualified physicians are being imported into the UK as a cost-cutting measure, as opposed to the "give the UK jobs to the UK grads first" plan the NHS has adopted as noted above.

You may have searched for a generic photo of "British doctors protesting" to include with your article, and made an honest mistake. If that is the case, and I have focused on an inadvertently misleading photo rather than the real issue, please let me know.

If so, I can post even more information for you about the differences in post-grad medical training
in the UK vs. the USA--which is pertinent to the claims made in your article about universal coverage leading to a slippery slope of cost cutting that will require cheap foreign medical professionals, taking jobs from Americans and driving down the prevailing wages for all health care workers. (In the UK, "training" posts are more prestigious than "non-training" posts, etc--it is much more complex than our system when it comes to finally being able to hang out your shingle and work as a full-fledged physician.)

I can also tell you a bit about the history of foreign doctors, nurses and other health care workers right here in the USA, which is by no means a new phenomenon resulting from health care reform. I can explain why their presence here normally has nothing to do with being paid lower wages than Americans, as these wages are in the same range for all workers in a given hospital in the same job classification, especially resident physicians. This may be changing soon due to our economic crisis prompting people to re-train for nursing and other health care jobs that are difficult to fill.

But now it is time for dinner and other offline tasks....

"The pictures were taken by me on 3/17/2007.... The main thing they felt was unfair about the change in policy was that it allowed foreign medial professionals with 2 years of training to be considered for posts that they were having to complete 4 years of training to achieve."

I cannot find any sources that back the claims of these protesters, i.e. that foreign professionals with less training were being given posts that should have gone to UK grads with more training. I would ask you to provide links that back your article and these assertions.

Quote from your original article, with emphasis added:

"Several of the people involved in the march were completing their fourth year of training only to find that the job they had been expecting was now being made available at a lower wage to workers from over seas that had only completed a two year program."

I also cannot find any evidence that this was done as a cost-saving measure, or that foreign doctors would be paid any less than their UK counterparts. A move to provide more guaranteed jobs for native-born doctors? Yes. A move to replace native-born doctors with foreigners willing to work for less? No. Again, I ask you to back up your assertions with something more concrete than "these protesters told me so."

I'd also like to go back to this claim from one of your posts:

"What had triggered the protest march was a change in rules announced by the British government mandating that the in person interview be eliminated from the hiring process and the Visa status be removed from consideration for certain medical positions.....now it would be based purely on transcript...... a transcript with credentials which require half as long to earn overseas."

You are correct about the interview portion being eliminated, but have assumed this was done to give an advantage to foreign candidates. I don't think you can conclude one from the other.

Here is a summary from the blog of a physician who was so upset about the MMC changes that he quit his job:

"before (or "in my day") doctors would secure jobs on the basis of their performance at medical school in written and clinical examinations and the strength and breadth of their CV coupled with the impression they gave at interview. this is not dissimilar to, well, ANY profession. now however, final year medical students/newly qualified doctors do not do this. instead they have to fill in a form. this form consists of 6 sections.

• Academic Achievements,
• Non-academic Achievements,
• Reasons for applying for a post,
• Good Medical Practice,
• Teamwork,
• Leadership

the applicant has to write a 75 word piece on each of these sections extolling their virtues. no more interview. also, each of these sections are equally weighted. so, academic achievements takes the same priority as non-academic and leadership."

Searching through his posts using Google, I find no mention of the words "foreign," "FMG," or "IMG" . If this guy was angry enough to quit his job, and he felt cheaper and less-qualified foreign labor was to blame, don't you think he would have mentioned something about it in at least one post?

Another UK medical blogger has a very detailed timeline wtih links. Again, no mention of foreigners outside of the fact that foreign doctors lost their permit-free status--which would make it harder for them to work in the UK, not easier.

***

On the other hand, I can find many sources about decreased post-graduate training within the UK, for grads from all countries, after they have been accepted into the training positions. The links in my earlier post are a start.

The main difference in training times that I can see under MMC are at the House Officer level. It used to take 3 or more years to move from this status to that of a Registrar, and under MMC it will take only 2 years. This may be what your protestors are angry about, but the UK grads and foreign grads are all subject to these changes. They have not made a fast-track option for foreigners because they are allegedly cheaper, nor are they accepting foreigners who are less trained at the med school level than the native docs.

Remember our (USA) system of 4 years of undergrad + 4 years of med school is different from the way medical education is handled in almost every other modern industrialized country. We have (or at least had) some accelerated programs that combine the 4 undergrad and 4 med school years into a 6 year program--such as the now discontinued Inteflex program that was available back when I was a U of M med student--which are a bit closer to how it is done in the UK, the rest of Europe, India, etc. They eventually extended Inteflex to 8 years before it was abandoned completely, making it more like an early guaranteed-admission program for high school students. I'm not sure if other schools that offered this type of accelerated program in the 70s-90s still have 6 year options today.

However, almost every European country has a standard 6-year program that students begin directly after high school ("gymnasium" is a common term for the high school level) as opposed to a system like ours. Some range from 5-7 years, but 6 is by far the most common.

The UK has both traditional 6 year programs like the rest of Europe, as well as few newer programs for those who already have a 4-year degree in something else (like our system.)

India, which is the source of most of the non-European FMGs in the UK, has a 5.5 year program. I'm not sure why your protesters would consider a 6-month difference from their own med school training to equal "foreign medial professionals with 2 years of training" as in your above quote.

***

"could you please explain a bit about what exactly a sub-consultant is that is mentioned in some of your links ?"

I'm not sure that part was actually carried out, but it sounds like the "Specialist Registrars" may have been able to move to newly-created full-fledged "Accredited Specialist" positions without having to become Consultants.

http://www.remedyuk.org/index.php/Campaigns/Was-MMC-a-Trojan-Horse-for-the-Subconsultant-Grade.html

http://www.rcseng.ac.uk/about/president/docs/PRCS%20July.pdf

From the NHS itself, with the disclaimer from the page stating: "These documents are now over three years old and refer to a policy proposal that was not pursued by the Department of Health." Note the mention of "accredited specialists" and "junior consultant grades" having a lower pay scale than full consultants in this document (again, not adopted--perhaps due to the protests like the one you witnessed.) There is no mention of bringing foreign workers in at this level, or any other level, to save money.

Perhaps they thought by paying all trainees (regardless of national origin or country of schooling) less at one point in their career, while also creating a new berth in which to move lower-level trainees (who are hanging around at the registrar level but not yet able to become traditional consultants,) and shortening the house officer phase to only two years, they would kill two birds with one stone--save money and open up slots for the glut of medical school graduates who needed training positions as incoming house officers.

***

"I also would like to know more about the UK recruiting overseas medical professionals if you have the time."

They are cutting back on this, and making it harder for immigrants--even skilled ones such as physicians--to work in the UK.

http://www.migrationwatchuk.com/briefingPaper/document/85

As far as the history of this recruitment prior to MMC, I will have to direct you back to my previous posts, documents such as this, and this, and to Google.

***

So, in summary, foreign doctors can still apply to train and work there, but it is harder for them to find training slots. I find nothing that states the pay they can expect to receive is any different from that of others at the same level. The training that foreign physicians receive during med school in other countries is as long as the med school training in the UK. The shorter training protested by groups such as remedyUK concerns the post-graduate levels completed within the UK system, not the level achieved before taking a position in the UK system.

It is not unheard of for someone who has been denied access to a scarce resource to point his finger at an outsider (minority, foreigner, etc) and say the outsider was given this resource unfairly, even if there were many other factors in play, and even if it was an "insider" who actually took his resource because of social connections and other non-merit-based considerations. Your 4 protestors may have fallen into this category.

It is also not uncommon for there to be differences of opinion within a group, as demonstrated by the numbers in this link from the remedyUK website. Notice that less than 100% of the survey respondents were against the proposed rules that would have given UK grads preferred status, and that 69% wanted to reduce future recruitment of FMGs.

Your protesters may have been from the group that was actually happy about the "UK first" provisions of the changed programs, and angry about the results of lawsuits that gave some protection back to FMGs. (Although the BAPIO lawsuit had not yet been decided at the time of your photo....) They also were probably angry about the MTAS system not giving preference to UK grads at first, but that system has since been abandoned (which also happened after the date of your photo.) Plus I would think the 2008 decision that led to difficulty in getting the proper papers for FMGs not already training in the UK would more than offset any such glitch.

As far as I can tell, the protest you photographed had nothing to do with pay grades based on national origin. There is no verifiable evidence presented in your article that the non-UK grads working in the NHS are paid any less than any others at the same level of training, either before or after MMC, and I cannot find any evidence of this either.

This protest was not about cost-cutting in general, but about difficult adjustments made after miscalculating the number of UK grads that would one day enter the workforce. You have taken a protest about limited numbers of training slots, changes in application processes, and changes in the definitions and lengths of training levels--and extrapolated it to mean that the evil socialized health care system has led to draconian cost-cutting measures that displace qualified health care workers from their jobs in favor of cheap foreign labor. The MTAS system that prompted some of the things they were protesting about no longer exists.

Your assertions that they are bringing foreign workers in for lower wages are not supported by anything you have presented, other than the word-of-mouth of 4 protesters. I have presented many links to the contrary, and I would ask you to support your claims in the same way. If you are unable to do so, I would have to label your article as fear-mongering, where you have misrepresented an unrelated event (and partially moot point given the end of MTAS ) to fit your own anti-health-care-reform agenda

BTW, training in both med school and residency is different here than in the UK, and we already have plenty of foreign professionals training and working here in the states--not because they are paid less, but because they are willing to take positions in less-popular residencies, work in less-popular geographic areas, and so forth. Even foreign nurses are paid at essentially the same rate as US-trained nurses. (And yes, I have links to back these statements up as well.) If anything, the MMC changes made the UK system a bit closer to the one we have had for many decades when it comes to FMGs. This is not like migrant farm workers being paid crap wages under the table, and I doubt it will become like that with any of the current health care bills, which are not yet law.

Sorry, it's been a busy week and I have not had much time for typing beyond short replies in other seeds. Let's resume our conversation:

"do you not think that odd or at the least highly improbable that more than just the four I spoke with felt that to be their reason for participating?"

They may not have been the only ones who felt that way, but the premise of your article--that socialized medicine led to cost-cutting, which in turn meant foreign workers were brought in at cheaper wages, and with less training--is not held up regardless.

"Also, did the web sites you reference interview everyone at the event."

No--and neither did you. Yet you want me to take the opinions of the 4 people you did interview over the large number of more objective sources that show the premise of your article is false.

The websites I provided were not news accounts of this protest, but general news stories about the MMC and MTAS programs, blog posts about these programs, links to explanations of the structure of medical education in the UK and other countries, links to information for foreign workers in the UK, and so forth. As you mention, none of these websites would have had a reason to interview people at a protest march.

But that is not the point; my links are from primary sources such as the NHS, and secondary sources such as news articles that looked at the protests as a whole. When the information from more authoritative sources such as these is ignored, while the opinions of 4 individuals is taken as gospel, then you are cherry-picking your facts to support the false premise of your article (i.e. that the cost-cutting within the NHS has led to the hiring of foreigners, and that socialized medicine in general would lead to a similar situation in the USA.)

Again, regardless of the opinions of the people at that rally--whether it was only 4, or over 400, who felt that way--the facts from a wide variety of sources do not back up the claims you and those protesters have made (foreign medical grads are being preferentially hired over UK ones, FMGs have less training than UK medical grads, etc.)

"my information is based on what was conveyed to me by the people on site."

While I do not believe you deliberately or maliciously passed on this misinformation, it seems what those people told you was based on assumptions made while there was still a highly emotional debate going on. The current state of things has shown that the few facts they had correct (i.e. the interview process) are now invalid as the MTAS program was scrapped. The claim that foreigners are or were displacing UK grads is false, and everything points to UK grads being given preferential access to training slots--quite the opposite of what you claim in your article.

Verifying the claims of these protesters before writing your article may have been a good idea, despite the "opinion" tag. The bigger problem is the seemingly additional assumptions you have made, which is to claim that the NHS did such things--whether you thought those specific things were true or not--to save money, and that the same thing would happen here under a scenario with universal coverage .

"As far as the links you have provided.....if we are going to get into the details, do not refer to protests on this 3/17/07 but quite frankly I really could care less..."

But you should care, because my links give you the background information that led to the confusion and anger that prompted this rally. The signs in your photo are from remedyUK, regardless of which date the rally occurred.

My links are absolutely pertinent to this discussion, and were provided to show you that the protesters you spoke with were mistaken in some of their assumptions, and you were mistaken to take those assumptions as the only basis for the protest.

Your picture caption about people angry over hiring practices was correct, but the assumption that these changes were made in order to bring in cheaper labor were false. Your additional extrapolation to what may happen in the USA under a system that provides universal coverage was not supported by the facts of the UK situation, either.

Again, if you are going to imply that an event in the UK is a harbinger of things to come in the US, it would be best to verify your facts. Dismissing my links in this way is sticking your head in the sand. In fact, had you not thrown in the "look what happens when you have socialized medicine--the Brits underestimated how expensive things would be, and now they are cutting costs by doing X" interpretation of the rally, I would not have commented on your article at all. I realize my long posts filled with links seem a bit like homework, but you are not participating in a valid debate if you refuse to read the links and absorb what they have to say before simply dismissing them as irrelevant.

***

"I am a strict proponent of health care reform in the US. The cost of medical care that I provided my employees escalated dramatically without, in my opinion, any cause or explanation. I would be the first to advocate a change to a more cost effective streamlined health care system."

Glad to hear it. Your assertions that health care workers and tax payers should fear reform as they will be the ones who "take the biggest hit" and are "hung out to dry" seemed to imply that you felt differently. Personally, as someone who falls into both groups, I have no problem with a stagnant or even slightly lower income, and higher taxes, if it will mean all my patients are covered, my friends and family with jobs that do not provide insurance are covered, etc. I'd love to see indigent people stop using the ER as a primary care office, and I'd love to see the end of cost-shifting to insured patients to cover the costs of indigent care.

For the record, I think a Bismarck-style plan would be the best for the USA, and I do not want a system like in the UK or Canada. Yes, there will have to be cost controls that people will not like. And it has to be universal, where all either participate, or opt out and purchase their own coverage. Allowing people to go bare continues to allow indigent patients to use the expensive ER for things that can be treated cheaply in an outpatient office, and allow people with invincibility delusions to rack up 6- and 7-figure bills they can never pay after vehicle accidents. Both of these events lead to cost-shifting to the insured patients, and continued reliance on state and federal tax-supported programs that defray the costs of indigent care given by hospitals.

You and I already defray the cost of providing care to the uninusred, whether you realize it or not. I'd rather pay a tax up front to provide affordable coverage that could prompt people to seek care for diseases earlier, with the cost of this care being paid mostly by an insurance company such as the ones in Germany's Bismarck plan. Remember, the tax is to defray the cost of the premium for one of the national/socialized insurance policies, not to pay directly for the care such as in the socialized medicine system in UK.

In the system we have now, our taxes pay directly for part of the costs of this indigent care after the fact (when medical problems have often become more expensive) and the hospitals shift the rest of the costs to the insured patients. This prompts the insurers to raise their premiums, which affects you as an employer (you did mention your costs skyrocketing in this manner....) You may find the amount you pay in additional payroll taxes under a Bismarck-style plan will be less than the additional costs of paying an insurance company's ever-increasing fees for your employees. I think it is worth investigating, don't you?

A system with many public options as they have in Germany will still allow for some competition, while ensuring that people cannot be locked out or have policies rescinded due to pre-existing conditions. It has worked, with some admitted problems, for over a century in Germany, and I think we could get a modified version to work here.

As long as we have for-profit health insurance where providing dividends for stockholders and bonuses for CEOs are more important than providing coverage for medical care, you will continue to see the premiums for your employees go through the roof.

"Any program that would take the proven approach to: ...."

No argument from me on these points, except maybe #4 which sounds a bit like an HMO punishing a physician for a patient having a bad outcome, even though the physician may have counseled the patient until he was blue in the face, and the patient is just non-compliant. I'm not at all thrilled with what Congress has come up with so far, but something has to change, and perhaps we have to start with incremental steps to reach this goal. Cost containment will be needed, but that can be the next hurdle.

***

"I would be interested in your links that show how bringing in foreign health care workers supports the current wage.....seems sort of out of whack the supply and demand thing.

My next post will be about how medicine and nursing seem to defy some of the usual "foreigners bring wages down" assumptions at this time, especially since the supply of US citizens willing to do the work actually fails to meet demand in some ways. It will also show you how many FMGs/IMGs are already here, and have been a huge part of the US medical workforce for decades--no socialized medicine or subsequent cost-cutting measures required!

***

"I would be interested in your links that show how bringing in foreign health care workers supports the current wage.....seems sort of out of whack the supply and demand thing."

Supply and demand does not seem to work in a simple or predictable fashion with certain jobs, especially in health care. Honestly, with nursing I had assumed that foreign workers would drag wages down because there is less education required as compared to becoming a physician, but I was surprised to find the opposite (more below.)

First, some background on obtaining a slot in a medical residency program in the US, which differs from the system in the UK.

U.S.-trained physicians (who are not always US citizens, BTW; there are foreign students who attend med school here in the USA) compete for residency positions through the "Match" done during the 4th year of allopathic medical school. Osteopathic medical students have a more traditional job interview-style matching process if they want a residency at an osteopathic institution, or at least they used to according to my D.O. colleagues. If D.O.students/grads seek a residency position at an allopathic institution, they enter the Match along with the M.D. students/grads.

Each year, foreign medical grads participate in the Match, too. This includes not only US students who attended foreign med schools, but also non-US citizens who trained at either foreign or US med schools. For the most part, US grads get preferential placement in programs, with the leftovers going to IMGs. The residency programs rank their choices, as do the students, and a computer sorts it all out.

Not everyone will get their first choice of residency, especially in highly competitive fields or attractive geographic locations. Likewise, not all residency programs will get the group of students they wanted, and will get some of their lower-ranked choices or "scramble" candidates (more below.) Every year, the residency slots in highly-competitive specialties (not highly-compensated during training, but those with the best income and/or lifestyle later on) have many more applicants than they need. These training positions almost always go to US-trained physicians.

This file shows the number of slots that went to each type of student in 2009. Note the "IMG" column in each table, which refers to non-US citizens, as opposed to the "US IMG" column which refers to US citizens who attended foreign med schools. Also note how the less-popular primary care slots in each state have a good number of IMGs taking the positions, while the popular specialty slots almost always go to students and grads who are US citizens.

Note how some of the primary care slots remain unfilled even when there are IMGs taking positions! Demand exceeds supply even in our current non-socialized "free market" system.

For example, here in Michigan, the Family Medicine openings were only 88.9% filled, with more slots going to foreign residents (30) than US 4th year students (24.) Some of the slots filled by US students may represent previously un-matched students who did not get specialty slots, who then were willing to take just about any open position during the "Scramble" after match day. Others may represent slots taken by married students as a compromise so they could train at the same hospital as their spouse. Despite all of that, there were still 11 slots left empty.

Let me repeat that last bit: Eleven slots left empty despite all of the IMGs accepted into the program. US residencies have been available to IMGs for decades, but even they don't seem to want all of our empty slots. If we also offered them a significantly lower wage than our native-born grads, it would hardly give them an additional incentive to fill these empty slots. You would expect the laws of supply and demand to fill this vacuum with people demanding higher wages rather than lower, correct? This certainly does not support a scenario where cheap and poorly-trained foreigners are displacing highly-trained Americans.

For medical residency positions, anyone working in a training hospital could tell you that foreign residents are paid essentially the same as US residents. (Heck, if the verbal report of 4 strangers is enough for you to write an article without additional research to verify their statements, then my personal experience with links to additional objective sources should be enough for you, too.)

We have had a perceived shortage of physicians for decades, and as a result there have been many full-fledged foreign physicians working here, as well as many IMGs training here (and often staying here after they are finished with residency.)

You will find a summary of the history of IMGs training in the US here: GLOBALIZATION AND THE PHYSICIAN WORKFORCE IN UNITED STATES. From the same document, you and other non-medical types may be surprised to learn that:

"Every year, there are about 100,000 residents in 8,000 different residency programs. Of the 100,000, on the order of 25,000 are IMGs."

and

"International medical graduates have formed an important part of the U.S. physician workforce of this country since the 1960’s. In the early 1960’s, IMGs were about 10% (26,048) of the physician workforce; by 1970 that percentage had increased to nearly 18% (57,217). Today, IMGs are about 25% (196,961) of the U.S. physician workforce."

So you see, we already have plenty of IMGs--no socialized medicine required! They were not brought to the US to drive down physician wages, but to work in medical specialties and geographic areas where there were not enough American physicians willing to take the jobs.

A shortage of qualified people seems to be the same thing that happened in the UK based on every link I have provided in my previous posts. The difference is that in the US, the number of native med school grads has been about constant since the 1980s, while the number of native UK grads has gone up. From what I have read in my previous links, the lower number of UK grads in the past stemmed from lack of interest in the field as opposed to limited number of med school slots.

If we suddenly had an increase in native grads here, then we may find ourselves needing to limit foreign grads, too. As in the UK at the time you visited, the first few years of such a transition may involve some initial growing pains where FMGs are stuck in limbo, with lawsuits being filed on their behalf, and US grads mistakenly believing that their jobs are being given to foreigners for financial reasons. But socialized medicine, or cost-cutting due to such a program, would not have to be the inciting factor.

Trust me, if foreigners were being accepted into residency programs instead of equally-qualified US grads, there would be so many lawsuits that the hospitals would eventually find it cheaper to only bring in US residents. These are not illegal aliens afraid to speak out over fear of deportation, or high school dropouts with limited resources who can't afford to fight the system, but people who can generally fall back on family support for a while as they sue the program they feel passed them over. New grads have spent many years of their lives training for a job, spent hundreds of thousands of dollars to get this training, and are now going to be willingly burdened with earnings of only about $10/hour for the next 4-7 years as residents. They would not react calmly if they thought they were being passed over on top of all of that; they would bring in the lawyers ASAP.

After all (if you insist on continuing to believe the premise of your article is correct) wasn't it outrage over being passed over for a "cheaper" foreigner the reason your 4 protestors gave for their presence at the rally? Most students spend/borrow even more in the USA to obtain a medical education than they do in the UK, so would you not think they would be just as likely to complain if such a thing were to happen?

Taxpayers, who support the costs of residency training to the tune of approx $96,000 per resident per year, would probably have a conniption, too, if they thought foreigners were the preferred beneficiaries of this tax-subsidized training.

Most medical residents are required to have H-1B or J-1 visas. J-1 is easier for the residency program, but the H-1B is more attractive to the FMGs, so most residents try to get H-1B status There are also limits on the number of visa holders each employer can sponsor. Full-fledged physicians need H-1B visas, or, if they are staying here to practice after a J-1 visa residency, a J-1 waiver. (also see page 10 of this document, which is page 15 of the pdf file). J-1 visas are often used to get people willing to work in rural and other under-served areas.

You have to pay J-1 waiver and H-1B employees at least the prevailing wage, by law. Although there is no requirement for a prevailing wage determination for J-1 employees, in the case of medical residents most programs pay them the same wages as the other residents. This keeps most foreign residents from being cheaper than US residents.

Now there is a way to exploit residents with J-1 visa (not J-1 visa waiver) status, as there is no law requiring them to be paid the prevailing wage. But many academic institutions (not limited to those with medical programs) also have internal policies that prevent the hiring of J-1 "visiting" workers or faculty at less than the prevailing wage. They do not want to be accused of exploiting workers or leave themselves open to lawsuits. In addition, because IMGs mainly take slots that would otherwise go unfilled, and they know that the workforce needs them in certain specialties, IMGs have become less willing to accept J-1 positions over time, making the H-1B (which does require prevailing wages to be paid) more common. Some residency programs even post their wages for all to see, which makes it difficult to pay Roberta less than you pay Robert, or to pay an IMG less than a native grad, without inviting a lawsuit.

As for nurses:

Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities

"In 2004 the U.S. Department of Labor reported median annual earnings for RNs in 2002 as $48,090; in hospitals and nursing homes where foreign nurses worked, earnings averaged $49,190 and $43,850, respectively."

Note the RN wage was higher at the hospitals with foreign nurses as compared to the median RN wage (ignore the nursing home number; they always pay the employees too little.) Again, these are not uneducated day-laborers and farmhands being brought in as cheap labor, they are desperately needed professionals in a country that does not produce enough of its own nurses. Nursing requires higher education, and a simple influx of foreign workers does not seem to do the same thing for nursing as it does for work in meat processing plants or fruit orchards. The need for foreign nurses may drop as our current recession sends former blue-collar workers back to school to enter a recession-proof field such as nursing, and perhaps then we will see a backlash as the one you witnessed in the UK--but again it will not be as a result of a cost-cutting move, just a shift in the sources of supply as relates to the demand.

2008 study on the effects of foreign nurses on the wages of nurses in the US: http://www.trinity.edu/eschumac/Foreignborn%20April%208.pdf See page 12 of the paper, or page 13 of the pdf:

"The final column of Table 4 allows the differential to vary by time in the US. The CPS contains information on when immigrant’s entered the US in two-year intervals. Similar to results for the population as a whole (Borjas, 2000; Chiswick, 1978) the regression results in column 4 shows that all of the penalty for foreign born workers is in the first few years after entry. There is an insignificant differential for the most recent entrants, but those who have been in the country between 2 and 4 years experience wages that are about 10 percent lower than natives. Once the RN has been in the country for about 4 years, the differential falls to -.023 and is no longer significant. For those who have been in the US more than 10 years, there is a small wage advantage over native born RNs.13"

Again, if you are bringing in foreigners simply to cut costs by dragging down the wages of your workers, does it make any sense to pay foreign workers more than native workers after 10 years?

Similar findings here--insignificant wage differences between native-born and foreign RNs, and no change in wages for native workers: http://client.norc.org/jole/SOLEweb/8320.pdf