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.
<
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.
<
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.
<
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?
And yet there’s only one desi or “Far East” Asian doc on “House,” “ER” and “Grey’s Anatomy.”
Thank you Huey!
Aside from ER and House, any East Indian doctor is usually an extra on the set or has a one-time appearance as the doctor from the other “department”.
Good work by Razib. This illustrates why “race” is increasingly absurd as a “class” signifier in the US.
What could be the author’s agenda? The article is certainly fodder for right-wing criticism of “the liberal media.” I don’t understand why anyone would persist in a racial argument like that, which is so clearly contradicted by facts.
3 · Nina P said
If one’s academic/policy think tank career was on the line, one would persist in this line of thinking. That covers a good deal of social science profs in the US, right?
I live in the Chicagoland area, obviously I know a bunch of brown & other Asians wanting to be doctors. It seems that when an Asian gets let say a 29 on his MCAT & a competitive GPA, it’s tougher for this person to get in. However, when a white/black/latino gets the exact score, this person would get in easily. I mean this goes on in Chicago…I feel bad for the Asians in Cali area (since the competition is fiercer over there).
3 · Nina P said
o crap! that was an article. i thought it was an op-ed.
for the record, i think issues of cultural compatability are real. but you need to be careful here. it is probably true that black, latino, etc. MDs disproportionately service their communities, and that black and latino patients feel more comfortable and prefer doctors of like ethnicity. but this logic applies to whites, too, right? i’ve heard whites complain about accents and lack of cultural fluency from immigrant indian doctors. how do you like those proportionalist apples? another byproduct of lower standards for latino and black med students is that these sorts of doctors won’t have much of a chance to treat outside of their “their community” because people with means will simply avoid them on the assumption that it’s better to be safe than sorry when it comes to your health.
finally, there’s a problem in human psychology where you simply dichotomize. liberal vs. conservative, white vs. black, rich vs. poor. that misses really, which has many dimensions. for a journalist with x hundred words particular narratives are convenient because they offer up a lot of free information for the readers. asians are really “problematic” for most leftish race theorists because they seem to be able to succeed despite the all-powerful affect of white Racism. so you have lots of arguments about how asians really aren’t succeeding, how they have to work harder, or that the statistics miss communities like the hmongs who are given so much attention that one wonders if they aren’t the true representatives of asian america….
Vinod’s post:
More likely to be a doc or more likely to become a doc? If the propensity theory is centered around the mere occurrence of physicians within an ethnic group, which means that the data includes the immigrant physicians as well as US born, then the “population to physician disparities” are immaterial. There are a lot of desi doctors here simply because there are a lot of desi doctors over there, and many of them end up coming here. Similarly, if the Vietnamese are 2X more likely to be doctors than Filipinos, we should look for answers in the number of medical graduates being churned out in their respective countries than in the educational focus within their respective communities here.
However, if the data filtered out the immigrants and focused solely on the propensity of US born ethnics to become doctors, then the entire discussion would have serious social connotations. There would be valid reasons then to contrast and compare one ethnic group vs. another, or better yet, to compare ethnics with the benchmark, the whites.
Interestingly, I contributed some time in the mid-seventies for a campaign to get Indians classified as a minority. The leaders of the various Indian associations never wanted us to be lumped with the whites for obvious economic reasons.
On a personal note, is that you Razib in that Dashiki shirt? I used to have one just like that.
As a sequel to my comment #8, I believe that the 6.8 propensity factor of Indians will be much lower in the ABD group, and if history of other immigrants is a guide, will continue to decrease as third and fourth generation ABD’s become more and more mainstreamed in a career sense.
Rahul S, are slutty Gujarati girls more likely to be docs as well?
I believe that the 6.8 propensity factor of Indians will be much lower in the ABD group, and if history of other immigrants is a guide, will continue to decrease as third and fourth generation ABD’s become more and more mainstreamed in a career sense.
1) yes, they’re mostly immigrants (see report where it shows where they were educated)
2) but the decrease isn’t going to be that great if the % in american medical schools of brown kids is evidence (on the order of 5-10% i think).
On a personal note, is that you Razib in that Dashiki shirt?
i don’t know what to call that.
http://www.aapimsr.org/ The AAPI Medical Student and Resident Section represents over 10,000 students across the country. Although Asian Indians constitute less than 1 percent of the population of the United States, they constitute 10-12 percent of the student body in medical schools in the U.S.
10 · portmanteau said
Well, stands to reason that those who play doctor are more likely to become one.
10 · portmanteau said
Portmanteau,
I don’t have the data for that. You could help me find data on this though; then, we can see if there is any empirical evidence on what you just asked.
Floridian #8:
Razib #11:
I had that shirt in high school. A friend of mine borrowed it to wear it on stage as he sang Harry Bellafonte’s “Day-0.” As high school kids in India of the sixties, we weren’t erudite enough to differentiate between the attires of the Caribbean and African blacks. And that was the last I heard of my Dashiki.
Floridian, in response to #8, I’m likely to speculate that the answer is both. Too many docs in India, so some end up immigrating. And ABDs are also more likely to be docs as well. We might see more people of South Asian origin becoming doctors because it might be one of those professions where people have some slight advantages in following in their parents’ footsteps. It is a profession where entry costs are relatively high (long expensive education; demonstrated academic and social ability) and information about the process of becoming a doctor are quite useful. Familiarity with the system can give a person a big boost in the admissions and internship process, as well as get you started early on. Inheriting patients and practices may also be one reason physicians might nudge their kids toward a medical career.* So already having desi doc parents may increase the chances of ABDs becoming physicians. In general, following your parents’ career does have some advantages, but I suspect these are heightened in fields where knowing how to deal with ‘the system’ is a big advantage. I remember reading some research that children of welfare moms were likely to be on welfare themselves for a variety of reasons. But one of the big reasons they were able to choose this lifestyle for a period of time (as now there are much more stringent time limits after PRWORA) in comparison to other people was because they knew how to navigate the system better and receive helpful advice from their parents about eligibility etc. I guess certain ‘career paths’ may become much more accessible if your family and friends have knowledge about them. My hypothesis is probably only a partial explanation. Other factors, such as higher than average per capita income for ABDs are also at work. This may also have an inter-generational angle. Desi immigrants are more likely to be educated because of immigration regs, therefore wealthier, and therefore, better able to secure the best educational advantages for kids. They are also more likely to push kids toward ‘more years of education’ since that is what allowed them a better lifestyle in the first place. Sorry no new wisdom in this post 🙂
*(Some people nudge their kids away — my mum is a medical academic in India, and always pushed me away from medicine because of various reasons. Poor research funding in India, job insecurity in an American lab; not enough creativity if you are a practicing or physician. My brother was not dissuaded, however.)
long expensive education;
most people take out loans here the USA from what i know. so if you can get in somewhere you can probably finance it, right? has the credit-crunch changed things?
17 · razib said
razib: i meant to emphasize that the longer period of education could be more excruciating for some. if you’re a bright kid, who doesn’t have that passion for medicine (some people are quite single-minded in their pursuit of medicine. anecdotally, i haven’t seen a manic obsession wrt to other careers) but are considering it as a career, you might be discouraged by the sheer amount of time you have wait until you’re independent. the net present value of being a physician is lower than earning a good salary now.
#16 · portmanteau
When dealing with such issues, there is never one salient factor, and to make matters more interesting, there is also the chicken-or-the-egg circular logic at work.
One factor I would like to add to your little catalog of reasons is the “My son, the doctor” factor. (Daughters may also apply, gender no bar.)
The first-generation desi community in the US, of which I am a card carrying member, is still time warped in such “old country” values as a snobbish pride in your children’s social standing. I did not say accomplishments. That would be all right. You can play the Carnegie Hall and they (we) don’t care. But if you are even a journeyman surgeon in small-town Idaho, vee are proud and writing Papa and Mummy back home about your new Mercedes.
No harm in being frank, is there?
14 · Rahul S said
Since when did the availability of “data” stop you from theorizing? 🙂 In any case, I become an RA only for hot professors.
19 · Floridian said
Nope, it is the one thing for which you’ll always get credit from me. I thought that*, but I did not include it in my post because I hesitated to open that can of worms.
*
21 · portmanteau:
I gotta admit, though. I am not immune to the “My daughter, the doctor” disease myself. I figure, as a parent, why not go all out to brainwash, cajole, coerce, threaten and force? (I don’t have a thesaurus handy.) It can’t hurt, right? And if at the end of the day, the kid ends up becoming a cashier at the supermarket, maybe he or she will remember the Great Motivator and become the best cashier at the supermarket. This whole thing could backfire, too.
An observation on children following in the footsteps of their physician parents – the propensity is unusually high. I know families in which three out of four siblings became doctors, following one of their parents’ example. I don’t see it among engineers, professors, entrepreneurs and other professions.
You probably meant here, Floridian, that the children of engineers, professors, etc are not becoming engineers, professors, etc. That is, they do not follow in their parent’s footsteps.
However, I know many children of engineers, professors, entrepreneurs (especially hotel owners, store owners etc) who became doctors. So this is another thing to factor in, in explaining the propensity – it’s not just that doctor’s kids are becoming doctors, it’s that kids of engineers, non-medical professors, entrepreneurs are becoming doctors too! In many (most?) cases it is actually a very well thought out plan – on the part of both the non-physician parents and their kids – they become doctors figuring that other professions do not provide comparable job security, status or remuneration, and for those so inclined, opportunity to serve society at large. The children of non-physicians going into medicine do not necessarily have the insider knowledge that children of physicians would, but make up for it in hard work, ability and motivation!
20 · portmanteau said
O, I had the data from before. I’m not a professor by the way.
24 · Rahul S said
Exactly. I was trying to say I would help only a hot professor with data collection. Clearly my assumption about you was correct.
Floridian, As usual your insightful comments are a treat to read here on this blog. But on this topic I have a slightly different view. I think that “ABDs taking different career plan than parents” may have something to do with the fact that the parents were not ABDs themselves. The ABD doctor parents kids may be more likely to follow the footsteps of parents, and I am basing this speculation based on my relatives back home. One of my uncles (both him and his wife are doctors) tried very hard for his kids to not chose Medicine as a profession (back home) but the kid went into medicine as that is the only thing he thought he would do eversince he became a teenager. This is just not one off case. A lot of Doctor parents’ kids become Doctors, back home. I am speculating that, that will happen here also as the parents also become mainstream in this society.
Could this pattern also be because Asian parents usually do take more of a financial responsibility for their kids, & for a longer period, than other ethnic groups.
From an Australian perspective, just from what I see in my cohort – 20 out of the 85 are Asian & the Asian proportion is even larger in the more junior cohorts showing that the trend is progressing. I havn’t looked up the data but I’m pretty sure that Asians do not make up a 1/4 of Australias youth population.
23 · chachaji said
I am a non-physician parent who had no difficulty finding information on the web to help my daughter get into medical school. I have to admit that my daughter’s desire to be a physician was primarily driven by the McMansions/Mercedes of the physicians in the Indian community. Being frank here.
I have two physician friends, and between their six kids no one chose to go to medical school. Both friends were extremely disappointed.
18 · portmanteau said
On an average, the NPV of a career in medicine is much higher–long education period notwithstanding–than most other professions. Medical career also has the added benefit of a much lower variance.
Floridian:
portmanteau:
Wow. This is such a brazen falsehood.
http://timesofindia.indiatimes.com/India_short_of_6_lakh_doctors_/articleshow/2921262.cms
India short of 6 lakh doctors 3 Apr 2008, 0014 hrs IST,Kounteya Sinha & Mahendra Kumar Singh,TNN………..Even as India faces an acute shortage of manpower in the healthcare sector, the country holds the top position when it comes to its physicians migrating to developed countries like Britain and the US. According to a Planning Commission report, while India is short of six lakh doctors, 10 lakh nurses and two lakh dental surgeons, Indian doctors who have migrated to developed countries form nearly 5% of their medical workforce. Almost 60,000 Indian physicians are estimated to be working in countries like US, UK, Canada and Australia alone.
#30 who
That’s exactly what we were talking about, who. The shortage of doctors in India is an entirely topic. Therefore, it is not a “brazen falsehood” but simple logic to say that a country as populous as India can export 60,000 doctors whereas smaller countries will export fewer doctors.
30 · who said
No I didn’t mean ‘too many’ in terms of need from India (Sorry, this was entirely unclear from context). The quantifier ‘too many’ referred to those who were able and willing to move actually because I’m assuming they thought better opportunities/compensation would be available to them in the US. In fact, this has to be the case. In the absence of higher perceived ROR in the USA, why would people be studying so hard for the USMLE back home? Having a prospective spouse in the US may be a reason, but anecdotally in India, doctors have a huge preference for marrying doctors (I happen to have grown in a pretty ‘medical’ family and am a former avid scanner of the matrimonial ads in Indian newspapers; prurient, I know) and will tend to pool where there is a presence of physicians. In the past few months, several medical journals have been focusing on the brain drain (specifically of all kinds of health personnel) from the third world and a major conference has also been convened (the focus is, of course, the shortage of qualified personnel in Africa; I’ll find the links and post them a little later). This work is also being done by political philosophers like Thomas Pogge, who are trying to propose plausible solutions for combating or ameliorating brain drain.
Sean (@29) as far as medicine is concerned, you may right about the low variance (except for the outliers who lose their licenses for various reasons, including malpractice and improper conduct during research), but a smart kid can make a lot of money as a hedge fund manager/in-house corporate lawyer without having to bear administrative costs practicing medicine and the rising malpractice premiums. Certainly, I think facing patient liability must deter some people — some of whom I suspect end up in research medicine, while others will move to an entirely different career altogether. And since health financing is a topic of much debate these days, I’ll wager in the next 10 years there will be a few dramatic changes in the way doctors are paid — although I’m perfectly willing to recognize that a very,very minuscule percentage of those considering to be doctors will acknowledge this in their calculations. It seems like a lot of individuals have an unusually strong emotional attachment to a career in medicine, much more so than in other professions.
Also forgot to add, some people discount time differently. So if you’re a poor kid who needs money now, a career in medicine is slightly less enticing because the prospect of lots of money 10 years later is great but what of immediate needs?
“asians are really “problematic” for most leftish race theorists because they seem to be able to succeed despite the all-powerful affect of white Racism.”
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.
34 · noblekinsman said
So how do you explain the fact that 9/10 blacks had jobs in the 1930’s (when racism occurred), while in the 1960’s (when blacks were given more rights) less blacks worked. Your left wing account of “anti-black racism” is simply wrong. Blacks have struggled due to the breakdown of family.
Read this article from an African American site.
http://www.theroot.com/id/45794
Plus, what about the Asians who suffered racism in this country as well? Weren’t the Chinese treated like s*** in California when they immigrated in the 1850’s (Chinese Exclusion Act), Japanese with the internment camps in the 1940’s, more Asian racism with the wars with the U.S. going to war in Asia in the 1950’s. I do agree that African Americans do have it tough, but it’s not racism that hurt them.
32 · portmanteau said
Some of my daughter’s classmates who took jobs in investment banking are likely to lose their jobs given the current financial sector meltdown. I agree with you that remuneration to physicians, in real terms and relative to other professions, will decline over the long term. Patient liability and office management are not major issues if you are willing to work for a large HMO like Kaiser.
I totally think that’s true (the concern with social standing), but I don’t think it’s an “old country” value — it seems to apply pretty strongly to other U.S. communities as well!
Thank you!
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?
razib, what’s the propensity score for whites and desis of the same income/SES background to go into medicine? Is the abundance of desis also impacted by not going into other comparable, high-earning industries?
And I do think the aggregation of “Asians,” especially in California, does a real disservice to API communities. If we’re talking about language-access and health services, then it does make a difference that there’s not a sufficient diversity of Asian doctors, and further, that there’s probably little to no socioeconomic diversity among those who continue in medicine, anyway.
With respect to the call for reclassifying APIs as “white,” I think this misses a HUGE picture and reality for many Asian American communities. Who is “white” in your categorization, then? Desi docs? Filipina nurses? Cambodian refugees? 5th-generation Chinese Americans? It sounds like there’s a desire to create a mutual exclusivity between race and SES (which, in my opinion includes the benefit of highly educated parents, as port discusses above). Couldn’t it be the case that APIs should not be reclassified as white, but rather, that we need a more nuanced and holistic perspective on diversity among our medical professionals?
1 · Huey said
I too was puzzled by this casting anamoly. In school I held an on-campus job at the department of medicine and helped process the post-ERIS paperwork, and was amazed at the disprpotionate of desi doctors. But I soon reasoned out that these paper thin plots of that use a hospital setting to play out the same potboiler combination of prime time emotional hooks, don’t possibly know how to represent desi doctors and med students. There would be problems showing all that romp and shake that happens in Greys. So now after years of ER we have one desi Parminder Nagra.
Wait a minute! I thought Desi’s are Caucasians, you know white people with perma-tan? I’m sure I’ve read comments on this site that definitely wanted to set the record straight on this important fact. I’m joking, (kinda) 😉
Rahul S,first lets both put on our flag pins,to show our love for America. I’m going to agree with your statement,I don’t know where your stats are from,the culprit (black/white achievement gap) is attributed to Educational attainment, which is definitely related to family structure, or lack thereof ,which, can in part, be traced to welfare dependecies.
. link to AEI
That is NOT TO SAY there isn’t validity in the points made in comment #34.
Interesting how the committment to family and education was never thought to be a positive in all the hooopla over Obama’s Church/J. Wright. Conservative Thomas Sowell and others argue that integration,black “political” progress was wrong becuase it made blacks dependent, yet I didn’t hear any support for from that school of thought during the firestorm eiether. In fact, just the opposite. Hypocrisy abounds.
I confess to Sepia Mutiny envy, great content and smart commenters, diversity of views. I never post on “The Root”in spite of its name it seems quite inorganic, corporate sponsored (maybe becuase it is)
“9/10 blacks had jobs in the 1930’s(when racism occurred)”
you’re a chimp. 9/10 of nobody had jobs in the midst of the great depression and black unemployment hovered around 60%.
40 · noblekinsman said
My bad. The stat was from 1940. It’s on that site.
portmanteau:
That does not make sense at all. \”Too many docs in India, so some end up immigrating\” implies a surplus of doctors in India which is the exact opposite of the reality.
Razib:
There may be a rational reason for white americans being wary of immigrant indian doctors with accents and indian degrees. Consider the examples of Dr Patel and Dr Desai who became infamous recently.
http://www.komoradio.com/news/local/16594561.html
http://www.sepiamutiny.com/sepia/archives/005093.html
43 · who said
2 out of a sample size of how many Indian doctors? But yea, you may be right on this. People tend to see doctors who are of the same race (my white college professor was telling me about that).
42 · who said
I did apologize for my hurried response — clarification in 30 and 31 by Floridian and me, explaining what we meant to imply. There may be an overall shortage of doctors, especially in rural areas. But there is a mismatch between what the Indian market is offering to these docs versus the opportunities they perceive are available in developed countries. So there is a surplus — only that surplus refers to the number of doctors left after desired Indian opportunities are exhausted. I am not disputing that there is a aggregate shortage of doctors in India.
That’s because all Indian people are too busy becoming actual doctors instead of actors.
43 · who said
If desis are disproportionately becoming doctors in large numbers, out of whom you have a few bad apples, then attributing similar characteristics to the entire community of South Asian doctors is actually quite unfair and prejudicial. If two jewish dermatologists are charged with malpractice would anyone accuse the entire set of jewish physicians with incompetence? Your logic baffles me.
Based on your definition of what constitutes a surplus of doctors there will be \”Too many docs in India\” despite the well known and long term acute shortage of doctors there, for as long as it remains behind the developed countries in offering desired opportunities. By the same rationale there will be \”Too many docs\” in rural India as well, as long as rural India remains underdeveloped compared to urban India. Correct?
vyasa, does the concept of bid-ask spread not exist in the Chinese free market? i know that if you are dumb as a hammer, everything looks like a nail, which has nothing to do with what the commenter said, but try to make at least a pretense of understanding the other person’s argument when responding.
48 · who said
not necessarily. some people within india suggest that maybe government-educated docs should serve in rural areas for a period of time to reciprocate the investment made for their technical education. if you genuinely care about this issue, this is a good place to start. also, some issues of hastings center report may be worthwhile if you have access. otherwise, happy sunday evening.