Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad

Preface

Preface 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 every crisis, from disease outbreaks to national disasters to wars, and hamstrings our ability to respond. As a mother, a pediatrician , and a health-policy expert, I feel deeply the urgent need to address this issue. During my time at the World Bank, I saw people out of work in the us while good jobs sat empty in their communities. I saw health workers being imported from countries that could ill afford to lose them. But no one seemed to be making the connection between the two problems and offering solutions. Many wealthy countries have their own shortage of healthcare workers , and rather than paying to train their own young people to work in these fields, these countries, led by the United States, are importing healthcare workers from poor countries. This practice has severely distorted and damaged the healthcare systems in those countries and has created perverse incentives to produce healthcare workers for export rather than to meet the needs of their own people. Concentrating on a short-term solution, the United States and other wealthy countries are failing to address the reasons they do not have enough healthcare workers and ignoring the damage they are doing both at home and abroad. So I have pursued the topic by researching and writing this book during vacation time, xiv Preface early-morning writing sessions, caffeinated evenings, and an extended maternity leave. My first exposure to health-workforce issues came as a student at the Johns Hopkins School of Public Health. My two advisers were Dr. Tim Baker, one of the giants of health-workforce planning, and Dr. Richard Morrow, a leader in introducing quality-assurance management and team efficiency into the field of public health. Both of them taught me that beyond and often more important than the science of medicine was the healthcare team: the actual people and personalities who delivered healthcare. My first opportunity to work formally on health-workforce issues came right after I graduated from Johns Hopkins University School of Medicine, in Baltimore, in 1999. I was doing my residency at Children’s National Medical Center, a top-ranked pediatric hospital in Washington, dc. To improve the quality and cost-effectiveness of its care, the hospital had recently added several types of healthcare workers to its staff teams. For example , phlebotomists, who are technicians specialized in drawing blood, now drew most of the blood samples for lab tests, which saved the pediatric residents hours of time they could spend treating patients. Phlebotomists have been shown to be at least as effective in drawing blood as physicians, and their wages are less than residents’ wages, so there were cost savings, too. At the hospital, X-ray and lab technicians had taken on very important tasks that freed up the more expensive time of the radiologists and pathologists. Physician assistants and nurse practitioners provided high-quality care that allowed the physicians to focus on more complicated aspects of diagnosis and treatment. Advanced-practice nurses, with several years of additional training in a subspecialty, such as pediatric cardiology, enabled the pediatric cardiologists to care more effectively for more Preface xv patients. Because advanced-practice nurses specialize, they have more in-depth knowledge in their specialty area than the general pediatric residents, who practice just a few months of pediatric cardiology each year. I had noticed the impressive ways in which the new healthcare workers had increased productivity at the hospital. So naturally, when a seat for a resident opened on the Expanded-Roles Committee (which advised on how nonphysician healthcare workers could be used to provide higher-quality, more cost-effective care), I jumped at the chance. While I was completing my clinical training, I was also pursuing my other passion: global health. Foreign cultures have been a particular interest of mine ever since I was a child and found a book on Mayan culture in my parents’ library. The notion of a people who had mapped the skies centuries before anyone in a Western culture, yet whose written language consisted of pictures rather than letters, fascinated me. Specializing in the field of global health—which...