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.

DR. KATE TULENKO is a physician with degrees from Harvard University, Cambridge University, and the Johns Hopkins School of Medicine. The former coordinator of the World Bank’s Africa Health Workforce Program, she currently serves as director of clinical services for a global health nonprofit and resides in Washington, D.C.