Regular SM Commentor Razib has a great post on one of his blogs about the racial mix of doctors in the USofA. What instigated a fresh take on the classic question was an article in SFGate decrying the lack of “minorities” in the medical profession –
A new study on physicians in California shows a glaring gap between the number of doctors of color compared with the state’s ethnically diverse population, especially among African Americans and Latinos.At the same time, the state has a disproportionate number of Asian and white doctors, according to the UCSF study, which focuses on doctor ethnicity and language fluency.
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p>The linear implication, of course is that if one group is under-represented, it must mean that other groups are over-represented and therefore must get penalized to address the imbalance. Advocates of measures to address this directly assert that minority under-representation is the product of historical transgressions by the over-represented majority. So, the penalty is a form of inter-generational justice.
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p>One problem with this logic is what to do when the overrepresented group(s) are another set of minorities – in this case, Asian docs. As Razib notes, the convenient, epicyclic solution to preserve the original theory is to simply reclassify Asians as whites –
To assert a glaring gap of color one has to de-colorizing Asians. Including Asians makes the gap far less glaring…The general focus of the news report here is pushing the thesis about a minority doctor shortage, so you see the standard deemphasis on statistics which show a surfeit of Asian Americans, but with a precise & clear reiteration of the dearth of blacks and Latinos…The background assumption is of course simple: a world of white and non-white must redress the injustice that the white metes out to the non-white.
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p>Where Razib’s piece powerfully demonstrates the power of blogging relative to the mainstream media is the additional work he does to actually compute the propensity of doctors by Race in a more thorough way than the SFGate reporter. For White docs, this “propensity” ratio is 1.32, for Indians it’s 6.78, and for those of Mexican descent, it’s 0.12. So yep, a given desi is about 5x more likely to be a doc than whitefolk who in turn are about 10x more likely to be a doc than Latino/Mexicans.
What’s also instructive are variances within the big buckets – the data shows Asian/Vietnamese have 2x the propensity to be docs as Asian/Filipino’s, for example. This makes Filipinos actually marginally less represented than Whites and yet, SFGate’s position buckets prospective Filipino docs with & competing against the hyper-represented Chinese and Indians for their “slots”… Or perhaps they’d add another racial epicycle to specifically address them?
But, but…that violates the principles of the free market, the \”bid-ask spread\” etc, based on which India will continue to paradoxically have a \”surplus\” of doctors, even while suffering an acute shortage of the same, so long as wealthy nations like America and Australia, where the doctor shortage isnt nearly as acute as India\’s, are able to outbid India for their services. Doesnt it?
vyasa, don’t you understand the difference between a description and a prescription? it is obvious to all but the most hare-brained that portmanteau and floridian are just making an (accurate) observation explaining the numbers in the post. nowhere are they making a normative judgment that rural india is undeserving of doctors, but maybe the giant chip on your shoulder obscures your ability to see that.
What are you yakking about? Who said anything about a prescription?
You say that India has a surplus of doctors (when in fact it has an extremely low doctor to patient ratio) based on the concept of bid-ask spread in a global \”free market\”. By that reasoning every third world country must be overflowing with a surplus of doctors. But if there is such a global free market for doctors as you think, why is there a \”surplus\” of doctors in India and the third world when there is a shortage of doctors in wealthy nations like Australia and the UK? How does the bid-ask spread account for this? Surely doctors in impoverished India arent asking for more than what wealthy nations are willing to bid for them?
52 · Who let the ‘who’ out? said
Don’t bother. Despite the truth of your comment, chances are he/she/it will just repeat themselves.
No they’re not. Asians do well, particularly Indians, because they are an artificially selected population, generally having already benefitted from 50 years of Indian government investment in technical education. While racists have long used the “why can’t you be like them?” reasoning against blacks and hispanics, and the Asians have kept quiet and benefitted from their model minority status, afforded them because of their relatively small numbers and their usefulness in the promotion of anti black racism, the relative success of many Asians does not disprove the powerful effects of white racism.
this is a standard argument used by “asian aren’t really a model minority” types. the problem is that the “model minority” argument arose before the mass wave of asian immigrants after 1965 which were selected for education. rather, they were the descendants of chinese & japanese peasants who were doing relatively well despite discrimination (in japan specifically it was the lower SES groups which were encouraged to emigrate the new world for malthusian rationales).
I’m amazed that we’re not talking about the dynamics of class and immigration policy in this apparent “over-representation” argument. While there has been some diversification (along class lines) of the immigrant desi community in the U.S., the vast number of desis in college are either (relatively) affluent immigrants or the children of relative elites who came under the strict migration regime of the 1960s/70s. Is it no wonder that those same groups self-select into high-earning “status” professions?
of course it is class. but we’re not doing affirmative action based on class, are we? so who cares. race matters; if you’re a cracker from appalachia you’re shit out of luck because you get white skin privilege 😉 (as can be attested by the smattering of undisguised contempt and distaste expressed on these boards toward lower class whites from brownz).
who = prema, right?
you stupid git! you need to go to the next room if you are looking for an argument!
razib, who = prema = vyasa = gupta = dev, and so on, and so forth.
30 · who said
Regarding the lack of medical doctors in India, one of the first things that we can do is DOUBLE THE NUMBER OF MEDICAL STUDENTS WHO GRADUATE EACH YEAR from 30,000 to 60,000. why? because currently: 1. our american kids are going to third world countries (i.e. st.thomas islands, caribbeans, etc.) for a medical degree. they don’t have to do this! 2. i find that bringing doctors from India/China worrisome, not because i doubt the abilities of these doctors, but because i KNOW that the indians and chinese need their doctors more than we need them.
3. the population of the USA has risen substantially over the years, but the number of doctors allowed to graduate has stayed the same.
4. having more doctors would lower the prices of certain medical practices. 5. The AMA (American Medical Association) is a racket: On one hand, they sell malpractice insurance to the doctors in the event they get sued by a patient, and on the other hand, they sell legal services to those same patients who are trying to sue doctors! This is even mentioned on their website. From what I understand, and I don’t have the data in front of me, is that the number of American doctors who matriculate hasn’t changed much in the last 30 years or so (once again, not sure).
there are some unnatural market forces at play here as well. why is it that the REAL (adjusted for inflation) prices for routine/standard procedures have risen over the years? they should have come DOWN due to technological advances or better policies for treatment. for example, resetting a broken arm 30 years ago was a lot cheaper than it is now – even if you adjust it for inflation. same goes for deliver of babies. SOMEONE IS MAKING A LOT OF MONEY HERE! the prices have been kept abnormally high. what’s at work here? also, i know this one japanese exchange student who had a cavity cared for at a dentist’s office here. he was without insurance. his bill to rectify this cavity was $1500!
I think that the medical profession is the most lucrative and “safe bet” type of occupation. It has quite a few perks, in addition to the lucrativeness of this job. Some of the added benefits are career stability, geographic flexibility (how many hedge fund managers in Milton, Oklahoma?), and everyone you work with are not sleazy when compared to other professions.
Regarding my previous post’s assertion that we should effectively double the entrants into medical schools, I believe that we can do this, and this would have so many benefits and very little costs. 1. If we double the number of entrants, we can do so be simply doubling the capacity of existing medical schools. We don’t have to build new schools, and this marginal cost is not that much. 2. It’s not much harder/more costly to teach 100 students VS 50 students. Therefore, the the medical schools would get roughly twice the revenues, and the tuition could reduce by roughly 50%. I envision that the average indebtitude today for MDs is about $400,000, but with my “2X Proposal” (2XP), the average indebtitude would decrease to, let’s say, $250K.
3. More MDs mean more supply, and this would decrease prices. Period. What happens to the wages when there are more of that type of worker? It goes down, and this isn’t necessarily a bad thing. MDs get paid too much for a job that will never see them getting laid off or fired.
The most common rebuttal that I’m hearing, however, is that my 2XP would dilute the pool with more mediocre and/or under-qualified MDs. This is partly true, but people are hyper-sensitive about it. To this, I have an analogy. Suppose that the USA had a restriction saying that people can only get a driver’s license if they are very athletic and they scored in the top quintile on some standardized exam. Sure, this selective pool would do a good job driving, but so would many people who did not pass this exam or meet the minimum athletic criteria. So in this hypothetical example, the criteria for driving is too selective.
Same way, there are many very smart, passionate, sincere, and competitive prospective MDs who did NOT get accepted to a medical program due to one reason or another (i.e. poor undergrad GPA due to personal reasons and/or other reasons). However, I’m convinced that these people would excel in a medical program.
Therefore, the rate-determining step for the production of an MD, is getting accepted to the medical program. Intuitively, I’d say that ~95%+ of the people who get in medical school graduate. The other ~5%- who don’t graduate, I’d say that most of them drop out because they realized that medical school was not for them.
Finally, the quality of the MDs would go down incrementally. However, the quality of our MDs are so high now, and our problem is not that we have bad doctors. Our problem is that we don’t have enough qualified doctors! Coming back to my driver’s license example: Sure if we only allowed very smart and very reflexive, scholarly ninja-samurai-types to become drivers, the roads would be safer than it is now. I’d say that there would be 1 error to 100,000 driving events, let’s say. However, in this situation, we can relax the standards a good bit (to say yellow belts – JK), and I would think that the error rate would be 1:80,000 driving events, and thus, the highway safety wouldn’t go down by much in spite of the glut of new drivers.
doctor = lots of ladies 😉
They’re planning to increase medical school entering classes by 30% by 2012. There are about 10 new MD and 5 new DO schools about to open up.
61 · anthroguy said
I doubt that the number will go up by 30%. Currently, there are about 18,000 MD matriculants each year in about 150 medical schools. I cannot find anything on the likelihood of 15 additional schools with 30% increase in enrollment by 2012. It’s a good thing if it were to happen.
Link to no. of matriculants by medical schools for entering class of 2007: http://www.aamc.org/data/facts/2007/2007school.htm
There were about 22,000 first year residency positions for 2008 which were matched; 15,000 of these were US MDs, 2000 US DOs, and about 5,000 non-US MDs.
If US MD/DO schools increased the number of students without a simultaneous increase in residency slots, then many of the foreign MD programs that attract US students will be out of business.
Lol. Running out of arguments to defend the indefensible with, eh?
What\’s stupid is portmanteau claiming that India has \”too many\” doctors. What\’s even more stupid is your asinine attempt to justify that outrageous falsehood with \”the concept of bid-ask spread\”! 🙂
Additional info . from AAMC on this topic: http://www.aamc.org/newsroom/pressrel/2007/071016.htm
The 2007 entering class to U.S. medical schools is the largest in the nation’s history, according to new data released today by the AAMC (Association of American Medical Colleges). The number of first-year enrollees totals almost 17,800 students, a 2.3 percent increase over 2006. More than 42,300 individuals applied to enter medical school in 2007, an increase of 8.2 percent over 2006.
As of 2006, 28.8 percent of the U.S. population was black/African American, Hispanic/Latino, or Native American, yet these groups accounted for only 14.6 percent of medical school graduates. Nationwide, only 6 percent of practicing physicians are members of these groups.
In addition to increases in the size of the applicant pool, 11 of the 126 U.S. medical schools boosted their entering class size by more than 10 percent this year. First-year enrollment at the nation’s medical schools has increased more than 7 percent since 2003, when the AAMC first began to investigate the possibility of a physician workforce shortage.
64 · who said
India has too many doctors, many more than it can gainfully train and emply. The post-MBBS training opportunities are severely limited, and less by an order of magnitude than the number of MMBS seats. That’s why doctors complete their residency and leave for the US. There are a quite a few doctors who leave India to take up PhD programs abroad, since all they want to do is research. As with most other portfolios, the Health portfolio in India is held by an A-grade chump – Anbumani Ramadoss – who is so busy exploting his 23 servants out of Lutyens bungalow in New Delhi and hectoring Rajanikanth that he doesn’t have the time to look into these matters. In the meanwhile Ramadoss is all set to hand out medical school licenses to Jerry Falwell Liberty University type diploma mills. The PM couldn’t care less as long as Ramadoss’s party continues to support the ruling alliance and his puppetmaster the lady on Race Course Road is happy.
65 · Sean in LA said
Apparently, someone in the AMA (or in its behalf) made a wrong mathematical calculation which resulted in a wrong forecast ie surplus doctors. It is quite surprising to know that the supply of physicians in the US depends on an organization which is not even reliable enough to cross-check its math.
I see a trend here that people attribute contrarian comments to who/prema/vyasa/etc.. and then dismiss those comments even though almost all the time, his/her comments tell the TRUTH.
It is ridiculous to say that India has ‘surplus’ doctors.
it is all well and good to pull out decontextualized statements in the interest of whipping up ire (your own or others’), but maybe you want to go back and read comments 31 and 32, as well as the original statements, not vyasa’s self-serving paraphrasing.
ha! like this? or this (pick your comment)? or maybe these are what you believe are the rules for reasoned debate? (anyways, the only thing less interesting than a “discussion” with that vyasa troll is a discussion about that vyasa troll, so that’s the last from me on the topic.)
69
Do you find anything FALSE in the comments you referred ?. If so, can you explain?. Do you think “who” made up the news reports about Dr. Patel and Dr. Desai?
you are right, ponniyin selvan. it is perfectly reasonable to conclude that immigrant indian doctors with indian accents are murderous, unethical scum from those two examples. my bad.
“problem is that the “model minority” argument arose before the mass wave of asian immigrants after 1965 which were selected for education.”
That’s just not true – nobody referred to asians as model minority prior to 1965, and the term didn’t really catch on until the 1980s. You made that up out of nowhere. perhaps you figure if you write “malthusian,” people will not realize what horseshit you come up with.
Another thing about my 2XP is that we won’t need to rely on the MDs from 3rd world countries anymore. Don’t you think that the people of India need their doctors more than we need their doctors? By enacting 2XP, the people of India (yay India!) can better serve our own people there.
Therefore, I believe that we should write letters to congress about this proposal for further analysis.
BTW, 18,000 MDs a year is too little. We import 25% of our MDs as well. This is pathetic. The AMA/AAMC/whatever is a guild with a vested interest in maximizing the earnings/profitMargin of their own – IDENTICALLY, to the board of directors at a multi-national corporation.
AMA = ExxonMobil: They create a dependency on imports, serve to maximize corporate value (not just measured in market capitalization, but maybe by other metrics – salary, personal prestige, clout, etc.), and attempt to profit on BOTH sides of the problems.
Did you know that the AMA, according to hoovers.com (a business analyst online site that’s very well respected/regarded), sells malpractice insurance to MDs, but they also cater to the other side of the problem by providing litigants with lawyers!
Talk about an unethical racket.
65 · Sean in LA said
68 · Ponniyin Selvan said
it is true that there is an aggregate shortage of doctors in india. but as jyotsana (very pertinent observation, j) pointed out in #66 post-mbbs opportunities in india are limited. you need to specialize to really take advantage of your basic medical degree. and, a lot of MBBS grads are complaining about how reservations at the specialization and super-specialization level further restrict the already limited set of available seats. it is true that a lot of indian medical graduates could be out in the villages as general physicians, providing primary care. but expecting only physicians to sacrifice personal gain is unfair, IMO. rural india needs a lot of engineers, businesspeople, nurses, bankers, inventors…….many of whom have benefited from technical education paid for by the indian taxpayer. why expect national service for docs that no else is willing to offer? those (eg sanjit ‘bunker’ roy) from privileged backgrounds with good educations who’ve given up personal comfort and wealth to make a contribution in indian villages — however, they have all my respect and admiration.
72 · noblekinsman said
Yes. And that’s the reason that accounts for the numerous 7-11, gas station, restaurant, and motel owners. We can’t forget about the cab drivers as well. Yep. So many educated Indians here. I think the late 80’s/early 90’s required most Indians who immigrated to be educated.
razib, your dates re: the usage of “model minority” as an extensive stereotype of Asians (including 2nd/3rd/4th gen. Japanese and Chinese Americans) is anachronistic.
Also, the major point of my comment (at the end of my post) was that people talk about racial and SES diversity as either a) proxies for one another, or b) mutually exclusive goals. They are neither.
I asked about SES because you’re using propensity scoring that weights populations as if they were identical. We know, by immigration policy and otherwise, that they are not. So how useful is it to talk about the likelihood of that poor Appalachian white kid you mentioned becoming a doctor next to the kid of a (relatively) affluent desi immigrant? Not very helpful at all. I want to know how desi kids stack up to their white peers in the same SES. I think there’s something to be said about immigrant groups choosing specific disciplines within which to specialize — hence my reference to Filipina nurses. It’s highly likely that, given external constraints (including racism), we are seeing migrant communities track in specific industries because of specific guarantees, e.g., similarity of field to previous training, financial/job security, etc. I also wonder what happens if you break this down generationally. Do we see a diffusion of the “propensity” effect based on cohort after the second generation? Probably.
Could we please ignore the prema/vyasa/who troll?
Rahul S, I’ll lend you $1 — please go buy a clue. Please read a textbook or ANYTHING related to Asian American history before using your limited world view/experience/familiarity with a subject as your substitute for reasoned discussion.
76 · Camille said
also, another similar community: keralite nurses. nice point, camille, about how a confluence of factors (immigration policy, professional knowledge accumulated by family and friends abroad as well support they can provide on arrival, recruiting agencies in india etc) leads to a disproportionate number of specific migrant communities in certain occupations. and yeah, it would be nice to measure propensities wrt identical populations in the relevant sense. so a stack-up with other affluent model minorities may also be informative.
77 · Camille said
Why would I need to read more? Here’s a breakdown of brief Asian American history in a minute. The early Asians to come to the U.S. were Chinese-Americans during the Gold Rush (some Punjabi’s came also) during the 1850’s. During this time, there was a great hostility towards these Chinese immigrants because they were hardworking. Therefore, the Chinese-Exclusion Act was enforced so the Chinese couldn’t get jobs. A large exodus of Asians immigrated to the West Coast, as we can see the large numbers of Asians in this region. The U.S. government feared that Asians were hard working, and would create hostile scenarios between the natives living in the states. Therefore, immigration was given preference to European countries. Eastern europeans were given shit as well, and they experienced a lot of racism as well. Back to the Asian part. Japanese Americans were placed in internment camps during the WWII. There was a supreme court decision (some guy named Singh) contesting for citizenship…however, he wasn’t given it in the 1920’s. Under President Truman in the 1940’s, Truman allowed more Asians to come to the U.S. (especially Indians). However, this was a small number. Yes, then in the 1960’s, more Asians were given citizenship preference if they were educated (which my grandfather benefited from, and immigrated in 1967). Yes, there were Indians that were uneducated, but still many of the Indian immigrants that we see today are educated. So why the f*** would I need your buck to buy books when I already know the basics of Asian American History.
71 · Who let the ‘who’ out? said
What you are conveniently neglecting to consider is that these two weren’t just the usual random examples of doctor misconduct, these are probably the two worst examples that have been in the news in the past few years. Dr Patel, known as Dr Death, is responsible for at least 87 deaths due to his incompetence and Dr Desai may have infected 40,000 americans with the AIDs virus due to shoddy practices in his clinics. Of course someone like you who is irrational enough to argue that the “bid-ask spread” explains the “surplus” of doctors in India may find it hard to understand why americans who have been following the news could have a reason to be wary of indian doctors based on just those two examples.
The reason I brought this up was to counter the self-serving putdown of black and hispanic doctors by one poster here. Apparently he thinks that black and hispanic doctors are incompetent due to lower standards applied to them in medical school and therefore whites choose to avoid them if they can afford to do so. Going with white doctors instead, which group according to his delusion includes indian doctors! Though he did throw in the caveat about indian accents turning whites off to give the impression that he was being fair and objective in his analysis.
66 · jyotsana said
How the heck does any of this lead to the conclusion that India has “too many doctors”, an overflowing “surplus” that spills over to the developed nations? When the reality is that India is suffering from an acute shortage of doctors. You are just giving reasons for why doctors trained in India prefer to go abroad instead of staying home. And amusingly you neglect to mention the bottom line reason: they are desperate to go abroad because they know they can make a helluva lot more money there than they can in India.
What you and portmanteau should say, if you were intellectually honest, is not “India has too many doctors” which is an outright lie, but “India has too many doctors who want to get the hell out of there”.
does this also mean that mexican immigrants do poorly because they are an artifically selected population, generally low skilled laboarer who’ve been hurt by 50years of anti-free market policies of the mexican oligarchy? if the model minority is a myth, wouldn’t ant-mexican racism be a myth too?
80 · who said
heh. after reading vinods post, i thought “my god, prema is going to have a conniption: indians are being classified as white.” apparently, the thought of whites classifying indians is white is too much for him to bear, so he projects the delusion onto razib, who obviously is as opposed to this classification as he is to affirmative action itself.
81 · who said
i say something like that in comment #74 (read line 1). india-trained physicians may not want to get the hell out of the motherland, but certainly, if they want to get a post-MBBS education, they might not have another option. if you wish us to express our sentiments as per your command, maybe you should take a page out of dear leader’s playbook. didn’t he say that power grows out of the barrel of a gun? haranguing people over the internet doesn’t work quite as well, little mao.
Why does Prema/Vyasa keep on changing its name.
Hey Prema/Vyasa/Who
WTF don’t you go hang out amongst your own kind ?
Just because Indians are hospitable doesn’t mean you wear out your welcome with your rage.
There is an old Persian curse “Be angry and die of this anger.”
Make sure your ER doctor isn’t from India though.
Hey folks – cut out the personal attacks or this comment thread gets shut down.
why are people forgetting the role of immigration policy in racial/class formation in the US? The model minority myth does not apply in all countries with a South Asian diaspora. I see a lot of sneering at “social science professors” and “leftists” in general for “harping” on racial inequality, so how do you all interpret the model minority myth? Proof that Indians and Chinese are the ubermensch? GTFO. I guess it’s just another day at Sepia Mutiny.
And this is old news – I don’t know how it’s a “gotcha” for “leftists”. The govt let in a whole bunch of degreed/middle class people, hence the demographics. The model minority myth is a convenient anti-black rhetorical tool that’s lapped up by ignorant, smug uppper-class asians who don’t have a grasp of how social policies form societies. I find the assumption that being a doctor or whatever necessarily means one is smart ridiculous – I know cus I’m surrounded by petty, gossipy, shallow people in “successful” job roles, and my mum who’s a doctor talks about dumbasses in her field who came to work drunk, didn’t use gloves before they became mandatory or re-used dirty needles. A young white woman who went for several years on maternity leave came back and became the director. The immigrant women doctors get the brunt of the crappy work and the least help.