Sunday, August 26, 2007

A profession that doesn't look like America

Some people may wonder why I have described myself, a white male conservative Christian, as a vanishing breed in the world of American medicine. "Oh, cry me a river," I can hear the left saying. "Everybody knows that doctors are a bunch of conservative hoary old coots!" Even those of the conservative persuasion may be puzzled. The image of the kindly, gentlemanly white male doctor still pervades the consciousness of our society. Yet in this as in so many other things, popular perception lags behind reality.

Unfortunately, historical data on the demographics of medical students is hard to find. It may be that no one was keeping track of the race and sex distribution of medical students prior to about 1980. But let's make do with what we can. Consider a hypothetical doctor on the verge of retirement. If he turned 65 years old today, he was born in 1942, and thus most likely started medical school around 1964. At that time, more than 93% of American medical school graduates were men. While racial data was hard to find, I figured from this table published in 1990 that in our hypothetical physician's age group (45-54 at the time), more than 75% of physicians were non-Hispanic white, so we can reasonably extrapolate that this same demographic datum applied to his fellow medical students when he was in school. Furthermore, we know that in the years prior to 1965, when the infamous immigration bill was passed that was responsible for the ongoing transformation of America into a multicultural society, our nation was 89% white. So our 65 year old doctor was a white medical student in a white world.

Some people might not know, however, how drastically the profession is changing. Fortunately, the American Association of Medical Colleges (AAMC) has collected all sorts of demographic data about medical students for the past 15-20 years, so it's much easier to look at what's happening now. First of all, there has been a massive influx of women into the field: 2003 made headlines as the first year in which more women applied to medical school than men (though still ever so slightly more men were accepted) and for several years now the ratio of male to female matriculants has appeared to asymptotically approach 50-50. While the implications of this are important, I'd like to confine a discussion of them to its own post and focus on the racial changes here.

In 2006, 61% of medical school matriculants were non-Hispanic white. 7% were black, 7% were Hispanic of any race, and 19% were Asian.* This is something that varies greatly by school. In many Southern and Midwestern state schools, the number of whites still dwarfs the number of Asians, but at East and West coast private schools, Asian students are admitted in numbers greatly out of proportion to their numbers in the general population, and at some California schools Asians outnumber whites. (At my own school, a fairly high-ranking private school, only 53% of this year's class is white while 30% are Asian. Interestingly, this means that the much-maligned and dreaded white males comprise less than 30% of our class.)

Now, everyone knows that for a long time, affirmative action was said to be necessary because "minorities" were at a historic disadvantage in America and needed a special boost in university admissions and job hiring to bring their average levels of education and representation in various professions up to their proportion of the general population. Originally, when we spoke of "minorities" in this sense we almost always meant blacks, though I suppose American Indians and non-white Hispanics may have been included under the banner as well. A funny thing happened on the way to equality, however. After the aforementioned 1965 immigration bill, we began admitting large numbers of Asian immigrants, who as a group have average IQs higher than not only blacks but whites as well. These high-IQ Asians naturally began rising to the top of our society, being admitted to prestigious universities and entering the "cognitive elite" professions in proportions vastly greater than their share of the general population. Suddenly, the word "minority" by itself was no longer useful to describe the groups supposedly needing affirmative action, since these Asians were and still are a minority. Hence, the name of the game these days in medical school admissions is "underrepresented minority," or URM.

The usual justification for affirmative action for URMs is that patients are better treated by physicians who are like them. White physicians, it is said, cannot understand blacks as well as blacks can, and black patients are less likely to feel comfortable with or confide in a white physician compared to a black one. The same is said to hold true for Hispanic patients. Therefore, just as Bill Clinton wanted to create a cabinet that "looks like America," we need to increase the number of URMs to serve the needs of society. But wait--whites are still 67% of the US population, but only 61% of last year's medical school matriculants. Who will meet the needs of that remaining 6% of the population? If black people need black physicians rather than white ones, don't white people need white physicians rather than Indian ones? By the liberals' logic, shouldn't we place some limits on the number of Asians and start practicing affirmative action for whites?

Maybe not. For one thing, large numbers of Asians increase "diversity," by which the left really means non-whiteness, and thus are just as useful as any other race in achieving the leftist goal of turning whites into a minority in our own country. But more significantly, America itself increasingly no longer looks like America. It's troubling enough that we've gone from 89% white in 1965 to only about 2/3 white in the early 2000's. Even worse, however, was the report earlier this year that only 55% of children under age 5 in America are white. So maybe we don't need more white doctors to serve the needs of the "white community." If whites become a minority in America, as we are on track to do unless we wake up, get off our duffs, and enact a moratorium on non-Western immigration soon, even 61% will be too high a proportion of white doctors. The only question that will remain is where we will get all of the Hispanic doctors needed to serve the needs of the swelling "Hispanic community", since most of the Mestizo peasants currently "immigrating" here, with their average IQ of 90, generally don't have a level of intelligence that is considered acceptable to make a good physician.

It doesn't end there, however. So far I have been speaking only of people admitted to and graduating from American medical schools. However, after medical school, in order to be licensed to practice medicine, one must complete a 1-year internship, and while this was not true 50 years ago, nowadays one must become board-certified by completing a full residency in order to realistically make a living as a doctor, since no hospital will bring a non-board-certified physician on staff nor will insurance companies reimburse for services provided by non-board-certified physicians. These residency programs, which exist at teaching hospitals across the country, are funded by Medicare and, unlike the number of slots available in medical schools, their numbers are not controlled by the AAMC. In 2007, 15206 US medical school seniors applied for residency positions, of which there were 21845 available. How did the remaining 6639 residency positions get themselves filled, you ask? Foreign medical graduates, who represent an ever-increasing share of the US physician workforce.

I'm sure I don't need to tell you that most of these foreign medical graduates don't come from Western Europe, Canada, and Australia. While some do, a great many are from South Asia and Eastern Europe. They tend to occupy the residency positions that American medical students find undesirable, like primary care fields and programs at community (as opposed to university) hospitals. My uncle, a private practice physician, told me recently of a patient satisfaction survey conducted by the community hospital where he is on staff. He said he suspected that a significant amount of the dissatisfaction patients expressed with the resident physicians could be attributed to their foreignness. "I mean, we've got guys wearing turbans, " he said. "Imagine you're a 75-year-old woman who's lived all her life in Jamison. The only place you've ever seen someone like that is on the evening news!" Yes, some of them really do wear turbans. Suffice it to say that they don't represent the "white community," or the black or Hispanic communities for that matter, very well. I don't think they have much "cultural competence," either. 30 years from now, when you need a primary care doctor, it may not only not be possible to find a white one--it may not even be possible to find an American-born one.

America is currently sick, with a disease called liberalism. Even though most Americans are still at a point where they are afraid to say it, America doesn't look like itself. Still, like many sick patients, it can get better. However, this cure is not going to come from doctors, who have been infected with liberalism themselves. What is needed is a behavioral approach rather than a biomedical one. The patient will need to find his own motivation, and to make some serious lifestyle changes, just as an overweight person who knows he is at risk for heart disease might go on a diet and start exercising. We as Americans can take this patient-centered approach and be cured if we really want to. Medicine and other institutions which represent only small segments of America can't cause top-down change; it has to come from the bottom up. Once we have set ourselves down the right path, medicine, as well as all of our other societal institutions, won't be able to help but follow.

*It's important to note that many demographic surveys don't make a distinction between Orientals and South Asians; thus, the term Asian encompasses Orientals, Indians, Pakistanis, etc. From purely anecdotal observation I'd say that the number of Indian students at my school is equal to if not greater than the number of Orientals.


American Cassandra said...

Your post made me think of something I've been reflecting on for awhile: the results of our attack on white people take a long time to materialize. Here we have whites, barely a majority of the young, losing demographic status RAPIDLY. And yet, people still have the perception that white people are the powerful majority that runs everything? Why? Because authority is not vested in the young, it's vested in the older generations. It is still the pre-demographic change generation that is in charge, and they are still largely white and able to run things just as before.

So, people look at America, and they say, all these minorities don't change our basic character, the percentage of whites has gone way down faster than the rate at which society has changed. They don't believe that a non white society will operate differently from a white society because it has become much less white without operating too differently yet. Take California. It hasn't fallen apart yet, and whites are a minority. But the future looks dim. If you look at the test scores of the current high school and elementary school generation, you simply cannot imagine them creating a large enough professional class to maintain California as the kind of society it was. But since they are just high schoolers now, they aren't being called upon to do those white collar jobs yet, and so we don't miss them yet.

I used to think it was very strange that people could tell me with a straight face that they don't see how massive immigration will change their lives, but now I do. The change doesn't happen as fast as the immigration. Or, too put it in terms of "looking like America": America is able to give the false appearance of being America even when it isn't America anymore.
That is why I am afraid we won't wake up until it is too late. Because of the time lag. It's very sad.

But despair really won't help.

Rick Darby said...

One of the pernicious effects of affirmative action is that when you see someone in a professional capacity who belongs to an ethnic group not often represented there, you wonder: is this person there because of favoritism?

Many people would deny that such a thought ever crosses their minds, I'm sure. I don't believe them.

Say you are boarding an airliner and you look into the flight deck. On the left, the captain is a black man. On the right, the first officer is a woman.

You are about to undergo surgery to remove a patch of brain cell cancer. You are introduced to the surgeon. He is a West Indian and wears a turban.

Practically everyone, including good liberals, will feel a twinge of doubt. Of course the liberal will quickly put the doubt out of mind. It's unworthy.

Concerns like those may well be mistaken in any given case. The pilots may be top ten-percenters. The surgeon may be uncommonly skilled. But the concern is not prejudiced, not in a society where reverse discrimination is openly sanctioned.

Those who are supposedly helped by affirmative action can be among its victims, because they can never completely erase the suspicion that they got their position because of their race or sex.

Hermes said...

Cassandra, that is a good point, and I have often had the same thoughts. I try to remain optimistic, but I fear that the lag between demographic changes and their full effects on society is so great that people won't wake up until it's too late. This has also caused me to speculate that Europe might wake up before America: Europe is out of space, whereas we have so much undeveloped land that people can just keep "white-flying," creating these exurban enclaves, until long after America becomes minority-white.

Your point about California is an interesting one. Certainly so many Mestizos are unlikely to be able to maintain a first-world California. But doesn't California also have huge numbers of Asians? Not that I support Asian immigration, since they don't maintain our Western heritage any more than Mestizos do, but they are highly intelligent and seem to excel at white-collar work. I mean, look at Japan and South Korea. They're not 1950s Iowa, but they're certainly not Tijuana either.

Rick, that is precisely what I think every time I see a black or non-white Hispanic doctor--is he only here because of affirmative action? And believe it or not, one might wonder the same thing about female doctors. While most women accepted to medical school are qualified, women on average score lower on the MCAT (the entrace exam) than men, and there is much sentiment that women make better doctors because they're more caring and sensitive, so you have to wonder if a female doctor was admitted to med school for that reason despite slightly lower scores than a man.

However, we know that Asians are NOT affirmative action admits--if anything, affirmative action works against them, like whites. They are extremely intelligent and high-achieving. This is why I think Asian immigration is something other conservatives and traditionalists don't talk about enough. By admitting so many Asians into the USA we are giving away the upper echelons of our society to foreigners, and economic arguments, crime-based arguments, anti-affirmative action arguments, or any of the typical arguments used against other immigrant groups don't work against this, because on average Asians are intelligent, hard-working, and well-behaved.

Anonymous said...

As an Asian med professional, I can relate to your note. I am actually surprised that there are still over 60% white students in the schools. Medicine is the most preferred route in Asian families to a safe, upper class lifestyle and high respect in society too. So even if the Asian population is small, there is intense pressure to enter the field and that makes for the numbers you cite.

This is similar to what larry Summers, former pres of Harvard, said a few years back when asked why intensely competitive professions tend to be dominated by certain races or gender. Far from the mean, small differences in aptitude and motivation can amount to a huge difference in success, whether in medicine or the NBA.