Dramatically recounts the causes and cascading effects of American insourcing of foreign healthcare workers

For years, opponents of outsourcing have argued that offshoring American jobs destroys our local industries, lays waste to American job creation, and gives foreigners the good jobs and income that would otherwise remain on our shores. Yet few Americans realize that a parallel dynamic is occurring in the healthcare sector—previously one of the most consistent sources of stable, dependable living-wage jobs in the entire nation.

Instead of outsourcing high-paying jobs overseas—as the manufacturing and service sectors do—hospitals and other healthcare companies insource healthcare labor from developing countries, giving the jobs to people who are willing to accept lower pay and worse working conditions than U.S. healthcare workers. As Dr. Tulenko shows, insourcing has caused tens of thousands of high-paying local jobs in the healthcare sector to effectively vanish from the reach of U.S. citizens, weakened the healthcare systems of developing nations, and constricted the U.S. health professional education system. She warns Americans about what she’s seeing—a stunning story they’re scarcely aware of, which impacts all of us directly and measurably—and describes how to create better American health professional education, more high-paying healthcare jobs, and improved health for the poor in the developing world.

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Reviews / Endorsements

“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. . . . Those interested in healthcare management or public policy will find plenty of cogent information in this well-researched treatise.”—Publishers Weekly

“Tulenko proposes some strategies the U.S should consider as it revamps its healthcare system. Strengthening training facilities for health workers, especially in rural areas would not only produce more workers but also support development of minority groups. One doctor from India accounts for only 0.0001 percent of its physicians but recruiting a physician from Liberia denies it one percent of its physicians. So becoming more cognizant of where the health workers are being imported from could go a long way in enabling poor countries to serve its people better.”—Smisha Agarwal, Huffington Post

“Tulenko provides a thought provoking story on how and why the US is making the global workforce crisis even worse and what should be done about it now. This compelling book is a must read for all those who work in or care about global health.”—Richard Scheffler, director, Global Center for Health Economics, UC Berkeley, and author of Is There a Doctor in the House? Market Signals and Tomorrow’s Supply of Doctors

“This is an important and timely book which throws down a challenge to policy makers and planners in the US and other rich countries. It comes at a time when power is shifting globally and relations between countries are changing and is a valuable contribution to global debate and policymaking.”—Lord Nigel Crisp, former NHS Chief Executive and Permanent Secretary of the UK Department of Health

“In an increasingly inter-connected world, Dr. Tulenko offers a powerful barometer for looking into the root causes of the US domestic health care workforce woes and their direct impact on the global health worker shortage. This compelling testimonial is a must read for global health practitioners, students and international development champions looking for long lasting solutions for strengthening health systems worldwide.”—Pape Gaye, president and CEO, IntraHealth International

“An important book for those who wish to tackle the root cause of inequity within U.S. health care. Tulenko takes a deep look inside the health professions establishment, and illuminates core elements of the system that contribute to widening economic, racial, and geographic health disparities. What she finds is often that the underserved are often doubly disadvantaged by the narrow health workforce pipeline — their intellectual capital tossed aside on one end, while they are often the victims of errors caused by workforce shortages at the other.”
—Jennifer Ng'andu, Director of National Council of La Raza's Health Policy Project