Abstract

For more than 60 years, the United States has trained fewer physicians than it needs, relying instead on the economically expedient option of soliciting immigrant physicians trained at the expense of other countries. In this talk, I will examine the first large scale migration initiated during the Cold War with the passage of the Hart-Celler Immigration and Nationality Act of 1965. This bill expedited the entry of Foreign Medical Graduates (FMGs) from postcolonial Asian nations and directed them to provide care in shortage areas throughout the country in exchange for legal status. Although this arrangement was conceived as a temporary measure, it has become a permanent feature of the US medical system with foreign physicians comprising a quarter of the total physician labor force. This neocolonial dynamic has entrenched a stratified healthcare system; foreign physicians are directed to America’s marginalized communities, thereby disincentivizing organized medicine from addressing the structural conditions that perpetually produce labor shortages. The ubiquitous and integral presence of foreign physicians not only reveals the racialized operations of US medicine, but it also makes visible how the political economy of care writ large operates in our globalized present.