Donde esta los medicos?

Here is another example that elections have consequences. According to an article in The New York Times: "Rural areas brace for shortage of doctors" by Miriam Jordan (reprinted by The Buffalo News on March 19, 2017), the U.S. Citizenship and Immigration Services has decided that it would "temporarily suspend a 'premium processing' option by which employers could pay an extra $1,225 to have H-1B visa applications for skilled workers approved in as little as two weeks, rather than several months." The reasoning behind this change in policy is ostensibly to reduce "the existing backlog due to the high volume of incoming petitions." However, the policy has raised much controversy by those who maintain it "displaces American workers, particularly in computer programming and engineering jobs."

There is no doubt that some companies have abused this policy. I have read articles and seen news stories of employers laying off American workers, but forcing them to train their foreign-born replacements as a contingency of their severance package. This is an awfully slimy thing to do, but some businesses have gotten away with it. With regard to foreign doctors, this is simply not the case. Most American-born physicians grew up in cities or suburban areas. They are accustomed to a certain lifestyle and work conditions. Many choose to work in large urban areas because they have teaching hospitals with the most advanced technology, plentiful specialists, trauma centers, and close ties with med schools and universities and colleges performing academic research. Others choose to practice in suburban communities where they are a relatively short commute to large hospitals but can set up their office in a low-crime neighborhood filled with middle-to-upper class residents and relatively few Medicaid patients, whose reimbursements are lower. When they are not working, they can appreciate the cultural advantages big cities and their nearby suburbs provide, such as major league sports, theaters, museums, fine dining and good schools. It is a fact that most American-born doctors do not want to live and work in remote rural areas lacking access to advanced technology and proximity to academic centers, and are virtually devoid of sophisticated cultural amenities.

That is precisely why the federal government and rural health centers have teamed up through this H-1B visa program. Foreign doctors are so desperate to move to America that they will gladly work wherever they can find a position. The federal government has sweetened the pot even more by offering foreign doctors the opportunity to "apply for a green card to live permanently in the U.S. after three years of working in under-served rural or inner-city areas." There are thousands of physicians around the world that would jump at that chance to come to America. Indeed, it has been a huge success. According to the article, "about 25% of all physicians practicing or training in the United States are foreign, but in some inner cities and most rural areas, that share is significantly higher." So whether patients in rural areas like it or not, health care systems located there have come to rely a great deal on foreign doctors. Therefore, this change in policy by the Trump administration, that is going to delay entry for many foreign doctors is going to disproportionately affect rural areas.

The great irony in all this is that the so-called red states, heavily Republican territories in the South, Midwest, Central Plains and Rocky Mountains, who voted overwhelmingly for Trump in the 2016 election, are the areas most harmed by the change in policy. So for all those red-staters who are so loyal to the Republican Party, even though Trump and his smug coterie of millionaire and billionaire Cabinet secretaries, along with wealthy establishment Congressmen, repeatedly put the interests of corporations and the filthy rich ahead of the large majority of Americans, yet still vote for these weasels, well you get what you voted for. There are plenty of legitimate reasons to vote Republican vs. Democrat, but it has always boggled my mind why lower-to-middle class rural people continue to be so loyal to the GOP when the party cares so little about their plight and geo-economic problems. Trump in particular, rode a massive wave of anti-immigrant, xenophobic (especially Muslim), America-First sloganeering to the presidency. And yet it is doctors from Lebanon, Jordan, Pakistan, India, China, Latin America and Africa that provide the lion share of health care to remote rural areas. Rural populations desperately need to be educated about what the federal government is actually doing and stop just listening indiscriminately to politicians' empty promises and rhetoric. Perhaps they will realize it when they are waiting for several hours in the ER to be treated for that tractor injury or diarrhea from drinking contaminated well-water because the hospital is under-staffed while still waiting for the foreign doctor that was supposed to start working there in June, but is now delayed indefinitely, to arrive. Or maybe Jethro is so xenophobic that he would rather not be operated on by a "brown surgeon" and is fine waiting for the next available white American doctor- even if his life is at risk in the interim.

Oh and by the way, I can't wait to see what Trump and the Republicans finally come up with to repeal and replace the Affordable Care Act- that is if they can actually arm-twist enough GOP members to pass legislation in the Senate. For all those that have criticized "Obamacare" for years and wanted to get rid of it ASAP, all I have to say is "Be careful what you wish for" because unless one has insurance through his or her employer or is wealthy enough to purchase insurance without a government subsidy, many people are going to be worse off under whatever policy the Republicans devise and dump on the American public.

#rural #doctors #H1Bvisa #foreign #hospitals #technology #universities #colleges #Medicaid #cultural #greencard #redstates #Republicans #Trump #GOP #Obamacare

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© 2017 by Peter McNeela.