Q&A: Behind the United States' conflicting ties with immigrant doctors

RICHMOND, Va. - In a forthcoming book, Eram Alam, assistant professor of the history of science at Harvard University, examines an often overlooked but vital part of American healthcare: foreign-born doctors, many of whom emigrated from South Asian countries like India.

Chronicling an influx after the passage of a 1965 immigration law, Alam explores the often fraught relationship between the United States and doctors who come from abroad to fill labour shortages, many of whom end up settling in vulnerable communities that are also hostile to immigrants.

"The Care of Foreigners: How Immigrant Physicians Changed U.S. Healthcare" will be published by Johns Hopkins University Press on Oct. 14.

Alam spoke with Context about immigration, the medical community and how the Trump administration's policies threaten to disrupt the fragile balancing act.

You write that historically 'foreign physicians entered a professional space hostile to their presence yet in desperate need of their labour.' Have you found that those competing sentiments reconcile or clash?

They don't reconcile. I think this is one of the uneasy things that is always the case with immigration. The U.S. has these shortages of labour ... In order for the functioning of the basic ... kinds of things of this country, immigrant labour is absolutely vital.

And so we see that with the mass deportations, and 'Oh wait, but we can't do it on farms.' 'Oh wait, but we can't do it in meat packing,' and 'We can't do it in the hospitality industry.'

I think that same kind of logic was at play with this initial Hart-Celler Immigration Act of '65, which exactly holds this paradox of 'We want you to come; we don't really want you to come, but we actually need your labour.'

What kind of moral considerations are at work when it comes to 'brain drain' from the Global South to the Global North?

It's a question that was being raised ... 60 years ago, and I think it really continues to resonate today. What exactly should the U.S. do as the (world's) superpower, as the place that spends the most on healthcare?

I think part of what the moral impetus (is) for the U.S. is how can we actually over-produce physicians since we have so much money? How do we create an infrastructure in which we're the ones doing the export of the labour instead of the ones doing the importation of the labour?

To what extent does the current administration's immigration crackdown threaten to upend this balance of foreign-born medical professionals?

There are some glimpses of it. July 1 is when residents begin their new positions. (Secretary of State) Marco Rubio decided (in May) we're not going to have any visa interviews at embassies abroad.

Some people had already secured their visas to begin the July 1 work start prior to this, but other people hadn't. So there are reports that are coming out of hospitals, especially in the communities that these immigrant physicians work (in) ... that had 10 immigrant physicians that were supposed to come. Well, eight of them were actually able to make it.

So there (were) delays that happened because of that and then all of a sudden there was, in June, 'Oh wait, we need to have mission-critical (visas) expedited for physicians.'

But I think in the meantime, people may have made different choices, and they may have gone to the UK, Australia, Canada – all of these other places that also have a huge immigrant physician cohort but don't have such hostile, antagonistic relations to immigrants at the moment.

What are you hoping people will take away from the book? What are the key aims in taking this topic on?

I really, really want people to understand how essential immigrant labour of all kinds – in my case, physician labour – is to the everyday functioning of U.S. healthcare.

The most vulnerable people are the ones that are being taken care of by immigrant physicians, and ... their expertise has been questioned. And all of the data has shown that they have fewer malpractice cases than U.S.-trained physicians, that the quality of care that they provide is on par or exceeds U.S.-trained physicians.

And I also just want the broader public to understand that this question of the distribution of healthcare labour has to be a global question.

This interview has been edited for clarity and brevity.

(Reporting by David Sherfinski; Editing by Ayla Jean Yackley.)