CHAPTER 12 INTERNATIONAL FACTOR MOVEMENTS 253 IN THE REALWORLD: IS THERE A LICENSING BIAS AGAINST FOREIGN MEDICAL GRADUATES? As of 1990, about 130,000 physicians in the United States had received their medical training abroad. This number represented approximately 21 percent of the profession and contained about 20,000 Americans who received their medical training in a foreign medical school. Approxi- mately one-half of these physicians practiced in ve statesNew York, New Jersey, California, Florida, and Illinoisiand many played an important role in caring for the low-income populations in major cities such as New York and Chicago. A 1990 article in The Wall Street Journal noted that, increasingly, members of this professional group claim that they are being discriminated against by licensing agencies. Because medical facilities, training, and tech- nology vary considerably around the world, most medical licensing agencies rely on certication tests and proce- dures to ensure that medical practitioners have some basic level of knowledge and expertise. Many procedures are attacked because they are used to discriminate against foreign-trained physicians in order to protect jobs for U.S.-trained physicians. One foreign-trained physician thought that discrimination in various ways was common and stated: \"Under false pretense of quality patient care the authorities are clandestinely eliminating the foreign medical graduates from the practice of medicine.\" Although the licensing agencies adamantly deny these charges, the International Association of American Physi- cians has pressed Congress to pass a bill to prevent state licensing boards from discriminating against physicians who were educated abroad. Such efforts have been opposed by the American Medical Association, which is worried about increasing federal control over the practice of medicine and the quality of health care in general. Foreign-trained physicians must pass tests demonstrating prociency in English and medicine, complete one to three years of training in a residency program, and pass a nation- wide exam before being licensed to practice by a state board. While it is necessary to make certain that foreign-trained physicians are qualied to practice medicine in the United States, it is easy to see how this testing system could be used by the domestic profession to control the supply of physi- cians in the country. Not surprisingly, the pressures seem to be coming from the profession itself and not from the general population being served, including those in the inner cities and rural areas, whose access to professional medical care would be more restricted without these doctors. Restrictions on entry extend beyond the medical profes- sion: other foreign professionals often face obstacles as well. For example, in 1995 the U.S. government issued new rules to, among other things, make it more difficult for U.S. com- panies to pay lower wages to workers in the \"H-lB\" category of immigrants, the category under which certain foreign spe- cialty workers are granted visas for employment for up to six years in the United States. It had been alleged by domestic labor groups that, prior to these new rules, the H-1B profes- sionals (such as physical therapists and engineers) were hired at wage rates lower than prevailing U.S. rates, at the expense of domestic workers. Clearly, U.S. employers have been opposed to these rules. In addition, events such as the Sep- tember 1 1, 2001, terrorist attacks have made it even more dif- cult to obtain appropriate work visas in the United States. Sources: Kenneth H. Bacon, \"Foreign Medical Graduates Claim Licensing Bias," The Wall StreerJoumaI, September 13, 1990, pp. B], B4; G. Pascal Zachary, \"Curbs on Foreign Professionals Assailed," The Wall SrreetJorrmaI, January 13, 1995, p. A2. . backgrounds.14 This suggests not only that they will likely have a heavier participation rate in U.S. welfare programs but also that this differential will carry over into second- generation wage and skill differences, which will be reected in widening ethnic income differences within the overall labor market.15 There is also weak evidence that the increasing numbers and declining skill levels of immigrants may have contributed to the relative decline of domestic unskilled wages in the 19805. For example, Borjas, Richard Freeman, and Lawrence Katz (1992) concluded that perhaps onethird of the 10 per- cent decline in the relative wage of high school dropouts from 1980 to 1988 could be 14Similar rcsuits have been observed by Wright and Maxim (1993) for Canada. 15Sec Borjas (1993) for analysis of intergcncrational characteristics of migrants