The Care of Foreigners

Why did South Asian physicians become essential to US health care starting in 1965?

For more than 60 years, the United States has trained fewer physicians than it needs, relying instead on the economically expedient option of soliciting immigrant physicians trained at the expense of other countries. In The Care of Foreigners, Eram Alam examines this migratory dynamic that began during the Cold War.

The passage of the Hart–Celler Immigration and Nationality Act of 1965 expedited the entry of foreign medical graduates (FMGs) from postcolonial South Asia and sent them to provide care in shortage areas throughout the United States. Although this arrangement was conceived as temporary, over the decades it has become a permanent fixture of the medical system, with FMGs comprising at least a quarter of the physician labor force since the act became law. This cohort of practitioners has not been extensively studied, rendering the impacts of immigration and foreign policy on the everyday mechanics of US health care obscure. Alam foregrounds global dynamics embedded in the medical system to ask how and why Asian physicians—and especially practitioners from South Asia—have become integral to US medical practice and ubiquitous in the US public imaginary.

Drawing on transcripts of congressional hearings, medical, scientific, and social scientific literature, ethnographies, oral histories, and popular media, Alam explores the enduring consequences of postcolonial physician migration. Combining theoretical and methodological insights from a range of disciplines, this book analyzes both the care provided by immigrant physicians as well as the care extended to them as foreigners.