Organized medicine in the United States and international medical graduates.

摘要

The overall immigration policy in the United States has been liberal toward professional workers. However, the actual flow of foreign-trained professionals may be greatly influenced by the political and economic interests of powerful professional organizations. While these professional organizations cannot influence immigration policy per se, they may influence actual immigration patterns by erecting their own barriers that effectively control the inflow.;In particular, this dissertation seeks to understand the behavior of the organized medical profession in the United States as it tries to control the inflow of foreign-trained physicians referred to as international medical graduates. All international medical graduates, irrespective of their medical experience in their home countries, have to go through residency programs in the United States. Since international medical graduates come from various parts of the world with a variety of medical training, there is no comparison possible across the varieties of training. Organized medicine administers a special examination to international medical graduates prior to their entry into post-graduate residency programs in the United States. The test has been changed periodically over the past two decades.;Organized medicine argues that it adjusts the test to protect consumers of medical care from unqualified international medical graduates. However, empirical evidence found in this dissertation provides only limited and weak support for this public interest argument. Using data from the Current Population Survey, Census and Immigrants Admitted to the United States, and information on the characteristics of test takers, pass rates and vacancies in residency program, the analysis shows that changes in the test reflect changes in vacant residencies and in the rate of return to medical education as well as changes in the quality of international medical graduates. The role of these additional parameters is consistent with an income maximization strategy for organized medicine.;The hypotheses that the effective "prior" barrier for international medical graduates to come to the United States is the medical examination administered by organized medicine rather than immigration laws adopted by the Immigration and Naturalization Services, that the barrier works through tightening-cum-loosening of examination standards, and that variations in this barrier reflect domestic labor market condition for physicians were advanced by Bhagwati in the 1970s. This dissertation provides a systematic examination of, and support for, these hypotheses.