Cover

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Title Page

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Dedication

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Contents

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pp. vii-xii

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Preface

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pp. xiii-xxiv

In developing countries, a child dies every four seconds. A major reason for such needless death is the lack of enough doctors, nurses, and other healthcare providers to prevent and treat illness. The global healthcare-worker shortage has been called the greatest humanitarian crisis of our time because it cuts across ...

Acknowledgments

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pp. xxv-xxviii

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Introduction

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pp. 1-9

Approximately 15 percent of all healthcare workers and 25 percent of all physicians in the United States were born and educated elsewhere.1 This means that 1.5 million healthcare jobs are “insourced,” occupied by foreign-born, foreign-trained workers brought into the United States on special visas earmarked for healthcare jobs. This number is 50 percent greater than the...

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1 | Shortage in the Land of Abundance

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pp. 10-39

With more than 308 million people, the United States is the world’s third most populous country, behind China and India. Health is this country’s largest and fastest-growing industry: More than 16 percent of all the money spent by consumers and the government goes to healthcare. By 2017, we will spend 19.5 percent—almost 20 percent!—of our Gross Domestic Product...

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2 | How the United States Created Its Healthcare-Workforce Problem

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pp. 40-65

The university system in the United States is the envy of the world. In more than half a dozen global university-ranking systems, such as the Global Universities Rankings or the Academic Ranking of World Universities, the majority of the top ten universities are in this country. The United States has more educational...

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3 | The Path to America

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pp. 66-90

It was March 18, 1999, my residency Match Day. With my 120 classmates, I sat in the Johns Hopkins medical school auditorium, holding a sealed white envelope. At precisely noon, we opened our envelopes and found out where we would start our first paid work as physicians and spend the next three to six years of our lives. The envelopes contained the names of the...

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4 | The Damage Done

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pp. 91-115

Lucy, one of our first known human ancestors, lived out her life in a breathtakingly beautiful gorge in the Rift Valley of Ethiopia. Not much is known about Lucy’s life. We know that she walked upright, used tools, and had a humanlike pelvis. We don’t know what killed Lucy; perhaps she died in childbirth— which would make her very much like her Ethiopian sisters of...

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5 | The Fox and the Hydra

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pp. 116-137

Management of the healthcare workforce, in the United States and abroad, has evolved from an essentially freemarket system to one that combines the worst aspects of the free market and regulation. Uncoordinated central authorities control the production of healthcare workers, and the free market allows them to move across national and international borders regardless...

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6 | Successful Efforts to Curb Insourcing

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pp. 138-149

When my husband and I honeymooned in Thailand in 1999, we had no idea we were in a country that had achieved a level of healthcare for its citizens comparable to that in the United States, with only a fraction of the wealth. Even though they live in a country with a gross domestic product of less than...

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7 | The Way Forward

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pp. 150-180

As a pediatrician serving some of the poorest communities in the United States and as a healthcare policy expert at the global level, I have examined many potential solutions to the healthcare-worker crisis. I have had the benefit of experiencing firsthand hundreds of different proposed and implemented solutions...

Notes

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pp. 181-196

Index

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pp. 197-210

About the Author

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pp. 211-212