Creating a global medical labor force; or, the trouble with standardizing human capital

Abstract Since the mid-twentieth century, foreign-physician migration to the United States has challenged mainstream medicine. Facing simultaneous demands to address physician shortages and concerns about the quality of foreign-trained doctors, regulators struggled to create effective systems for evaluating international credentials. This essay traces three pivotal episodes reflecting the evolution of this regulatory landscape: the postwar incorporation of Jewish émigré doctors, the rise of Asian physician migration following the Hart-Celler Immigration and Nationality Act of 1965, and the contemporary role of global regulatory entities. Over the past sixty years, as physician migration from the global South has increased, the regulatory apparatuses to facilitate this mobility have grown in scale, size and number. The multiplication of these supranational bureaucracies and institutions is not a value-neutral endeavour. It reflects racialized assumptions coded through ‘competence’ discourses, geopolitical investments and a bias toward global North educational models, and raises broader questions about global health care equity. Despite these overlapping and sometimes redundant global-governance structures, however, foreign-physician integration continues to raise questions about trust, equivalency and the variability of human capital.