People around the world want the same thing from their doctors. First, do no harm. Second, take a look at this weird bump and tell me if I should get worried.
The job is basically the same in many countries around the world. But the pay is wildly different. The median salary for U.S. doctors is about $250,000 a year. In Western Europe, it's less than half that. In developing countries, the salaries are even lower.
Through insurance and out of our own pockets, we pay for doctors' services, just like we pay for all other kinds of goods and services.And yet, with lots of other things we buy, we often turn to imports to save money.
"We should think of doctors the same way we think of shirts," says the economist Dean Baker. "If we can get doctors at a lower cost from elsewhere in the world then we could save enormous amounts of money."
The big difference, of course, is that a bad t-shirt won't kill you.
So, in the name of protecting patients, we put a lot of barriers up to make it harder for foreign doctors to work in the U.S. Even for fully qualified doctors practicing in countries very similar to ours, it can take years of extra training to get licensed to practice in the U.S.
Many U.S. states recognize Canadian medical schools, and have tried to streamline the process for Canadian doctors to work here. But it can be complicated. Every state has its own bureaucracy and license application and requirements.
A Canadian critical care doctor I talked to moved with his wife to California, where he planned to practice. After nine months of paperwork and bureaucracy, he gave up and went back to Canada.
For doctors from other parts of the world, the process is guaranteed to take even longer. Foreign-trained doctors — even those with advanced skills, who have been practicing medicine for years — are required to repeat years of the basic residency training that doctors go through right after medical school.
"The process may be seen as perhaps cumbersome to practicing physicians," says Dr, Humayan Chaudhry, President of the Federation of State Medical Boards. "But... the goal at the end of the day is to protect the public."
Chaudhry says there simply isn't a way to evaluate the quality of medical training in every country around the world. And clearly, he says, it doesn't deter doctors from coming. Chaudhry says that 22 percent of all the licensed doctors in the United States went to medical school outside the country.
But, Dean Baker argues, there should be even more foreign-trained doctors than there already are. A lot of poor and rural areas in the U.S. don't have enough doctors. And foreign-trained physicians are much more likely to specialize in primary care and go to work in such places.
Baker says that rather than have professionals spend years redoing their training, the U.S. should try to make the process more simple and transparent. He says we should tell young, aspiring doctors:
Here's what you have to do. Here are the courses you have to take. Here's is the test you have to pass. If you pass those tests you get to come to the United States and be a doctor just like anyone who was trained in the United States.
And the benefit, he argues, isn't just for foreign doctors, or rural areas where they might work. More doctors means more competition. That means lower health-care prices.
As they say about t-shirts: if you can make sure the quality is the same, why pay more?