The care of foreigners: a history of South Asian physicians in the United States, 1965-2016

This project explores the enduring consequences of postcolonial physician migration to the United States initiated during the Cold War. By examining local and global circuits of medical labor, I show how the intimate spaces of healthcare were influenced by liberal economic policies and ideological shifts to multiculturalism. Using oral histories, popular media, archival sources, and an ethnography of archiving, this project analyzes the ambiguous directionality of “care” attending to both the care provided by foreigners as well as the care extended to foreigners. Under the Hart-Celler Immigration and Nationality Act of 1965, the United States began to solicit the care of Foreign Medical Graduates (FMGs) largely from postcolonial Asian nations. FMGs were granted permanent residency or US citizenship in exchange for medical service in marginalized communities. Although this arrangement was conceived as a temporary solution, in the last fifty years, it has become a permanent fix with foreign physicians comprising a quarter of the physician labor force. This understudied contingent has become the numerical supplement built into the system, the global reserve labor force instrumentalized as a response to doctor shortages in inner city and rural communities. Their presence has deferred substantive structural improvements allowing organized medicine and the state to maintain a two-tier system of healthcare delivery. Although the foreign physician was invited into the nation, the care provided by foreigners was received as different, an imperfect facsimile of their US counterparts. When care passed from the foreigner to the patient, there were confrontations because FMGs complicated normative constructs of physician expertise and authority. Over time, as familiarity with foreign physicians increased, the South Asian physician has notably disaggregated from the larger foreign physician group to emerge as a recognizable commodified cultural form. This is particularly significant today when the rhetorical threat of foreignness is used to incite terror. The South Asian physician is absolved from this homogenizing discourse as a result of the morality inhered in care work in addition to their socioeconomic position. This has mitigated their foreignness allowing a migration to the spaces of popular mass media where they are tolerated as fixed multicultural representations.