It's literally baked into the H1B law was confirmed by a congressional report on the program: https://www.uscis.gov/sites/default/files/document/reports/O...

> Just pay American workers more.

If we set aside software engineering - 40% of rural doctors in the US are here on H1B visas. There's not a "pay them more" button we can hit that generates more domestic doctors, especially not in under 10 years. All you'd do is compete amongst a limited supply.

> There's not a "pay them more" button we can hit that generates more domestic doctors, especially not in under 10 years.

That's literally how the button works. An undersupply in the market, increases prices.. kids and students deciding what they want to do with their life, see the wages and decide 10 years of school is worth it... and after 10 years you get more doctors.

If there's an undersupply, that's a clear indication that young people are looking at the field and deciding the wages don't justify the investment.

By short-circuiting the process of the free market, you're guaranteeing the shortage will continue.

As an American who grew up in one of these underserved markets, you couldn't pay me enough to work there. My mom works at a rural hospital and loathes every minute of it. The reality is, American workers value more than just dollars. Especially professionals with options.

Immigrant doctors may also hate working at these facilities, but the prospect of raising their family somewhere in the USA is a huge value add for them.

> As an American who grew up in one of these underserved markets, you couldn't pay me enough to work there.

Eh I think this is sort of BS. First yes literally you could be paid enough. Everyone has a price, including you, and you’re not fooling anyone. Second you can find arrangements that perhaps enable you to spend a few years doing what amounts to public service in exchange for maybe no debt or higher pay and then move on - this is a very common thing in the labor market.

Also, what does that say about you that you hate being around your fellow countrymen more than someone from outside of your country?

I really don't think this is true.

The problem is that the relationship is non-linear. The data shows that at a certain amount of comfort and income, most people really aren't willing to make drastically uncomfortable lifestyle choices for any amount of money. I'm not suddenly going to become a lineman even if it pays double what I make now.

How many kids in our culture are actually looking at earning potential as the #1 factor when they choose a career?

The pay for doctors does not matter for recruiting more doctors when the bottleneck is residencies.

There actually is a pay them more button that the federal and state government controls, but I doubt they'd hit it. Many of those rural docs are compensated heavily by Medicaid (EDIT: have a high % of Medicaid patients - compensation is a separate story), but the reimbursement structure often penalizes those rural docs vs. those that take positions in suburban and urban environments. Some states permit a flat reimbursement structure where patient volume is the only difference, but other states further penalize the rural docs by "shaping" reimbursement rates such that more funding goes to the urban and suburban areas.

This administration could address that, but if anything, they seem to be moving in the opposite direction.

Rural medical specialists are compensated very well. In my experience the bigger obstacle to getting those roles filled is more social, for example, unless you are already married the dating pool in a rural area is a consideration for new doctors, or if you are married and your spouse has a career moving to a rural area may require them to give up that career which they may not be willing to do. Cities better support dual-career households b/c they have a density of industries. Also - after 10+ years of school a lot of new doctors want to live it up a bit in a place with things to do and see.

Not to mention if you have kids there are more limited options for their schooling and extracurriculars in a rural area.

Sure there is, we can make school affordable.

And stop degree inflation. A doctor with 4 years of med school and a year internship from 60 years ago can diagnose your sniffles or refer you to a specialist just as well as a doctor with an unrelated 4-5 year BS degree then 4 years in med school, then a year of internship followed by 3-4 more years of residency.

At the same time, the doctor with just 4-5 years of school and hundreds of thousands less debt can not only treat patients more cheaply, but will have more years of practice too.

We call those doctors with less medical school and training ARNPs. I've seen several and they seem to do well for basic needs.

The first 4 years are basicaly worthless. I remember reading that the best doctors got their initial BS in engineering which has nothing to do with medicine. It simply shows they have a higher IQ than average and would have made superior doctors whether they got that engineering degree or not.

That leaves the only real difference (other than degree inflation) as being 3 years of residency, but most of the older generation of doctors effectively did the same thing entering into an existing practice or working in a hospital under an experienced physician.

If you climbed the ladder (like a lot of nurse practitioners do), the ADN+BSN took 5 years with 3-4 more years for the MSN or 4-5 years for the DNP.

Put another way, that nurse practitioner has MORE applicable years of schooling than a doctor who got some random degree with the handful of med prereqs then went to med school, internship, and residency. Lots of nurse practitioners also work in the field all the while they are in school which further increases their actual experience.

The real takeaway is that all these extra years, loans, and interest combined with fewer years to practice medicine translate into more expensive care without improving outcome.

That would be like DEI for American workers, no? Not to mention, discrimination based on nationality is illegal.

> That would be like DEI for American workers, no?

No for a couple of reasons which you’re aware of. Plus liberals say DEI is good so they can’t be against it.

> Not to mention, discrimination based on nationality is illegal.

Sort of - but you’re taking a narrow view here. We discriminate (nothing wrong with that, all countries do it) who we let in to the US for example. Many universities had or have de facto race quotas, and by being an American you can’t be discriminated against as a nationality outside of being an American. Let’s say you are Chinese American. You’re American, not Chinese. There isn’t anything to discriminate against. Welcome to team USA. All the way baby. But if you aren’t an American then we just decide what we want to do with you and whether it fits our needs or we send you back home or whatever.

The parent was asking to "just pay Americans more". That is just illegal.

I’m the parent. Society makes up laws. We can just make up a new law for whatever purposes we want.

Would be a bit difficult to change the constitution, but yeah, nothing is impossible.

What part of the Constitution would be needed to change? The US government for example gives preferential hiring to veterans which is discriminating against some Americans.

It is literally a requirement for that kind of Visa.

> Employers must attest to the Department of Labor that they will pay wages to the H-1B nonimmigrant workers that are at least equal to the actual wage paid by the employer to other workers with similar experience and qualifications for the job in question, or the prevailing wage for the occupation in the area of intended employment – whichever is greater.

https://www.dol.gov/agencies/whd/immigration/h1b