Is the U.S. stealing health care workers from abroad?

It's become a stock image in the immigration debates: the flooded emergency room, halls packed with sick illegals seeking subsidized care. But now that image's negative is at the heart of a far smaller battle-not over the immigrants awaiting care in the E.R., but the immigrants providing it.

The immigration bill passed by the Senate last week includes a provision that would allow unlimited entry to foreign-trained nurses until 2014, and as a committee attempts to reconcile that bill with the less permissive House version, an open door policy for foreign nurses has a shot at becoming law. A free flow of RNs may seem like sound policy for a country in the midst of a severe nursing shortage, but opponents claim it's parasitic, emblematic of a ruinous American practice of stealing skilled labor from poor countries that can ill afford to export their most educated workers. The Philippines, in particular, seems to be hemorrhaging nurses, while the U.S. soaks up thousands of Filipino-trained RNs annually. Last week, a New York Times article, headlined "U.S. Plan to Lure Nurses May Hurt Poor Nations," implied that the Philippines' health system risks collapse if the U.S. keeps it up. Talking Points Memo Blogger Nathan Newman excoriated supporters of the Senate provision, complaining that " The U.S. refuses to invest in training and education of our own population, then instead leeches off the tiny investments in education done by developing countries."

The vision of American hospital administrators prowling the streets of Manila poaching nurses from Filipino hospitals presupposes that the number of Filipino RNs is fixed, completely independent of U.S. demand. But that hasn't been true for at least half a century. According to Catherine Ceniza Choy's 2003 book Empire of Care, Americans began training Filipino nurses in 1907, and the first wave of Filipino-trained nurses arrived in the United States between 1956 and 1969 as part of an Exchange Visitor Program. The Philippines has since become the world's largest exporter of trained nurses according to the World Health Organization. Filipino nurses trained in Americanized schools in English have been showing up in the U.S. for decades and in droves, and a nursing education has long been seen as a ticket out.

The government of the Philippines clearly thinks it gains something when America "leeches" off its investment. The government has consistently lobbied for more, not fewer, nursing visas in the United States and United Kingdom, with an eye on the massive remittances nurses send back to families still at home. The Philippines is heavily dependent on money sent from abroad; the government is famous for encouraging its citizens to leave, and eight percent of its population resides abroad as domestic workers in Malaysia, English teachers in China, and nurses all over the developed world. According to the Philippines Central Bank, large scale labor migration brought home remittances totaling $9.7 billion last year, and nurses have historically been among the most stable earners.

If the United States agreed to take in fewer nurses, would Filipino hospitals suddenly be flush with staff? Not likely. According to a 2005 report by the International Council of Nurses, new Filipino graduates "report that they can't find jobs in nursing." It's true that the Philippines suffers from a nursing shortage, but it doesn't suffer from a lack of trained nurses. Its hospitals are simply too poor to employ adequate numbers of them. That's a tragedy, but it won't be solved by slamming the gates at the U.S. border. Underfunded health care programs are a symptom of poverty, not of poaching. If the United States were to turn away nurses seeking placement, they would simply fill vacancies in every other developed country-the current nurse dearth is a global phenomenon affecting every region on Earth. U.S. demand has created supply in the Philippines: The medical professionals leaving now-at least some of whom will eventually return-would have been far less likely to invest years in study and training without the prospect of high pay abroad.

The Philippines won't suffer for the opportunities America offers its citizens. But it's not for well-meaning Westerners to decide where a health care worker would be "better off" anyway. Workers are not the property of countries that train them, and any policy that seeks to limit their options will prove cruelly restrictive. After all, stemming the flow of skilled labor doesn't just mean locking workers out of wealthy nations. It means locking them into poor ones.

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Australian Medical School biases to be investigated

There are four generations of doctors in Lucy Verco's family and yet, despite recieving 99.9 in her academic results, she was rejected by the University of Adelaide's school of medicine. Ms Verco said she felt "insulted" after being told she had not made the grade following an interview. The 20-year-old is now studying medicine at the University of Melbourne.

Federal Education Minister Julie Bishop has ordered medical experts to investigate methods for selecting medical undergraduates, after The Australian reported concerns that students applying for medical school places were being subjected to "personality assessments".

Ms Verco received the near-perfect results in her Tertiary Admissions when she finished Year 12 in 2003. "I thought the point of the interview was to show that students didn't have any psychological issues or anything like that," Ms Verco told The Australian. "If I'd been tripped up on my marks I could have thought I could have worked harder but it wasn't my fault. "It was quite personally insulting to find that a 30-minute interview could determine that I was a bad person or that I wouldn't go through."

The concerns about "personality assessments" include claims that medical schools were asking students their views on the Iraq war and gay marriage. Adelaide University's former deputy chancellor Harry Medlin has also criticised the institution's medical school for an unwritten discrimination policy against private-school students and the children of doctors. The Australian understands at least six children from prominent medical families have been rejected during the Adelaide University interview process in the past three years.

But the interview process has been defended by eminent educators including professors Peter Smith and Richard Henry of NSW University's faculty of medicine. It is argued the structured interview leads to a selection of a "better cohort of medical students who make better doctors". They argue knowledge and skills form only part of what makes a good doctor.

Ms Verco was educated at Adelaide's exclusive girls' school Wilderness and is the daughter of highly regarded Adelaide obstetrician Christopher Verco. Her grandfathers and great-grandfather were specialist doctors. Her great-great-uncle was dean of the university's faculty of medicine. Ms Verco's mother is Judith Sloan, an economist whose credentials include being a commissioner with the Fair Pay and Productivity commissions and a director of Santos.

Ms Verco said the interview process was fraught with problems as students were asked different questions in each interview. Apart from the usual questions about teamwork, difficult situations she had faced and her strengths and weaknesses, Ms Verco was asked how she would deal with the family of a deceased cancer patient who had found a cure overseas via the internet. "I think it's a difficult question to ask a 17-year-old. Even if you're a 45-year-old oncologist it would still be very hard," she said. She was not specifically asked about her family history.

Professor Sloan has pursued the university since her daughter's rejection in early 2004 in the hope of effecting change for future students. "(The interview process) is supposed to be the great leveller but people spend a lot of money on preparations for the (exams) and people lie (in the interview)," Professor Sloan said. The university's Health Sciences faculty executive dean, Justin Beilby, said the process had been validated and that there were set questions.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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