Tulenko, a physician and director of clinical services for a global health nonprofit, pursues a new angle in the ongoing healthcare debates in this intriguing and lucid study. She argues that the insourcing of health care workers—i.e. bringing them to the U.S. after they complete training in their own countries—is a destructive trend. Currently, 25% of physicians are "imported" from "countries that can least afford to lose them," a practice that has resulted in a "multibillion-dollar international healthcare-worker recruitment" industry operating in at least 74 countries. In the U.S., she says, this results in lower salaries and employees who are less likely to unionize, as well as medical errors due to cultural differences or language barriers. Despite insourcing, there is nevertheless a scarcity of trained medical staff, and that shortage of workers will grow as baby boomers age. To address this deficit and provide jobs for Americans, Tulenko suggests reducing the cost of education needed to attain necessary credentials, training more workers at every level, better aligning students with healthcare needs (such as those of rural communities), and increasing efficiency in hospitals and doctors' offices (e.g., via the use of electronic records, which technology has been available since the 1960s, but largely unutilized). Those interested in healthcare management or public policy will find plenty of cogent information in this well-researched treatise. (May)
