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Mark Steyn: British bomb plot and Michael Moore-style health care
| Rolled over to Monday. AoS. |
The legacy of Britain's socialized medical system is a growing reliance on foreign doctors, like seven of the eight suspects arrested in the failed London car bombing and Glasgow airport attack.
| I disagree. It's common enough in the U.S., as well. It's a function of prosperity. The original immigrant shows up and if he doesn't have a hard skill he digs ditches and scrimps so his kids will. The hard skills are marketable and they make the family. The post-hard skill generation goes into something a little less demanding of intellect; the MD's child becomes a lawyer, the engineer's child an MBA. The generation after that, the kids major in modern dance or ethnic studies. Tour most American hospitals and count the number of African, Asian, and probably even Antarctic accents among the staff. Take a tour a nursing homes and the native American accents are likely outnumbered even by the Micronesians. |
The IMGs (international medical graduates, and we can't call them 'FMGs' any more) are here because a) we have openings in our graduate medical education system (i.e., residency programs), b) we have hospitals that run these residency programs that make money and gain certain other benefits from having residency programs, and c) we have IMGs who'd rather be a doc in the U.S. than in Peshawar. Many of the American programs that cater to IMGs are rather low on the food-chain of training programs in terms of respect and are usually located in innner cities. The programs work hard to provide decent (not outstanding, but decent) clinical training and meet local community needs, and for the most part the IMGs pick up on that and work to serve the community they're in.
I admire the IMGs as a group, and the events at Glasgow have really saddened and angered me. The IMGs who make it to the U.S. are generally among the best and brightest of their home countries -- they have to be in order to score well enough on the ECFMG exam, the English exams, and the clinical performance exam to get into an American residency program. And they have to have the moxie to decide to leave the home country behind and come to a new culture. I'd like to think that the Muslim IMGs are, as a group, more reasonable, more moderate, and more willing to get along with Western culture than the average Muslim -- that's what I believed until Glasgow.
I also note that we now have the children of these IMGs, American citizens all, who are competing for American medical school admissions -- and winning. We have a fair number of them in our own program, and they are, as a group, simply outstanding. Most are either Hindi or East Asian, thoroughly American, and smart as all get out. Some of their siblings are lawyers and engineers. |
There are many things wrong with U.S. health care, as there inevitably are with any health care system. The question is whether America wants to go down the British-Canadian-Cuban route, to name three government medical systems that Michael Moore admires in his new film "Sicko." Cuba, of course, is a totalitarian state, and even Hollywood celebrities, though they like to visit, wouldn't want to live there. (Incidentally, the best health treatment available on Cuba is at Gitmo.) The United Kingdom, by contrast, is a free society, but last week's incendiary Jeep Cherokee at Glasgow Airport has shone a rare light on the curious character of its government health system.
Of the eight persons arrested as of Friday in the terrorist plot, seven are doctors with the National Health Service (the eighth is the wife of one, and a lab technician at the same hospital). The bombs failed to go off because a medical syringe malfunctioned. I don't mean it malfunctioned as a syringe (even in the crumbling NHS, the syringes usually work) but as a triggering mechanism, to which it had been adapted, though evidently not too efficiently.
Does government health care inevitably lead to homicidal doctors who can't wait to leap into a flaming SUV and drive it through the check-in counter? No. But government health care does lead to a dependence on medical staff imported from other countries.
| Does government health care inevitably lead to homicidal doctors who can't wait to leap into a flaming SUV and drive it through the check-in counter? |
A part of the problem is also attributable to tightening and revising qualifications standards. While dullards might be discouraged from entering the medical field at the MD level in the U.S., where med schools are terribly competitive, so are perfectly acceptable folk who aren't particularly brilliant. Hence the proliferation of medical schools in places like Grenada. |
| Ah yassss, Saint Georges University, home to American kids from New Joisey and New Yolk who can't quite get into an American med school (that includes some of the children of IMG docs!). I've worked with a few; turns out they're perfectly acceptable docs once they get the chance, and they're usually grateful for any teaching you give them. |
To fill the gap, we now have physicians' assistants and nurse practitioners, who function more like the family practitioners of the days of my youth. RNs are now at a premium for the same reason. Their position in the heirarchy has become elevated, while the Licensed Practical Nurse and the LVN are now mostly extinct. RNs don't have to touch a bedpan anymore; that's left to medical assistants and medical technicians and such folk, much lower on the caduceus.
A hundred years ago, if the ambulance came for you there was a doctor driving. 50 years ago doctors still made housecalls. Today you get an EMT (6 months training, not full time) driving, with a paramedic if you're an advanced life support case, otherwise another EMT. When you get to the emergency room, you're likely to be seen by someone born in Mumbai if you're lucky, Peshawar or Zarqa if you're not. |
| Emergency medicine is fairly popular with American medical grads (AMGs); interesting work, decent money, and a scheduled life. That appeals to docs with outside interests or family needs. So you might actually be seen by someone from Boston :-) |
Some 40 percent of Britain's practicing doctors were trained overseas and that percentage will increase, as older native doctors retire, and younger immigrant doctors take their place.
| The answer would seem to be to open more domestic medical schools and take the competent along with the brilliant, but that might impinge on domestically-raised MDs' status. The exclusive private practice guys are more likely to be named Charles or Richard, or at least Irving or Milton than they are to be named Mahmoud or Ahmed. |
| Ahem. Most of us American docs would like to open more domestic medical schools, and/or expand the existing ones -- that would provide more academic jobs, more opportunities for medical care and medical practice, and would generally improve our status. The roadblock isn't the medical profession, it's the state legislatures that would have to finance the expansion. |
According to the BBC, "Over two-thirds of doctors registering to practice in the UK in 2003 were from overseas the vast majority from non-European countries." Five of the eight arrested are Arab Muslims, the other three Indian Muslims. Bilal Abdulla, the Wahhabi driver of the incendiary Jeep and a doctor at the Royal Alexandra Hospital near Glasgow, is one of over 2,000 Iraqi doctors working in Britain.
Many of these imported medical staff have never practiced in their own countries. As soon as they complete their training, they move to a Western world hungry for doctors to prop up their understaffed health systems: Dr. Abdulla got his medical qualification in Baghdad in 2004 and was practicing in Britain by 2006. His co-plotter, Mohammed Asha, a neurosurgeon, graduated in Jordan in 2004 and came to England the same year.
| And again, most of these IMGs understand the difference between a practice in Birmingham and a practice in Zarqa. The U.S. has had rules on J-1 and H-1B visas for a while to get IMGs who are finished with their training to return to their countries of origin, and let me tell you, the IMGs are very creative, motivated and desparate to beat those rules. And they usually do. |
When the president talks about needing immigrants to do "the jobs Americans won't do," most of us assume he means seasonal fruit pickers and the maid who turns down your hotel bed and leaves the little chocolate on it. But in the United Kingdom the jobs Britons won't do has somehow come to encompass the medical profession.
| See my opening statements. The fruit picker, if he doesn't take the pittance and run, has kids who'll either become barrio thugs or will work hard to get into medical or engineering school. America has remained great because of immigration. If we were still a nation of Knickerbockers and Virginia planters we'd likely still be technologically and economically on par with Mexico -- the same par we started on. |
| You bet. Each generation complains about immigration, and the succeeding generation takes as the normal state of affairs the immigrants who came before. |
Aneurin Bevan, the socialist who created the National Health Service after World War II, was once asked to explain how he'd talked the country's doctors into agreeing to become state employees: "I stuffed their mouths with gold," he crowed. Sixty years later, no amount of gold can persuade Britons to spend their working lives in the country's dirty, decrepit hospitals (they spend enough of their nonworking lives there, waiting to be seen, waiting for beds, waiting for operations). According to a report in the British Medical Journal, white males comprise 43.5 percent of the population but now account for less than a quarter of students at UK medical schools. In other words, being a doctor is no longer an attractive middle-class career proposition. That's quite a monument to six decades of Michael Moore-style socialist health care.
| Men are less common in American medical schools today than thirty years ago: back then the ratio was about 3:1 favoring men, and today it's just under 1:1. Women are a majority in American medical schools; women see medicine as an acceptable career, they have opportunities they didn't have in the past (when the general guidance on careers was, "go be a nurse, young lady, and forget any dreams of being a doctor"), and -- let's be blunt -- more women than men are in college today. You can't get into med school if you don't compete as an undergrad, and we have fewer men on campus today. |
So today the NHS is hungry for medical personnel from almost anywhere on the planet, so hungry that the government set up special fast-track immigration programs: Mohammed Asha, Mohammed Haneef and their comrades didn't even require a work permit to come and practice as doctors in state hospitals. You don't have to be the smartest jihadist in the cave to see that as an opportunity, any more than it required no great expertise for the 9/11 killers to figure that the quickest place to get the picture IDs with which they boarded the planes was through Virginia's "undocumented worker" network. Everyone else from the Venezuelan peasantry to the Russia mafia knows the vulnerabilities of Western immigration systems, so why not the jihadists?
Maybe their mistake was trying to blow up the airport instead of wreaking subtler havoc on the infidels. Did you see this week's scare-of-the-week from the Chinese health system? "About 420 bottles of fake blood protein, albumin, were found at hospitals in Hubei province but none had been used to treat patients, said Liu Jinai, an official with the inspection division of the provincial food and drug administration."
Well, this being China, where public lies about public health are routine, we just have to take Liu Jinai's word that "none had been used to treat patients." But imagine what Doctor Jihad could get up to if he stopped trying to use the syringe as a detonator and just resumed using it as a syringe?
| And that's the scariest thought of all -- to the extent that we have Muslim IMGs who are or become susceptible to 'sudden jihad syndrome', we'll eventually face a situation in which a smart jihadi physician decides that the best way to wreak havoc in America is one patient at a time. |
But beyond that the Glasgow Jeep story symbolizes a more basic reality. The NHS is the biggest employer in Europe, and it's utterly dependent on imported staff such as Dr. Asha and Dr. Abdulla. In the West, we look on mass immigration as a testament to our generosity, to our multicultural bona fides. But it's not: A dependence on mass immigration is always a structural weakness and should be understood as such. In the socialized health systems of the Continent, aging, shrinking populations of native Europeans will spend their final years being cared for by young Muslim doctors and nurses. Indeed, in the NHS, geriatric medicine is a field overwhelmingly dependent on immigrant staff.
| Immigration is not dependence or weakness so long as the immigrants are assimilated into the culture of the country. That's been the biggest weakness of the Y'urp-peons -- the acceptance of a social theory that mandates separateness, group identity and an enforced social equality instead of a single culture, individual identity and personal liberty. Most of the IMGs coming to America are from India and East Asia. They get it real fast, and their children are completely American. They aren't a threat to us. If we take more and more Muslim IMGs, that might be okay, but we have to make damned sure they assimilate. |
And what of the other end of the medical business? Take Japan, a country with the same collapsed birth rates as Europe but with virtually no immigration. In my book, I note an interesting trend in Japanese health care: The shortage of newborn children has led to a shortage of obstetricians. For in a country with deathbed demographics, why would any talented ambitious med-school student want to go into a field in such precipitous decline? In Japan, birthing is a dying business.
Back at the Royal Alexandra Hospital, three doctors were under arrest, and the bomb squad performed a controlled explosion on a vehicle in the parking lot. Pulled from the flaming Cherokee, Dr. Kafeel Ahmed is now being treated for 90 percent burns in his own hospital by the very colleagues he sought to kill. But at one level he and Dr. Asha and Dr. Abdulla don't need to blow up anything at all. The fact that the National Health Service the "envy of the world" in every British politician's absurdly parochial cliché has to hire Wahhabist doctors with no background checks tells you everything about where the country's heading.
Posted by: Fred 2007-07-09 |
