I know I'm opening up a can of worms with this topic. I even did a forum search assuming this topic was probably covered recently given all the recent legislation, demonstrations...
Any thought on the whole illegal immigration issue from a standpoint specifically on it's impact to the medical field, healthcare expenditure?
I try to be very objective, and I can understand the side of those demonstrating for the rights of the illegal immigrants... however, as a healthcare professional, it's frustrating to me to see how much money goes into unpaid medical expenses for visits to the ER, hospitalizations at University hospitals by undocumented people, etc, etc... I live in Texas and we obviously see it more than some other states. It was frustrating for me during residency and med school to be unable to communicate with quite a few patients because I don't speak spanish/having to rely on a translator to show up. people assume I speak spanish because i have a spanish last name, but it's a married name (my husband is half Mexican. Obviously, as healthcare professionals, our duty is to take care of the patient without judgement on other factors...

It's frustrating for me to see Americans in my clinic who do work hard but are struggling so hard with medical expenses because they have poor healthcare coverage, but don't qualify for other assistance. But you can go to a border town on the American side and the clinics there are filled with patients who somehow are all on Medicaid.

I know there is no easy answer... but I would like to limit this topic just specifically to how this affects the medical side of things... I don't anticipate that 12 million people will be sent back to their country... however, we have a significant number of people (and still will continue to grow) who will make minimum money, who will be unable to afford healthcare if something were to happen, who will eventually get older/sicker, etc.... our hospitals are already burdened by them, what's to happen in another 10 years?

Obvioulsy the US is going to have to make some changes to how it distrubutes healthcare. However, to look at the immigration issue as one that just effects healthcare is one sided and IMHO you can't fairly talk about the negaitive impact of immigration without looking at all the benefits. Immigrants are often willing and from what I've observed do a fantastic job of, performing jobs many in our society don't want so the tax monye they pay goes INTO the medicaid fund. And my personal belief is that any person working that pays into the system has a right to use it when it is necessary. It's simply the humane thing to do. Second, my quest to become a physician has been made much easier by a mexican immigrant nanny I occasionally share with a divorced Mom.

As for the language issue the way I see it, with the except of most slaves, we are ALL decendants of immigrants and so the language we should ALL be speaking is one of those that represents any of the Native American togues that were spoken here before their land was stolen/purchased at a ridiculously cheap price. I think it's just time to learn to speak spanish (which I can already do a little).

Yes, immigrants make minimal money now, but I imagine that in a generation of 2, they will eventually catch up. With few exceptions many immigrants that came through Ellis Island had nothing but the shirts off thier backs and they managed to within a generation or two, begin to prosper finanically. I have absolutely no reason to believe that current immigrants, if given citizenship will more the "make up" for whatver drain they have caused on the healthcare system.

I think it's great that you're so idealistic and optimistic...

That said, in my ideal world, I'd have the time to learn Spanish... but frankly, it's just one of a hundred things on my list of things to do... and with 2 kids, job, etc, I just don't have the time, so I'll just have to deal with that myself. I don't think it should be necessary that we all need to learn spanish. (it'd be nice, but we shouldn't expect it)

And obviously, I know that this issue doesn't just affect the medical side... I just wanted us to focus on that aspect since the topic in itself is so broad and affects every part of our lives.

I do think that if we're going to allow everyone to stay whether they're legal or not... and they are in the lowest paying jobs... their options for healthcare are limited; do we need to start going ahead and offering them preventive care, routine check-ups, etc... so that we don't face more cost by their trips to the ER, chronic diseases in the future, etc?

I think like most Americans, I'm kinda in the middle on this topic. Obviously, illegal immigrants contribute a lot to our society... whether it evens out all the negative impact, I honestly don't know.

Do illegal immigrants really pay taxes? I thought they were paid under the table because no Social Security number, etc.

Introducing arguements with these types of statements imply a lack of sense of what the true issues are in having with this discussion (there seems to be geenral theme here on mommd that premeds don't know anything :rolleyes: ). At almost 40 years old, I can assure that my arguements derive not from a naivete about how the real world works but primarily from the position of caring about the well being of others. Moreover, the consequesnces of not responding to the basic health care needs of a portion of our population often results on a bigger impact on the healthcare system than would normally have been seen.

There are many, many articles on the internet discussing the fact the illegeal immigrants DO pay taxes. Here's one from CBS online:

http://www.cbsnews.com/stories/2003/04/14/politics/main549153.shtml

Even with fake SSN's, they pay taxes.
The fact that many americans don't realize that the majority of illegeal immigrants pay taxes is part of a larger scheme to drum up support for their exclusion from society. But I say how can you exclude a group of people who are already here AND in great numbers?

So perhaps the answer for those who live in states that border the entryways of illigeal immigrants is to 1) Impress upon the politicians in states that border Mexico (since people don't seem to be complaining about immigrants form here than other places :rolleyes: ) to do more to secure the borders 2) Require that in border states, physicians be required to speak spanish in much the same way as board certification is required 3) Offer immigrants preventative services, routine check-ups ect for reasons mentioned above. 4) Develop programs for the admisison of mexican/spanish speaking students into med school with the requirements that they complete residencies/work/practice in states like Texas for a few years. 5) Require the IRS send a large portion of the money they collect in taxes back to those states with high numbers of illegal immigrants,like Texas and California. This one is HUGE.

The solution to this problem won't be easy and will require compromise from EVERYONE in some form or another, but with some compassion for the health and well being of others being the driving force, a viable one can be implemented.

Truly a can of worms, but I have to add my two cents. Illegal immigrants do, indeed put an undue burden on an already overtaxed healthcare system. Sure, some immigrants do pay taxes by obtaining a fake social security number, but most do not want to risk the chance of discovery and deportation (personal experience in the agriculture and construction industry). What the burden from illegal immigrants vs hard working legal Americans without healthcare is, I do not know, but I imagine they are about equal? This presents two problems for legislators: 1)Healthcare reform and 2)illegal immigrants. Which, leads us to this discussion. Certainly, we cannot turn an individual away if they are legal or illegal, as we have an obligation to the public to provide equal access to healthcare, but at what cost are we doing so.
I spent several years in a rural clinic, that had a moderate illegal patient base. The patients, who came to the clinic, payed their bills better than some Americans. Even in the workman's comp clinic, employers of the illegal immigrants were (mostly)very good about paying for procedures. The problem arises with hospital stays, surgical procedures, etc. This is where the healthcare field, really feels the crunch. Sure, alot can be written off, but that just helps with the hospitals tax burden, not actually paying staff. Another problem, too, is illegals often do not seek medical attention, until they have reached an advanced stage of their disease, making it more expensive and difficult to treat. I hate to be so wishy washy, but the reality seems to be this way. There is good and bad in everything.
One important thing to remember here as well, is that our country is at war with terrorism (whether you agree with it or not) security is at issue. If you look at our country during times of war, specifically world war II, when our country packed up the Japanese (legal and illegal) as they were seen as a security threat. I agree that as physicians, patients cannot be treated with any sort of prejudice, but in an era, where we (VA hospital) routinely undergo disaster training and drills, it is difficult not to be aware of the security threat. (Mexico and Canada are huge and easily penetrate borders). I am in no way implying that the Mexicans will somehow aid the radical Muslim groups, who so dislike western culture, but just saying it is something to think about.

It would appear to me that the biggest threat to American Security is Americans. Oklahoma City is the one case that comes to mind and the attacks on the pentagon/world trade center may have very well been prevented had WE paid a little more attention to what was going on in the world. Remember, the uS has a chance to apprehend Osama years before the attack on the pentagon/world trade center.

And the rounding up of the Japaneses was simply an imhumane thing to do which is probably why they received financial reparations for their trouble. However, since the Japanese are used in this example,can anyone deny the great contributions they have made, particularly in medicine and science to this country?
This is the same thing I hear about "legal" minorities like Blacks and Hispanics and this would be a could place for a focus on preventative services. But more than that, we have to train profesinals to go into these communities and speak about healthcare. Here is where having more Black/Hispanic matriculants into med school could make a HUGE difference.

Bottom line is that healthcare is GOING to feel the crunch no matter what. We have a choice to continue to go on the defensive like we always are when it comes to solving problems of national importance, or we can for the first time be offensive and develop the type of programs which will lead to better healthcare options and health for EVERYONE who lives here.

This isn't just an issue of illegeal immigrants impact on healthcare costs but of the poor poeple as well who live in this country and don't have/can't afford decent healthcare.

Honestly all it takes is the outbreak of one incurable disease (like bird flu) among a poor population of people for ALL of us to get our acts together and develop a sound means of dealing with the healthcare problem in the US. An immigrant that comes down with Bird Flu or any other incurable infectious disease is going to end up in the SAME ER you're in when you visit after your son breaks his arm. My question is, how many people have to die needlessly before a specific course of action is implemented? We may not "care" too much now about illgeals having poor healthcare options but it's just a matter of time before thier healthcare problem becomes ours in more ways than we are prepared to deal with.

"pathdr2b"... I respect your opinion and idealism... but come on... asking that border states need to require their physicians to learn spanish... come on, we have enough hurdles to go through as it is. And med schools do try hard to recruit minorities... unfortunately, in Texas, there was a lawsuit several years ago which found affirmative action illegal and since then, the number of minorities in med school has dropped.
I'm curious what your current situation is right now? Are you still in med school, in practice? Actively seeing patients. I think it's one thing to make statements when you're not in the day to day of dealing with these things...but experience does change people's perspectives. I think most of us who entered into medicine went into it with all your idealism... and we can't be judged for losing some of that idealism after we see what the reality is... there is no simple answer... and no matter how many complaints there are about our healthcare system, I wouldn't trade it for any other country's... a lot of countries won't even treat you in an emergency unless you have money. We are a very compassionate country in that in times of emergencies, etc... we do treat and ask for money later (which often is not even collected). There are a lot of disparities in healthcare... but that's a whole another topic.

Ok, here we go again. Why is it that the docs THIS site and women not surprisingly :rolleyes: ALWAYS pull this premeds don't know jack ****, stuff ANYTIME there's a debate about medicine??? Well guess what, medicine is about a hellva lot more than PRACTICING but then again LIFE in most ANY career is more than about the career itself. And you think I'm naive? Anyone who has had a demanding a career (Ohh, and docs aren't the only ones with demanding careers either :rolleyes: ) knows this much. The strategy I set out for resolving this immigrant impact on health problem (where's yours, BTW) was about how anyone and everyone who is being impacted by then can do their part. FYI, I've been an ADMINISTRATOR of a state public heath program in a state with a LOT (Florida) of immigrants so my "opinion" aren't just being pulled arbitrarily out of my arse! Have you ever administered a state public health program? But it's funny once again that since I'm not an MD, my comments about this point aren't valid.

The word I am is REALISTIC about medicine and it seems to me that the people who complain the most about it are those who weren't "real" when their journeys began. I'm quite realistic about medicine. Having more than 2 natural kids and trying to be a doc won't work for me. Doing an internship year won't work for me. Working as a part-time Doc isn't going to work for me since I'd like to become an expert in my field before I'm 90. Marrying a doc wouldn't have worked for me because SOMEONE has to have a schedule flexible to fill in when I can't be there and that will happen a LOT. Working in Texas or California wouldn't work for me because my Spanish is way too rusty even though they say once you speak the language fluently (which I learned to do when I lived in Fla ) you get it right back. Working in rural medicine wouldn't work for me because I value personal time with my family and wouldn't want to have to explain scripts to a patient while I was there picking up my own. Becoming a Family Practitioner wouldn't work for me because I don't like the idea of having a career where I know a little about a lot and prefer instead to know a LOT about one particular field. Becoming a pediatrician wouldn't work for me because quite frankly I'm desperately trying to avoid specialities with lots of OTHER women. And men don't bitch nearly as much as women :rolleyes: Being in a primary care field wouldn't work for me because I like having a reasonably set beginning and ending to my work day and NO call. Being a surgeon wouldn't work for me because I have bad back despite having effectively sliced and diced many a lab rat in my day (translation, I have great hands for surgery).

So as you can see, I've spent a Lot of time thinking about medicine and working around docs where luckily for me, I feel that I've been given the TRUTH about the practice of a field that is bound to change probably more than any of us could imagine today. And what today's premed needs to think about when she decides on medicine that what's UNREALISTIC are many of the complaints/demands many young female doctors want today. There is NO "having it all" at the same time, and in the same "quantity"!!! If you want to have a say in your schedule while working with patients, nursing is a great option. But I'd also like female premeds to consider the advantages of being highly adaptable to change without stubbornly and childishly
"stopping their feet" when they don't get their way. That, and seeing the glass as half-full doesn't hurt much either.

I presented a strategy for how your original question could be addressed. Perhaps it's best to refrain from further discussion (and insults to if you don't mind) until you present one yourself.

I'm a person who thinks 25 should be the minimum age at matriculation into med school, so perhas my response to this comment is moot. It's not a matter of being judged for being idealistic as you call it, to me it's about the idea that you have to "sleep in the bed you made for youself". The fact is that too many people go into medicine for all the wrong reasons then wonder why their unhappy? Well duh! Many times on this site, docs say that people tried to warn them abou tthe pitfalls of certain specialities well guess what? I'm one whose actually LISTENING when people with more experience in a specific area talk to me/post messages. I have yet to meet an unhappy pathologist and they ALL have families so besides my strong interest in this field (complete with home microscope and being good on the ol' back)) choosing this field NOW seems like a no brainer to me. Irronically, I don't know a single person in their 30's or older(aka oldpremeds website) who decided to pursue medicine and is now unhappy with their decision.

In my mind it's too easy to "see the reality" of medicine BEFORE you matriculate and I'm not talking about theose "fluffY' volunteer health expereinces you guys put on your med school applications. Wanna know what it's like to treat poor patients? Then "sashey" yourself down to the local homeless shelter or public health clinic. Want to know what It's like to be a surgeon or OB/Gyn? Shadow one on call for 36 hours or better yet, don't shadow but meet with them for coffee AFTER such a 36 hour shift.
Do these types of experiences replace the actual practice of medicine? Of course not,but for those who are willing to LISTEN, they are valuable expriences that can easily be used to make smarter career decisions in the future.

I'm curious, what exactly did you think practicing medicine (I'm assuming you're in a primary care field) in an area of Texas near the border would be like? I've been to Texas once (last year in San Antonio for a meeting) and what was painfully clear to me during that one week I was there was that IF I were planning on living in Texas as a Physician, speaking spanish fluently would not only be a great help to me personally but professionally as well. And accoring to 2 friends, one who is an MD/PhD and the other a PharmD both living in Texas, speaking the language gives you an advantage when negotiong a salary as well!

So in my mind, at some point you have to either say to yourself that I made a wrong decision somewhere, with speciality choice or in choosing where to live, ect or that I was too stubborn to listen when people were giving me advice. But what I don't think ANYONE can fairly do is blame ANY career for their unhappiness because ultimately we make CHOICES. Happiness or the lack thereof, begins and ends with YOU and you cart it around no matter what career you choose.

OK, i'll get off my "don't worry, be happy" soapbox now!