And yet there's only one desi or "Far East" Asian doc on "House," "ER" and "Grey's Anatomy."

Thank you Huey!

Aside from ER and House, any East Indian doctor is usually an extra on the set or has a one-time appearance as the doctor from the other "department".

Good work by Razib. This illustrates why "race" is increasingly absurd as a "class" signifier in the US.

The linear implication, of course is that if one group is under-represented, it must mean that other groups are over-represented and therefore must get penalized to address the imbalance. Advocates of direct measures to address this assert that minority under-representation is the product of historical transgressions by the over-represented majority and so, the penalty is a form of inter-generational justice.

3 · Nina P said

What could be the author's agenda? The article is certainly fodder for right-wing criticism of "the liberal media." I don't understand why anyone would persist in a racial argument like that, which is so clearly contradicted by facts.

If one's academic/policy think tank career was on the line, one would persist in this line of thinking. That covers a good deal of social science profs in the US, right?

I live in the Chicagoland area, obviously I know a bunch of brown & other Asians wanting to be doctors. It seems that when an Asian gets let say a 29 on his MCAT & a competitive GPA, it's tougher for this person to get in. However, when a white/black/latino gets the exact score, this person would get in easily. I mean this goes on in Chicago...I feel bad for the Asians in Cali area (since the competition is fiercer over there).

3 · Nina P said

The article is certainly fodder for right-wing criticism of "the liberal media."

o crap! that was an article. i thought it was an op-ed.

for the record, i think issues of cultural compatability are real. but you need to be careful here. it is probably true that black, latino, etc. MDs disproportionately service their communities, and that black and latino patients feel more comfortable and prefer doctors of like ethnicity. but this logic applies to whites, too, right? i've heard whites complain about accents and lack of cultural fluency from immigrant indian doctors. how do you like those proportionalist apples? another byproduct of lower standards for latino and black med students is that these sorts of doctors won't have much of a chance to treat outside of their "their community" because people with means will simply avoid them on the assumption that it's better to be safe than sorry when it comes to your health.

finally, there's a problem in human psychology where you simply dichotomize. liberal vs. conservative, white vs. black, rich vs. poor. that misses really, which has many dimensions. for a journalist with x hundred words particular narratives are convenient because they offer up a lot of free information for the readers. asians are really "problematic" for most leftish race theorists because they seem to be able to succeed despite the all-powerful affect of white Racism. so you have lots of arguments about how asians really aren't succeeding, how they have to work harder, or that the statistics miss communities like the hmongs who are given so much attention that one wonders if they aren't the true representatives of asian america....

Vinod's post:

...“propensity” ratio is 1.32, for Indians it’s 6.78, and for those of Mexican descent, it’s 0.12. So yep, a given desi is about 5x more likely to be a doc than whitefolk who in turn are about 10x more likely to be a doc than Latino/Mexicans.

More likely to be a doc or more likely to become a doc? If the propensity theory is centered around the mere occurrence of physicians within an ethnic group, which means that the data includes the immigrant physicians as well as US born, then the "population to physician disparities" are immaterial. There are a lot of desi doctors here simply because there are a lot of desi doctors over there, and many of them end up coming here. Similarly, if the Vietnamese are 2X more likely to be doctors than Filipinos, we should look for answers in the number of medical graduates being churned out in their respective countries than in the educational focus within their respective communities here.

However, if the data filtered out the immigrants and focused solely on the propensity of US born ethnics to become doctors, then the entire discussion would have serious social connotations. There would be valid reasons then to contrast and compare one ethnic group vs. another, or better yet, to compare ethnics with the benchmark, the whites.

Interestingly, I contributed some time in the mid-seventies for a campaign to get Indians classified as a minority. The leaders of the various Indian associations never wanted us to be lumped with the whites for obvious economic reasons.

On a personal note, is that you Razib in that Dashiki shirt? I used to have one just like that.

As a sequel to my comment #8, I believe that the 6.8 propensity factor of Indians will be much lower in the ABD group, and if history of other immigrants is a guide, will continue to decrease as third and fourth generation ABD's become more and more mainstreamed in a career sense.

Rahul S, are slutty Gujarati girls more likely to be docs as well?

I believe that the 6.8 propensity factor of Indians will be much lower in the ABD group, and if history of other immigrants is a guide, will continue to decrease as third and fourth generation ABD's become more and more mainstreamed in a career sense.

1) yes, they're mostly immigrants (see report where it shows where they were educated)

2) but the decrease isn't going to be that great if the % in american medical schools of brown kids is evidence (on the order of 5-10% i think).

On a personal note, is that you Razib in that Dashiki shirt?

i don't know what to call that.

http://www.aapimsr.org/
The AAPI Medical Student and Resident Section represents over 10,000 students across the country. Although Asian Indians constitute less than 1 percent of the population of the United States, they constitute 10-12 percent of the student body in medical schools in the U.S.

10 · portmanteau said

Rahul S, are slutty Gujarati girls more likely to be docs as well?

Well, stands to reason that those who play doctor are more likely to become one.

10 · portmanteau said

Rahul S, are slutty Gujarati girls more likely to be docs as well?

Portmanteau,

I don't have the data for that. You could help me find data on this though; then, we can see if there is any empirical evidence on what you just asked.

Floridian #8:

On a personal note, is that you Razib in that Dashiki shirt?

Razib #11:

i don't know what to call that.

I had that shirt in high school. A friend of mine borrowed it to wear it on stage as he sang Harry Bellafonte's "Day-0." As high school kids in India of the sixties, we weren't erudite enough to differentiate between the attires of the Caribbean and African blacks. And that was the last I heard of my Dashiki.

Floridian, in response to #8, I'm likely to speculate that the answer is both. Too many docs in India, so some end up immigrating. And ABDs are also more likely to be docs as well.
We might see more people of South Asian origin becoming doctors because it might be one of those professions where people have some slight advantages in following in their parents' footsteps. It is a profession where entry costs are relatively high (long expensive education; demonstrated academic and social ability) and information about the process of becoming a doctor are quite useful. Familiarity with the system can give a person a big boost in the admissions and internship process, as well as get you started early on. Inheriting patients and practices may also be one reason physicians might nudge their kids toward a medical career.* So already having desi doc parents may increase the chances of ABDs becoming physicians.
In general, following your parents' career does have some advantages, but I suspect these are heightened in fields where knowing how to deal with 'the system' is a big advantage. I remember reading some research that children of welfare moms were likely to be on welfare themselves for a variety of reasons. But one of the big reasons they were able to choose this lifestyle for a period of time (as now there are much more stringent time limits after PRWORA) in comparison to other people was because they knew how to navigate the system better and receive helpful advice from their parents about eligibility etc. I guess certain 'career paths' may become much more accessible if your family and friends have knowledge about them.
My hypothesis is probably only a partial explanation. Other factors, such as higher than average per capita income for ABDs are also at work. This may also have an inter-generational angle. Desi immigrants are more likely to be educated because of immigration regs, therefore wealthier, and therefore, better able to secure the best educational advantages for kids. They are also more likely to push kids toward 'more years of education' since that is what allowed them a better lifestyle in the first place. Sorry no new wisdom in this post :)

*(Some people nudge their kids away -- my mum is a medical academic in India, and always pushed me away from medicine because of various reasons. Poor research funding in India, job insecurity in an American lab; not enough creativity if you are a practicing or physician. My brother was not dissuaded, however.)

long expensive education;

most people take out loans here the USA from what i know. so if you can get in somewhere you can probably finance it, right? has the credit-crunch changed things?

17 · razib said

most people take out loans here the USA from what i know. so if you can get in somewhere you can probably finance it, right? has the credit-crunch changed things?

razib: i meant to emphasize that the longer period of education could be more excruciating for some. if you're a bright kid, who doesn't have that passion for medicine (some people are quite single-minded in their pursuit of medicine. anecdotally, i haven't seen a manic obsession wrt to other careers) but are considering it as a career, you might be discouraged by the sheer amount of time you have wait until you're independent. the net present value of being a physician is lower than earning a good salary now.

#16 · portmanteau

When dealing with such issues, there is never one salient factor, and to make matters more interesting, there is also the chicken-or-the-egg circular logic at work.

One factor I would like to add to your little catalog of reasons is the "My son, the doctor" factor. (Daughters may also apply, gender no bar.)

The first-generation desi community in the US, of which I am a card carrying member, is still time warped in such "old country" values as a snobbish pride in your children's social standing. I did not say accomplishments. That would be all right. You can play the Carnegie Hall and they (we) don't care. But if you are even a journeyman surgeon in small-town Idaho, vee are proud and writing Papa and Mummy back home about your new Mercedes.

No harm in being frank, is there?

14 · Rahul S said

I don't have the data for that. You could help me find data on this though; then, we can see if there is any empirical evidence on what you just asked.

Since when did the availability of "data" stop you from theorizing? :)
In any case, I become an RA only for hot professors.

19 · Floridian said

No harm in being frank, is there?

Nope, it is the one thing for which you'll always get credit from me. I thought that*, but I did not include it in my post because I hesitated to open that can of worms.

*

You can play the Carnegie Hall and they (we) don't care. But if you are even a journeyman surgeon in small-town Idaho, vee are proud and writing Papa and Mummy back home about your new Mercedes.

21 · portmanteau:

Nope, it is the one thing for which you'll always get credit from me.

I gotta admit, though. I am not immune to the "My daughter, the doctor" disease myself. I figure, as a parent, why not go all out to brainwash, cajole, coerce, threaten and force? (I don't have a thesaurus handy.) It can't hurt, right? And if at the end of the day, the kid ends up becoming a cashier at the supermarket, maybe he or she will remember the Great Motivator and become the best cashier at the supermarket. This whole thing could backfire, too.

An observation on children following in the footsteps of their physician parents - the propensity is unusually high. I know families in which three out of four siblings became doctors, following one of their parents' example. I don't see it among engineers, professors, entrepreneurs and other professions.

I don't see it among engineers, professors, entrepreneurs and other professions.

You probably meant here, Floridian, that the children of engineers, professors, etc are not becoming engineers, professors, etc. That is, they do not follow in their parent's footsteps.

However, I know many children of engineers, professors, entrepreneurs (especially hotel owners, store owners etc) who became doctors. So this is another thing to factor in, in explaining the propensity - it's not just that doctor's kids are becoming doctors, it's that kids of engineers, non-medical professors, entrepreneurs are becoming doctors too! In many (most?) cases it is actually a very well thought out plan - on the part of both the non-physician parents and their kids - they become doctors figuring that other professions do not provide comparable job security, status or remuneration, and for those so inclined, opportunity to serve society at large. The children of non-physicians going into medicine do not necessarily have the insider knowledge that children of physicians would, but make up for it in hard work, ability and motivation!

20 · portmanteau said

14 · Rahul S said

I don't have the data for that. You could help me find data on this though; then, we can see if there is any empirical evidence on what you just asked.

Since when did the availability of "data" stop you from theorizing? :) In any case, I become an RA only for hot professors.

O, I had the data from before. I'm not a professor by the way.

24 · Rahul S said

I'm not a professor by the way.

Exactly. I was trying to say I would help only a hot professor with data collection. Clearly my assumption about you was correct.

I believe that the 6.8 propensity factor of Indians will be much lower in the ABD group, and if history of other immigrants is a guide, will continue to decrease as third and fourth generation ABD's

long expensive education;

The AAPI Medical Student and Resident Section represents over 10,000 students across the country. Although Asian Indians constitute less than 1 percent of the population of the United States, they constitute 10-12 percent of the student body in medical schools in the U.S.

23 · chachaji said

The children of non-physicians going into medicine do not necessarily have the insider knowledge that children of physicians would, but make up for it in hard work, ability and motivation!

I am a non-physician parent who had no difficulty finding information on the web to help my daughter get into medical school. I have to admit that my daughter's desire to be a physician was primarily driven by the McMansions/Mercedes of the physicians in the Indian community. Being frank here.

I have two physician friends, and between their six kids no one chose to go to medical school. Both friends were extremely disappointed.

18 · portmanteau said

razib: i meant to emphasize that the longer period of education could be more excruciating for some. if you're a bright kid, who doesn't have that passion for medicine (some people are quite single-minded in their pursuit of medicine. anecdotally, i haven't seen a manic obsession wrt to other careers) but are considering it as a career, you might be discouraged by the sheer amount of time you have wait until you're independent. the net present value of being a physician is lower than earning a good salary now.

On an average, the NPV of a career in medicine is much higher--long education period notwithstanding--than most other professions. Medical career also has the added benefit of a much lower variance.

Floridian:

There are a lot of desi doctors here simply because there are a lot of desi doctors over there, and many of them end up coming here.

portmanteau:

Too many docs in India, so some end up immigrating

Wow. This is such a brazen falsehood.

http://timesofindia.indiatimes.com/India_short_of_6_lakh_doctors_/articleshow/2921262.cms

India short of 6 lakh doctors
3 Apr 2008, 0014 hrs IST,Kounteya Sinha & Mahendra Kumar Singh,TNN...........Even as India faces an acute shortage of manpower in the healthcare sector, the country holds the top position when it comes to its physicians migrating to developed countries like Britain and the US. According to a Planning Commission report, while India is short of six lakh doctors, 10 lakh nurses and two lakh dental surgeons, Indian doctors who have migrated to developed countries form nearly 5% of their medical workforce. Almost 60,000 Indian physicians are estimated to be working in countries like US, UK, Canada and Australia alone.

#30 who

...the country holds the top position when it comes to its physicians migrating to developed countries like Britain and the US....Almost 60,000 Indian physicians are estimated to be working in countries like US, UK, Canada and Australia alone.

That's exactly what we were talking about, who. The shortage of doctors in India is an entirely topic. Therefore, it is not a "brazen falsehood" but simple logic to say that a country as populous as India can export 60,000 doctors whereas smaller countries will export fewer doctors.

30 · who said

Wow. This is such a brazen falsehood.

No I didn't mean 'too many' in terms of need from India (Sorry, this was entirely unclear from context). The quantifier 'too many' referred to those who were able and willing to move actually because I'm assuming they thought better opportunities/compensation would be available to them in the US. In fact, this has to be the case. In the absence of higher perceived ROR in the USA, why would people be studying so hard for the USMLE back home? Having a prospective spouse in the US may be a reason, but anecdotally in India, doctors have a huge preference for marrying doctors (I happen to have grown in a pretty 'medical' family and am a former avid scanner of the matrimonial ads in Indian newspapers; prurient, I know) and will tend to pool where there is a presence of physicians. In the past few months, several medical journals have been focusing on the brain drain (specifically of all kinds of health personnel) from the third world and a major conference has also been convened (the focus is, of course, the shortage of qualified personnel in Africa; I'll find the links and post them a little later). This work is also being done by political philosophers like Thomas Pogge, who are trying to propose plausible solutions for combating or ameliorating brain drain.

Sean (@29) as far as medicine is concerned, you may right about the low variance (except for the outliers who lose their licenses for various reasons, including malpractice and improper conduct during research), but a smart kid can make a lot of money as a hedge fund manager/in-house corporate lawyer without having to bear administrative costs practicing medicine and the rising malpractice premiums. Certainly, I think facing patient liability must deter some people -- some of whom I suspect end up in research medicine, while others will move to an entirely different career altogether. And since health financing is a topic of much debate these days, I'll wager in the next 10 years there will be a few dramatic changes in the way doctors are paid -- although I'm perfectly willing to recognize that a very,very minuscule percentage of those considering to be doctors will acknowledge this in their calculations. It seems like a lot of individuals have an unusually strong emotional attachment to a career in medicine, much more so than in other professions.

Also forgot to add, some people discount time differently. So if you're a poor kid who needs money now, a career in medicine is slightly less enticing because the prospect of lots of money 10 years later is great but what of immediate needs?

"asians are really "problematic" for most leftish race theorists because they seem to be able to succeed despite the all-powerful affect of white Racism."

No they're not. Asians do well, particularly Indians, because they are an artificially selected population, generally having already benefitted from 50 years of Indian government investment in technical education. While racists have long used the "why can't you be like them?" reasoning against blacks and hispanics, and the Asians have kept quiet and benefitted from their model minority status, afforded them because of their relatively small numbers and their usefulness in the promotion of anti black racism, the relative success of many Asians does not disprove the powerful effects of white racism.

34 · noblekinsman said

inority status, afforded them because of their relatively small numbers and their usefulness in the promotion of anti b

So how do you explain the fact that 9/10 blacks had jobs in the 1930's (when racism occurred), while in the 1960's (when blacks were given more rights) less blacks worked. Your left wing account of "anti-black racism" is simply wrong. Blacks have struggled due to the breakdown of family.

Read this article from an African American site.

http://www.theroot.com/id/45794

Plus, what about the Asians who suffered racism in this country as well? Weren't the Chinese treated like s*** in California when they immigrated in the 1850's (Chinese Exclusion Act), Japanese with the internment camps in the 1940's, more Asian racism with the wars with the U.S. going to war in Asia in the 1950's. I do agree that African Americans do have it tough, but it's not racism that hurt them.

32 · portmanteau said

Sean (@29) as far as medicine is concerned, you may right about the low variance (except for the outliers who lose their licenses for various reasons, including malpractice and improper conduct during research), but a smart kid can make a lot of money as a hedge fund manager/in-house corporate lawyer without having to bear administrative costs practicing medicine and the rising malpractice premiums. Certainly, I think facing patient liability must deter some people -- some of whom I suspect end up in research medicine, while others will move to an entirely different career altogether. And since health financing is a topic of much debate these days, I'll wager in the next 10 years there will be a few dramatic changes in the way doctors are paid

The first-generation desi community in the US, of which I am a card carrying member, is still time warped in such "old country" values as a snobbish pride in your children's social standing.

No they're not. Asians do well, particularly Indians, because they are an artificially selected population, generally having already benefitted from 50 years of Indian government investment in technical education.

I'm amazed that we're not talking about the dynamics of class and immigration policy in this apparent "over-representation" argument. While there has been some diversification (along class lines) of the immigrant desi community in the U.S., the vast number of desis in college are either (relatively) affluent immigrants or the children of relative elites who came under the strict migration regime of the 1960s/70s. Is it no wonder that those same groups self-select into high-earning "status" professions?

razib, what's the propensity score for whites and desis of the same income/SES background to go into medicine? Is the abundance of desis also impacted by not going into other comparable, high-earning industries?

And I do think the aggregation of "Asians," especially in California, does a real disservice to API communities. If we're talking about language-access and health services, then it does make a difference that there's not a sufficient diversity of Asian doctors, and further, that there's probably little to no socioeconomic diversity among those who continue in medicine, anyway.

With respect to the call for reclassifying APIs as "white," I think this misses a HUGE picture and reality for many Asian American communities. Who is "white" in your categorization, then? Desi docs? Filipina nurses? Cambodian refugees? 5th-generation Chinese Americans? It sounds like there's a desire to create a mutual exclusivity between race and SES (which, in my opinion includes the benefit of highly educated parents, as port discusses above). Couldn't it be the case that APIs should not be reclassified as white, but rather, that we need a more nuanced and holistic perspective on diversity among our medical professionals?

1 · Huey said

And yet there's only one desi or "Far East" Asian doc on "House," "ER" and "Grey's Anatomy."

I too was puzzled by this casting anamoly. In school I held an on-campus job at the department of medicine and helped process the post-ERIS paperwork, and was amazed at the disprpotionate of desi doctors. But I soon reasoned out that these paper thin plots of that use a hospital setting to play out the same potboiler combination of prime time emotional hooks, don't possibly know how to represent desi doctors and med students. There would be problems showing all that romp and shake that happens in Greys. So now after years of ER we have one desi Parminder Nagra.

Wait a minute! I thought Desi's *are* Caucasians, you know white people with perma-tan? I'm sure I've read comments on this site that definitely wanted to set the record straight on this important fact. I'm joking, (kinda) ;-)

Rahul S,first lets both put on our flag pins,to show our love for America. I'm going to agree with your statement,I don't know where your stats are from,the culprit (black/white achievement gap) is attributed to Educational attainment, which is definitely related to family structure, or lack thereof ,which, can in part, be traced to welfare dependecies.

All things being equal, since the early 1980s, differences in educational attainment and in work skills generally have resulted in often substantial differences in earnings. Hence, the main proximate cause of the lack of economic progress among African Americans is the continuing difference in educational attainment between whites and blacks

That is NOT TO SAY there isn't validity in the points made in comment #34.

Interesting how the committment to family and education was never thought to be a positive in all the hooopla over Obama's Church/J. Wright. Conservative Thomas Sowell and others argue that integration,black "political" progress was wrong becuase it made blacks dependent, yet I didn't hear any support for from that school of thought during the firestorm eiether. In fact, just the opposite. Hypocrisy abounds.

Read this article from an African American site.

"9/10 blacks had jobs in the 1930's(when racism occurred)"

you're a chimp. 9/10 of nobody had jobs in the midst of the great depression and black unemployment hovered around 60%.

40 · noblekinsman said

"9/10 blacks had jobs in the 1930's(when racism occurred)"

you're a chimp. 9/10 of nobody had jobs in the midst of the great depression and black unemployment hovered around 60%.

My bad. The stat was from 1940. It's on that site.

portmanteau:

The quantifier \'too many\' referred to those who were able and willing to move actually because I\'m assuming they thought better opportunities/compensation would be available to them in the US.

That does not make sense at all. \"Too many docs in India, so some end up immigrating\" implies a surplus of doctors in India which is the exact opposite of the reality.

Razib:

black and latino patients feel more comfortable and prefer doctors of like ethnicity. but this logic applies to whites, too, right? i\'ve heard whites complain about accents and lack of cultural fluency from immigrant indian doctors. how do you like those proportionalist apples?

There may be a rational reason for white americans being wary of immigrant indian doctors with accents and indian degrees. Consider the examples of Dr Patel and Dr Desai who became infamous recently.

http://www.komoradio.com/news/local/16594561.html

http://www.sepiamutiny.com/sepia/archives/005093.html

43 · who said

Razib:

black and latino patients feel more comfortable and prefer doctors of like ethnicity. but this logic applies to whites, too, right? i\'ve heard whites complain about accents and lack of cultural fluency from immigrant indian doctors. how do you like those proportionalist apples?

There may be a rational reason for white americans being wary of immigrant indian doctors with accents and indian degrees. Consider the examples of Dr Patel and Dr Desai who became infamous recently.

http://www.komoradio.com/news/local/16594561.html

http://www.sepiamutiny.com/sepia/archives/005093.html

2 out of a sample size of how many Indian doctors? But yea, you may be right on this. People tend to see doctors who are of the same race (my white college professor was telling me about that).

42 · who said

That does not make sense at all. \"Too many docs in India, so some end up immigrating\" implies a surplus of doctors in India which is the exact opposite of the reality.

I did apologize for my hurried response -- clarification in 30 and 31 by Floridian and me, explaining what we meant to imply. There may be an overall shortage of doctors, especially in rural areas. But there is a mismatch between what the Indian market is offering to these docs versus the opportunities they perceive are available in developed countries. So there is a surplus -- only that surplus refers to the number of doctors left after desired Indian opportunities are exhausted. I am not disputing that there is a aggregate shortage of doctors in India.

And yet there's only one desi or "Far East" Asian doc on "House," "ER" and "Grey's Anatomy."

43 · who said

There may be a rational reason for white americans being wary of immigrant indian doctors with accents and indian degrees. Consider the examples of Dr Patel and Dr Desai who became infamous recently

If desis are disproportionately becoming doctors in large numbers, out of whom you have a few bad apples, then attributing similar characteristics to the entire community of South Asian doctors is actually quite unfair and prejudicial. If two jewish dermatologists are charged with malpractice would anyone accuse the entire set of jewish physicians with incompetence? Your logic baffles me.

But there is a mismatch between what the Indian market is offering to these docs versus the opportunities they perceive are available in developed countries. So there is a surplus -- only that surplus refers to the number of doctors left after desired Indian opportunities are exhausted

Based on your definition of what constitutes a surplus of doctors there will be \"Too many docs in India\" despite the well known and long term acute shortage of doctors there, for as long as it remains behind the developed countries in offering desired opportunities. By the same rationale there will be \"Too many docs\" in rural India as well, as long as rural India remains underdeveloped compared to urban India. Correct?

Based on your definition of what constitutes a surplus of doctors there will be \"Too many docs in India\" despite the well known and long term acute shortage of doctors there, for as long as it remains behind the developed countries in offering desired opportunities. By the same rationale there will be \"Too many docs\" in rural India as well, as long as rural India remains underdeveloped compared to urban India. Correct?

vyasa, does the concept of bid-ask spread not exist in the Chinese free market? i know that if you are dumb as a hammer, everything looks like a nail, which has nothing to do with what the commenter said, but try to make at least a pretense of understanding the other person's argument when responding.

48 · who said

Correct?

not necessarily. some people within india suggest that maybe government-educated docs should serve in rural areas for a period of time to reciprocate the investment made for their technical education.
if you genuinely care about this issue, this is a good place to start. also, some issues of hastings center report may be worthwhile if you have access. otherwise, happy sunday evening.

some people within india suggest that maybe government-educated docs should serve in rural areas for a period of time to reciprocate the investment made for their technical education.

But, but...that violates the principles of the free market, the \"bid-ask spread\" etc, based on which India will continue to paradoxically have a \"surplus\" of doctors, even while suffering an acute shortage of the same, so long as wealthy nations like America and Australia, where the doctor shortage isnt nearly as acute as India\'s, are able to outbid India for their services. Doesnt it?

vyasa, don't you understand the difference between a description and a prescription? it is obvious to all but the most hare-brained that portmanteau and floridian are just making an (accurate) observation explaining the numbers in the post. nowhere are they making a normative judgment that rural india is undeserving of doctors, but maybe the giant chip on your shoulder obscures your ability to see that.

don\'t you understand the difference between a description and a prescription? it is obvious to all but the most hare-brained that portmanteau and floridian are just making an (accurate) observation explaining the numbers in the post.

What are you yakking about? Who said anything about a prescription?

You say that India has a surplus of doctors (when in fact it has an extremely low doctor to patient ratio) based on the concept of bid-ask spread in a global \"free market\". By that reasoning every third world country must be overflowing with a surplus of doctors. But if there is such a global free market for doctors as you think, why is there a \"surplus\" of doctors in India and the third world when there is a shortage of doctors in wealthy nations like Australia and the UK? How does the bid-ask spread account for this? Surely doctors in impoverished India arent asking for more than what wealthy nations are willing to bid for them?

52 · Who let the 'who' out? said

vyasa, don't you understand the difference between a description and a prescription? it is obvious to all but the most hare-brained that portmanteau and floridian are just making an (accurate) observation explaining the numbers in the post. nowhere are they making a normative judgment that rural india is undeserving of doctors, but maybe the giant chip on your shoulder obscures your ability to see that.

Don't bother. Despite the truth of your comment, chances are he/she/it will just repeat themselves.

No they're not. Asians do well, particularly Indians, because they are an artificially selected population, generally having already benefitted from 50 years of Indian government investment in technical education. While racists have long used the "why can't you be like them?" reasoning against blacks and hispanics, and the Asians have kept quiet and benefitted from their model minority status, afforded them because of their relatively small numbers and their usefulness in the promotion of anti black racism, the relative success of many Asians does not disprove the powerful effects of white racism.

this is a standard argument used by "asian aren't really a model minority" types. the problem is that the "model minority" argument arose before the mass wave of asian immigrants after 1965 which were selected for education. rather, they were the descendants of chinese & japanese peasants who were doing relatively well despite discrimination (in japan specifically it was the lower SES groups which were encouraged to emigrate the new world for malthusian rationales).

I'm amazed that we're not talking about the dynamics of class and immigration policy in this apparent "over-representation" argument. While there has been some diversification (along class lines) of the immigrant desi community in the U.S., the vast number of desis in college are either (relatively) affluent immigrants or the children of relative elites who came under the strict migration regime of the 1960s/70s. Is it no wonder that those same groups self-select into high-earning "status" professions?

of course it is class. but we're not doing affirmative action based on class, are we? so who cares. race matters; if you're a cracker from appalachia you're shit out of luck because you get white skin privilege ;-) (as can be attested by the smattering of undisguised contempt and distaste expressed on these boards toward lower class whites from brownz).

who = prema, right?

What are you yakking about? Who said anything about a prescription?

you stupid git! you need to go to the next room if you are looking for an argument!

razib, who = prema = vyasa = gupta = dev, and so on, and so forth.

30 · who said

Floridian:

There are a lot of desi doctors here simply because there are a lot of desi doctors over there, and many of them end up coming here.

portmanteau:

Too many docs in India, so some end up immigrating

Wow. This is such a brazen falsehood.

http://timesofindia.indiatimes.com/India_short_of_6_lakh_doctors_/articleshow/2921262.cms

India short of 6 lakh doctors
3 Apr 2008, 0014 hrs IST,Kounteya Sinha & Mahendra Kumar Singh,TNN...........Even as India faces an acute shortage of manpower in the healthcare sector, the country holds the top position when it comes to its physicians migrating to developed countries like Britain and the US. According to a Planning Commission report, while India is short of six lakh doctors, 10 lakh nurses and two lakh dental surgeons, Indian doctors who have migrated to developed countries form nearly 5% of their medical workforce. Almost 60,000 Indian physicians are estimated to be working in countries like US, UK, Canada and Australia alone.

Regarding the lack of medical doctors in India, one of the first things that we can do is DOUBLE THE NUMBER OF MEDICAL STUDENTS WHO GRADUATE EACH YEAR from 30,000 to 60,000. why? because currently:
1. our american kids are going to third world countries (i.e. st.thomas islands, caribbeans, etc.) for a medical degree. they don't have to do this!
2. i find that bringing doctors from India/China worrisome, not because i doubt the abilities of these doctors, but because i *KNOW* that the indians and chinese need their doctors more than we need them.
3. the population of the USA has risen substantially over the years, but the number of doctors allowed to graduate has stayed the same.
4. having more doctors would lower the prices of certain medical practices.
5. The AMA (American Medical Association) is a racket: On one hand, they sell malpractice insurance to the doctors in the event they get sued by a patient, and on the other hand, they sell legal services to those same patients who are trying to sue doctors! This is even mentioned on their website. From what I understand, and I don't have the data in front of me, is that the number of American doctors who matriculate hasn't changed much in the last 30 years or so (once again, not sure).

there are some unnatural market forces at play here as well. why is it that the *REAL* (adjusted for inflation) prices for routine/standard procedures have risen over the years? they should have come *DOWN* due to technological advances or better policies for treatment. for example, resetting a broken arm 30 years ago was a lot cheaper than it is now - even if you adjust it for inflation. same goes for deliver of babies. SOMEONE IS MAKING A LOT OF MONEY HERE! the prices have been kept abnormally high. what's at work here? also, i know this one japanese exchange student who had a cavity cared for at a dentist's office here. he was without insurance. his bill to rectify this cavity was $1500!

I think that the medical profession is the most lucrative and "safe bet" type of occupation. It has quite a few perks, in addition to the lucrativeness of this job. Some of the added benefits are career stability, geographic flexibility (how many hedge fund managers in Milton, Oklahoma?), and everyone you work with are *not* sleazy when compared to other professions.

Regarding my previous post's assertion that we should effectively double the entrants into medical schools, I believe that we can do this, and this would have so many benefits and very little costs.
1. If we double the number of entrants, we can do so be simply doubling the capacity of existing medical schools. We don't have to build new schools, and this marginal cost is not that much.
2. It's not much harder/more costly to teach 100 students VS 50 students. Therefore, the the medical schools would get roughly twice the revenues, and the tuition could reduce by roughly 50%. I envision that the average indebtitude today for MDs is about $400,000, but with my "2X Proposal" (2XP), the average indebtitude would decrease to, let's say, $250K.
3. More MDs mean more supply, and this would decrease prices. Period. What happens to the wages when there are more of that type of worker? It goes down, and this isn't necessarily a bad thing. MDs get paid too much for a job that will never see them getting laid off or fired.

The most common rebuttal that I'm hearing, however, is that my 2XP would dilute the pool with more mediocre and/or under-qualified MDs. This is partly true, but people are hyper-sensitive about it. To this, I have an analogy. Suppose that the USA had a restriction saying that people can only get a driver's license if they are very athletic and they scored in the top quintile on some standardized exam. Sure, this selective pool would do a good job driving, but so would many people who did not pass this exam or meet the minimum athletic criteria. So in this hypothetical example, the criteria for driving is too selective.

Same way, there are many very smart, passionate, sincere, and competitive prospective MDs who did NOT get accepted to a medical program due to one reason or another (i.e. poor undergrad GPA due to personal reasons and/or other reasons). However, I'm convinced that these people would excel in a medical program.

Therefore, the rate-determining step for the production of an MD, is getting accepted to the medical program. Intuitively, I'd say that ~95%+ of the people who get in medical school graduate. The other ~5%- who don't graduate, I'd say that most of them drop out because they realized that medical school was not for them.

Finally, the quality of the MDs would go down incrementally. However, the quality of our MDs are so high now, and our problem is not that we have bad doctors. Our problem is that we don't have enough qualified doctors! Coming back to my driver's license example: Sure if we only allowed very smart and very reflexive, scholarly ninja-samurai-types to become drivers, the roads would be safer than it is now. I'd say that there would be 1 error to 100,000 driving events, let's say. However, in this situation, we can relax the standards a good bit (to say yellow belts - JK), and I would think that the error rate would be 1:80,000 driving events, and thus, the highway safety wouldn't go down by much in spite of the glut of new drivers.

doctor = lots of ladies ;-)

They're planning to increase medical school entering classes by 30% by 2012. There are about 10 new MD and 5 new DO schools about to open up.

61 · anthroguy said

They're planning to increase medical school entering classes by 30% by 2012. There are about 10 new MD and 5 new DO schools about to open up.

Link to no. of matriculants by medical schools for entering class of 2007:
http://www.aamc.org/data/facts/2007/2007school.htm

There were about 22,000 first year residency positions for 2008 which were matched; 15,000 of these were US MDs, 2000 US DOs, and about 5,000 non-US MDs.

If US MD/DO schools increased the number of students without a simultaneous increase in residency slots, then many of the foreign MD programs that attract US students will be out of business.

you stupid git!

Lol. Running out of arguments to defend the indefensible with, eh?

What\'s stupid is portmanteau claiming that India has \"too many\" doctors. What\'s even more stupid is your asinine attempt to justify that outrageous falsehood with \"the concept of bid-ask spread\"! :)

Additional info . from AAMC on this topic:
http://www.aamc.org/newsroom/pressrel/2007/071016.htm

The 2007 entering class to U.S. medical schools is the largest in the nation's history, according to new data released today by the AAMC (Association of American Medical Colleges). The number of first-year enrollees totals almost 17,800 students, a 2.3 percent increase over 2006. More than 42,300 individuals applied to enter medical school in 2007, an increase of 8.2 percent over 2006.

As of 2006, 28.8 percent of the U.S. population was black/African American, Hispanic/Latino, or Native American, yet these groups accounted for only 14.6 percent of medical school graduates. Nationwide, only 6 percent of practicing physicians are members of these groups.

In addition to increases in the size of the applicant pool, 11 of the 126 U.S. medical schools boosted their entering class size by more than 10 percent this year. First-year enrollment at the nation's medical schools has increased more than 7 percent since 2003, when the AAMC first began to investigate the possibility of a physician workforce shortage.

64 · who said

you stupid git!

Lol. Running out of arguments to defend the indefensible with, eh?
What\'s stupid is portmanteau claiming that India has \"too many\" doctors. What\'s even more stupid is your asinine attempt to justify that outrageous falsehood with \"the concept of bid-ask spread\"! :)

India has too many doctors, many more than it can gainfully train and emply. The post-MBBS training opportunities are severely limited, and less by an order of magnitude than the number of MMBS seats. That's why doctors complete their residency and leave for the US. There are a quite a few doctors who leave India to take up PhD programs abroad, since all they want to do is research. As with most other portfolios, the Health portfolio in India is held by an A-grade chump - Anbumani Ramadoss - who is so busy exploting his 23 servants out of Lutyens bungalow in New Delhi and hectoring Rajanikanth that he doesn't have the time to look into these matters. In the meanwhile Ramadoss is all set to hand out medical school licenses to Jerry Falwell Liberty University type diploma mills. The PM couldn't care less as long as Ramadoss's party continues to support the ruling alliance and his puppetmaster the lady on Race Course Road is happy.

65 · Sean in LA said

First-year enrollment at the nation's medical schools has increased more than 7 percent since 2003, when the AAMC first began to investigate the possibility of a physician workforce shortage.

Apparently, someone in the AMA (or in its behalf) made a wrong mathematical calculation which resulted in a wrong forecast ie surplus doctors. It is quite surprising to know that the supply of physicians in the US depends on an organization which is not even reliable enough to cross-check its math.

I see a trend here that people attribute contrarian comments to who/prema/vyasa/etc.. and then dismiss those comments even though almost all the time, his/her comments tell the TRUTH.

It is ridiculous to say that India has 'surplus' doctors.

It is ridiculous to say that India has 'surplus' doctors.

it is all well and good to pull out decontextualized statements in the interest of whipping up ire (your own or others'), but maybe you want to go back and read comments 31 and 32, as well as the original statements, not vyasa's self-serving paraphrasing.

his/her comments tell the TRUTH.

ha! like this? or this (pick your comment)? or maybe these are what you believe are the rules for reasoned debate? (anyways, the only thing less interesting than a "discussion" with that vyasa troll is a discussion about that vyasa troll, so that's the last from me on the topic.)

#69

ha! like this? or this (pick your comment)? or maybe these are what you believe are the rules for reasoned debate?

Do you find anything FALSE in the comments you referred ?. If so, can you explain?. Do you think "who" made up the news reports about Dr. Patel and Dr. Desai?

Do you find anything FALSE in the comments you referred ?. If so, can you explain?. Do you think "who" made up the news reports about Dr. Patel and Dr. Desai?

you are right, ponniyin selvan. it is perfectly reasonable to conclude that immigrant indian doctors with indian accents are murderous, unethical scum from those two examples. my bad.

"problem is that the "model minority" argument arose before the mass wave of asian immigrants after 1965 which were selected for education."

That's just not true - nobody referred to asians as model minority prior to 1965, and the term didn't really catch on until the 1980s. You made that up out of nowhere. perhaps you figure if you write "malthusian," people will not realize what horseshit you come up with.

Another thing about my 2XP is that we won't need to rely on the MDs from 3rd world countries anymore. Don't you think that the people of India need their doctors more than we need their doctors? By enacting 2XP, the people of India (yay India!) can better serve our own people there.

Therefore, I believe that we should write letters to congress about this proposal for further analysis.

BTW, 18,000 MDs a year is too little. We import 25% of our MDs as well. This is pathetic. The AMA/AAMC/whatever is a guild with a vested interest in maximizing the earnings/profitMargin of their own - IDENTICALLY, to the board of directors at a multi-national corporation.

AMA = ExxonMobil: They create a dependency on imports, serve to maximize corporate value (not just measured in market capitalization, but maybe by other metrics - salary, personal prestige, clout, etc.), and attempt to profit on *BOTH* sides of the problems.

Did you know that the AMA, according to hoovers.com (a business analyst online site that's very well respected/regarded), sells malpractice insurance to MDs, but they also cater to the other side of the problem by providing litigants with lawyers!

Talk about an unethical racket.

65 · Sean in LA said

Additional info . from AAMC on this topic:
http://www.aamc.org/newsroom/pressrel/2007/071016.htm

The 2007 entering class to U.S. medical schools is the largest in the nation's history, according to new data released today by the AAMC (Association of American Medical Colleges). The number of first-year enrollees totals almost 17,800 students, a 2.3 percent increase over 2006. More than 42,300 individuals applied to enter medical school in 2007, an increase of 8.2 percent over 2006.

As of 2006, 28.8 percent of the U.S. population was black/African American, Hispanic/Latino, or Native American, yet these groups accounted for only 14.6 percent of medical school graduates. Nationwide, only 6 percent of practicing physicians are members of these groups.

In addition to increases in the size of the applicant pool, 11 of the 126 U.S. medical schools boosted their entering class size by more than 10 percent this year. First-year enrollment at the nation's medical schools has increased more than 7 percent since 2003, when the AAMC first began to investigate the possibility of a physician workforce shortage.

68 · Ponniyin Selvan said

It is ridiculous to say that India has 'surplus' doctors.

it is true that there is an aggregate shortage of doctors in india. but as jyotsana (very pertinent observation, j) pointed out in #66 post-mbbs opportunities in india are limited. you need to specialize to really take advantage of your basic medical degree. and, a lot of MBBS grads are complaining about how reservations at the specialization and super-specialization level further restrict the already limited set of available seats.
it is true that a lot of indian medical graduates could be out in the villages as general physicians, providing primary care. but expecting only physicians to sacrifice personal gain is unfair, IMO. rural india needs a lot of engineers, businesspeople, nurses, bankers, inventors.......many of whom have benefited from technical education paid for by the indian taxpayer. why expect national service for docs that no else is willing to offer? those (eg sanjit 'bunker' roy) from privileged backgrounds with good educations who've given up personal comfort and wealth to make a contribution in indian villages -- however, they have all my respect and admiration.

72 · noblekinsman said

"problem is that the "model minority" argument arose before the mass wave of asian immigrants after 1965 which were selected for education."

Yes. And that's the reason that accounts for the numerous 7-11, gas station, restaurant, and motel owners. We can't forget about the cab drivers as well. Yep. So many educated Indians here. I think the late 80's/early 90's required most Indians who immigrated to be educated.

razib, your dates re: the usage of "model minority" as an extensive stereotype of Asians (including 2nd/3rd/4th gen. Japanese and Chinese Americans) is anachronistic.

Also, the major point of my comment (at the end of my post) was that people talk about racial and SES diversity as either a) proxies for one another, or b) mutually exclusive goals. They are neither.

I asked about SES because you're using propensity scoring that weights populations as if they were identical. We know, by immigration policy and otherwise, that they are not. So how useful is it to talk about the likelihood of that poor Appalachian white kid you mentioned becoming a doctor next to the kid of a (relatively) affluent desi immigrant? Not very helpful at all. I want to know how desi kids stack up to their white peers in the same SES. I think there's something to be said about immigrant groups choosing specific disciplines within which to specialize -- hence my reference to Filipina nurses. It's highly likely that, given external constraints (including racism), we are seeing migrant communities track in specific industries because of specific guarantees, e.g., similarity of field to previous training, financial/job security, etc. I also wonder what happens if you break this down generationally. Do we see a diffusion of the "propensity" effect based on cohort after the second generation? Probably.

Could we please ignore the prema/vyasa/who troll?

Rahul S, I'll lend you $1 -- please go buy a clue. Please read a textbook or ANYTHING related to Asian American history before using your limited world view/experience/familiarity with a subject as your substitute for reasoned discussion.

76 · Camille said

Filipina nurses.

also, another similar community: keralite nurses. nice point, camille, about how a confluence of factors (immigration policy, professional knowledge accumulated by family and friends abroad as well support they can provide on arrival, recruiting agencies in india etc) leads to a disproportionate number of specific migrant communities in certain occupations.
and yeah, it would be nice to measure propensities wrt identical populations in the relevant sense. so a stack-up with other affluent model minorities may also be informative.

77 · Camille said

Rahul S, I'll lend you $1 -- please go buy a clue. Please read a textbook or ANYTHING related to Asian American history before using your limited world view/experience/familiarity with a subject as your substitute for reasoned discussion.

Why would I need to read more? Here's a breakdown of brief Asian American history in a minute. The early Asians to come to the U.S. were Chinese-Americans during the Gold Rush (some Punjabi's came also) during the 1850's. During this time, there was a great hostility towards these Chinese immigrants because they were hardworking. Therefore, the Chinese-Exclusion Act was enforced so the Chinese couldn't get jobs. A large exodus of Asians immigrated to the West Coast, as we can see the large numbers of Asians in this region. The U.S. government feared that Asians were hard working, and would create hostile scenarios between the natives living in the states. Therefore, immigration was given preference to European countries. Eastern europeans were given shit as well, and they experienced a lot of racism as well. Back to the Asian part. Japanese Americans were placed in internment camps during the WWII. There was a supreme court decision (some guy named Singh) contesting for citizenship...however, he wasn't given it in the 1920's. Under President Truman in the 1940's, Truman allowed more Asians to come to the U.S. (especially Indians). However, this was a small number. Yes, then in the 1960's, more Asians were given citizenship preference if they were educated (which my grandfather benefited from, and immigrated in 1967). Yes, there were Indians that were uneducated, but still many of the Indian immigrants that we see today are educated. So why the f*** would I need your buck to buy books when I already know the basics of Asian American History.

71 · Who let the 'who' out? said

Do you find anything FALSE in the comments you referred ?. If so, can you explain?. Do you think "who" made up the news reports about Dr. Patel and Dr. Desai?

you are right, ponniyin selvan. it is perfectly reasonable to conclude that immigrant indian doctors with indian accents are murderous, unethical scum from those two examples. my bad.

What you are conveniently neglecting to consider is that these two weren't just the usual random examples of doctor misconduct, these are probably the two worst examples that have been in the news in the past few years. Dr Patel, known as Dr Death, is responsible for at least 87 deaths due to his incompetence and Dr Desai may have infected 40,000 americans with the AIDs virus due to shoddy practices in his clinics. Of course someone like you who is irrational enough to argue that the "bid-ask spread" explains the "surplus" of doctors in India may find it hard to understand why americans who have been following the news could have a reason to be wary of indian doctors based on just those two examples.

The reason I brought this up was to counter the self-serving putdown of black and hispanic doctors by one poster here. Apparently he thinks that black and hispanic doctors are incompetent due to lower standards applied to them in medical school and therefore whites choose to avoid them if they can afford to do so. Going with white doctors instead, which group according to his delusion includes indian doctors! Though he did throw in the caveat about indian accents turning whites off to give the impression that he was being fair and objective in his analysis.

66 · jyotsana said

India has too many doctors, many more than it can gainfully train and emply. The post-MBBS training opportunities are severely limited, and less by an order of magnitude than the number of MMBS seats. That's why doctors complete their residency and leave for the US. There are a quite a few doctors who leave India to take up PhD programs abroad, since all they want to do is research. As with most other portfolios, the Health portfolio in India is held by an A-grade chump - Anbumani Ramadoss - who is so busy exploting his 23 servants out of Lutyens bungalow in New Delhi and hectoring Rajanikanth that he doesn't have the time to look into these matters. In the meanwhile Ramadoss is all set to hand out medical school licenses to Jerry Falwell Liberty University type diploma mills. The PM couldn't care less as long as Ramadoss's party continues to support the ruling alliance and his puppetmaster the lady on Race Course Road is happy.

How the heck does any of this lead to the conclusion that India has "too many doctors", an overflowing "surplus" that spills over to the developed nations? When the reality is that India is suffering from an acute shortage of doctors. You are just giving reasons for why doctors trained in India prefer to go abroad instead of staying home. And amusingly you neglect to mention the bottom line reason: they are desperate to go abroad because they know they can make a helluva lot more money there than they can in India.

What you and portmanteau should say, if you were intellectually honest, is not "India has too many doctors" which is an outright lie, but "India has too many doctors who want to get the hell out of there".

Asians do well, particularly Indians, because they are an artificially selected population, generally having already benefitted from 50 years of Indian government investment in technical education.

does this also mean that mexican immigrants do poorly because they are an artifically selected population, generally low skilled laboarer who've been hurt by 50years of anti-free market policies of the mexican oligarchy? if the model minority is a myth, wouldn't ant-mexican racism be a myth too?

80 · who said

Going with white doctors instead, which group according to his delusion includes indian doctors!

heh. after reading vinods post, i thought "my god, prema is going to have a conniption: indians are being classified as white." apparently, the thought of whites classifying indians is white is too much for him to bear, so he projects the delusion onto razib, who obviously is as opposed to this classification as he is to affirmative action itself.

81 · who said

What you and portmanteau should say, if you were intellectually honest, is not "India has too many doctors" which is an outright lie, but "India has too many doctors who want to get the hell out of there".

i say something like that in comment #74 (read line 1). india-trained physicians may not want to get the hell out of the motherland, but certainly, if they want to get a post-MBBS education, they might not have another option. if you wish us to express our sentiments as per your command, maybe you should take a page out of dear leader's playbook. didn't he say that power grows out of the barrel of a gun? haranguing people over the internet doesn't work quite as well, little mao.

Why does Prema/Vyasa keep on changing its name.

Hey Prema/Vyasa/Who

WTF don't you go hang out amongst your own kind ?

Just because Indians are hospitable doesn't mean you wear out your welcome with your rage.

There is an old Persian curse "Be angry and die of this anger."

Make sure your ER doctor isn't from India though.

Hey folks - cut out the personal attacks or this comment thread gets shut down.

why are people forgetting the role of immigration policy in racial/class formation in the US? The model minority myth does not apply in all countries with a South Asian diaspora. I see a lot of sneering at "social science professors" and "leftists" in general for "harping" on racial inequality, so how do you all interpret the model minority myth? Proof that Indians and Chinese are the ubermensch? GTFO. I guess it's just another day at Sepia Mutiny.

And this is old news - I don't know how it's a "gotcha" for "leftists". The govt let in a whole bunch of degreed/middle class people, hence the demographics. The model minority myth is a convenient anti-black rhetorical tool that's lapped up by ignorant, smug uppper-class asians who don't have a grasp of how social policies form societies. I find the assumption that being a doctor or whatever necessarily means one is smart ridiculous - I know cus I'm surrounded by petty, gossipy, shallow people in "successful" job roles, and my mum who's a doctor talks about dumbasses in her field who came to work drunk, didn't use gloves before they became mandatory or re-used dirty needles. A young white woman who went for several years on maternity leave came back and became the director. The immigrant women doctors get the brunt of the crappy work and the least help.