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

1 | Shortage in the Land of Abundance

Shortage in the Land of Abundance Every year, as the United States imports more than 20,000 foreign-trained workers on special visas earmarked for the healthcare sector, American nursing and medical schools turn away tens of thousands of qualified applicants. These Americans are forever denied a career in one of the country’s most economically rewarding fields. Even more troubling, the gap between the supply of and demand for healthcare workers continues to grow—a literally life-and-death problem. Why is it happening? 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 on healthcare.1 If you want figures, $2.5 trillion—that’s with a t—was spent on the us healthcare industry in 2009, up from $2.3 trillion the previous year.2 Yet we have a huge deficit in the number of people needed to run this industry—we do not have enough doctors, nurses, pharmacists , and other healthcare workers to protect the health of all our people. Worse still, the shortages are most severe among the most highly trained and highly paid healthcare workers, such as 1 Shortage in the Land of Abundance 11 doctors and nurses, who provide the majority of direct, hands-on care. These are the very areas in which we import the most workers from other countries. Yet the gap between supply and demand is growing larger each day. For the patients, this causes more than frustration and inconvenience . It means something far worse than longer waits for an appointment with your doctor, or having to drive farther because the physicians or hospitals nearest your home are not taking new patients. Unable to be seen by a physician in a timely manner, many people either delay care or do not seek care at all, which can lead to the escalation of easily treatable conditions, such as simple infections or early diabetes, and much higher rates of permanent disability and death. More directly and dramatically , nurses and physicians trying to care for too many patients in clinics and hospitals are more likely to make medical errors or overlook medical conditions that can result in disability or death. Pushing the “call” button on a hospital bed and wondering when a nurse will arrive is so common it has achieved the status of a joke, although there is nothing funny about being in pain. Every family has a loved one who has waited for what seemed an eternity to receive pain medication, who has felt extreme anxiety while waiting for someone to explain why an alarm went off in the room, or who has suffered the indignity of soiling him- or herself while waiting for a nurse to bring a bedpan or help the patient into the bathroom. But there are far more tragic stories caused by the healthcareworker shortage. In one case, a woman bled to death in a Los Angeles emergency room while vomiting blood, as she pleaded to be seen by a doctor.3 In another, a woman bled to death following a routine hysterectomy, because there was only one registered nurse on the ward, and she was caring for 40 patients.4 12 I N S O U R C E D With such inadequate staffing, it is impossible for a single registered nurse, no matter how qualified, to identify a patient in trouble and respond in a timely and effective manner. I could fill this whole book with heartbreaking stories like this. The United States Institute of Medicine’s landmark report on medical errors, “To Err Is Human,” determined that each year, medical errors in American hospitals cause an estimated 100,000 people to die unnecessarily and injure an additional 1.5 million.5 This was back in 1999. And the number one cause of medical error, even then? Mistakes made by nurses and physicians forced by staff shortages to work long shifts or to care for large numbers of patients. A study published in the Journal of the American Medical Association in 2002 found that nurses with high patient loads reported greater job dissatisfaction and emotional distress and that “failure...