April 1, 2023

Path to United States Practice Is Long Slog to Foreign Doctors

The involved testing process and often duplicative training these doctors must go through are intended to make sure they meet this country’s high quality standards, which American medical industry groups say are unmatched elsewhere in the world. Some development experts are also loath to make it too easy for foreign doctors to practice here because of the risk of a “brain drain” abroad.

But many foreign physicians and their advocates argue that the process is unnecessarily restrictive and time-consuming, particularly since America’s need for doctors will expand sharply in a few short months under President Obama’s health care law. They point out that medical services cost far more in the United States than elsewhere in the world, in part because of such restrictions.

The United States already faces a shortage of physicians in many parts of the country, especially in specialties where foreign-trained physicians are most likely to practice, like primary care. And that shortage is going to get exponentially worse, studies predict, when the health care law insures millions more Americans starting in 2014.

The new health care law only modestly increases the supply of homegrown primary care doctors, not nearly enough to account for the shortfall, and even that tiny bump is still a few years away because it takes so long to train new doctors. Immigrant advocates and some economists point out that the medical labor force could grow much faster if the country tapped the underused skills of the foreign-trained physicians who are already here but are not allowed to practice. Canada, by contrast, has made efforts to recognize more high-quality training programs done abroad.

“It doesn’t cost the taxpayers a penny because these doctors come fully trained,” said Nyapati Raghu Rao, the Indian-born chairman of psychiatry at Nassau University Medical Center and a past chairman of the American Medical Association’s international medical graduates governing council. “It is doubtful that the U.S. can respond to the massive shortages without the participation of international medical graduates. But we’re basically ignoring them in this discussion and I don’t know why that is.”

Consider Sajith Abeyawickrama, 37, who was a celebrated anesthesiologist in his native Sri Lanka. But here in the United States, where he came in 2010 to marry, he cannot practice medicine.

Instead of working as a doctor himself, he has held a series of jobs in the medical industry, including an unpaid position where he entered patient data into a hospital’s electronic medical records system, and, more recently, a paid position teaching a test prep course for students trying to become licensed doctors themselves.

For years the United States has been training too few doctors to meet its own needs, in part because of industry-set limits on the number of medical school slots available. Today about one in four physicians practicing in the United States were trained abroad, a figure that includes a substantial number of American citizens who could not get into medical school at home and studied in places like the Caribbean.

But immigrant doctors, no matter how experienced and well trained, must run a long, costly and confusing gantlet before they can actually practice here.

The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training).

The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck.

That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.

The whole process can consume upward of a decade — for those lucky few who make it through.

Article source: http://www.nytimes.com/2013/08/12/business/economy/long-slog-for-foreign-doctors-to-practice-in-us.html?partner=rss&emc=rss

Netflix Revenue Tops $1 Billion for the Quarter

The results were well within the company’s projections, but investors — who had made Netflix the best-performing stock in Standard Poor’s 500-stock index this year — were hoping for more, sending the stock down more than 7 percent in after-hours trading.

Looking ahead, Netflix projected that it would add another 1.1 million subscribers in the United States in the third quarter, continuing a growth trajectory that has made it one of the most closely tracked companies in the media and technology industries.

In the second quarter, the company’s revenue topped $1 billion for only the second time ever, totaling $1.07 billion, in line with analysts’ expectations. It reported earnings of 49 cents a share, beating the consensus expectations of 40 cents a share. It returned to positive cash flow for the first time in a year, because of a one-time decline in payments to content providers and overall profit growth.

Outside the United States, Netflix added 610,000 streaming subscribers in markets like Britain and Brazil. The international business continued to operate at a loss, but it was lower than expected in the quarter.

“We are thrilled to be pleasing more members than ever,” the Netflix chief executive, Reed Hastings, and its chief financial officer, David Wells, wrote in a quarterly letter to investors.

Mr. Hastings and Mr. Wells attributed some of the second-quarter subscriber gains in the United States to its late-May revival of “Arrested Development.” “This show already had a strong brand and fan base, generating a small but noticeable bump in membership when we released it,” they wrote.

But they cautioned investors not to expect a similar bump from other new shows, like “Orange Is the New Black,” which came onto the service earlier this month. “Other great shows don’t have that noticeable effect in their first season because they are less established,” they wrote.

Last week, Netflix gained widespread attention for its first-ever Primetime Emmy nominations, led by the Washington drama “House of Cards,” which is in the running for nine Emmys. Over all, however, original shows like “House of Cards” remain just a sliver of subscribers’ viewing; TV shows and films that have already had their premieres elsewhere “accounts for the bulk of viewing and leads to a lot of member enjoyment,” Mr. Hastings and Mr. Wells wrote. They cited a revealing statistic on Monday: three-fourths of the hours streamed on Netflix are spurred by the algorithms that recommend specific shows and movies based on the subscriber’s past viewing.

In a hint of the company’s plans for more original programming, Mr. Hastings and Mr. Wells said they would be expanding to “include broadly appealing feature documentaries and stand-up comedy specials.”

Before the earnings announcement, Netflix stock closed down $2.62 at $261.96. A year ago, it was hovering below $100.

“The stock’s meteoric rise to-date reflects management’s traction in repairing the brand, following the 2011 fiasco, but further momentum in the stock will have to be supported by better 2Q results and higher guidance,” Youssef Squali, an analyst for Cantor Fitzgerald, wrote in a note to investors before the earnings announcement.

Article source: http://www.nytimes.com/2013/07/23/business/media/netflix-revenue-tops-1-billion-for-the-quarter.html?partner=rss&emc=rss

DealBook: Sprint Reaches Deal to Buy Out Clearwire

Clearwire demonstrated its 4G modem, which uses cell signals for wireless broadband, in Las Vegas in 2009.Warren Mell/ClearwireClearwire demonstrated its 4G modem, which uses cell signals for wireless broadband, in Las Vegas in 2009.

Sprint announced on Monday that it had reached an agreement to buy the nearly 50 percent stake in Clearwire that it did not already own for $2.97 a share — a bump up from the $2.90 a share that was offered on Thursday.

The improved $2.2 billion offer, Sprint said, represents a premium of 128 percent over Clearwire’s stock price in early October before speculation emerged — following SoftBank‘s investment in Sprint — that Sprint would seek to buy out the wireless network operator.

Sprint already owns 51.7 percent of Clearwire. Buying the rest would give it full control over spectrum that it could use to build out its network.

Related Links

Sprint is able to complete the deal thanks to cash from SoftBank of Japan, which agreed in October to a $20.1 billion transaction to gain majority control of the American telecommunications company, which lags far behind the market leaders, ATT and Verizon Wireless.

The deal would allow Sprint to expand its Long-Term Evolution network, which is based upon the same data standard used by the newest generation of smartphones. Clearwire owns spectrum that is similar to what SoftBank uses in Japan, potentially giving the newly strengthened Sprint more clout in ordering the latest devices.

The chief executive of Sprint, Dan Hesse, said in a statement: “Today’s transaction marks yet another significant step in Sprint’s improved competitive position and ability to offer customers better products, more choices and better services. Sprint is uniquely positioned to maximize the value of Clearwire’s spectrum and efficiently deploy it to increase Sprint’s network capacity.”

A Sprint store in Manhattan.Brendan McDermid/ReutersA Sprint store in Manhattan.

SoftBank added in a statement that it supports the deal, which it believes will improve the landscape for American cellphone service.

Clearwire’s board approved the offer based on the recommendation of a special committee of directors not appointed by Sprint. Clearwire also has commitments from Comcast, Intel and Bright House Networks, which collectively own 13 percent of the voting shares, to support the deal.

Some of Clearwire’s minority shareholders believed that the company should hold out for a higher price, with one analyst calling for at least $5 a share. One of these investors, Crest Financial, said that it would try to block Sprint’s deal with Softbank if the earlier offer of $2.90 a share went through.

And another, Mount Kellett, had argued that based on what ATT paid for roughly similar spectrum, Sprint should be paying at least four times as much.

But Sprint argued privately that its previous bid valued the network operator’s spectrum at about the same level that Verizon paid for spectrum that it acquired from cable companies, according to a person briefed on the matter. And Clearwire’s spectrum, Sprint claimed, is of lower quality and therefore less valuable, meaning that the company was effectively paying more than Verizon did.

Clearwire has struggled to to join the ranks of the biggest American cellphone service providers, despite bringing on big-name investors. Some of its previous stakeholders, including Google and Time Warner Cable, chose to sell off their holdings for a fraction of their purchase prices.

Agreeing to the deal announced Monday will help shore up Clearwire’s finances, at a time when it projected having enough cash to last a year or so and still faces significant debt obligations. Sprint has pledged to provide up to $800 million in interim financing to the network operator.

Citigroup and the law firms of Skadden, Arps, Slate, Meagher Flom and King Spalding advised Sprint. The Raine Group acted as financial adviser to SoftBank and Morrison Foerster acted as counsel to SoftBank.

Evercore Partners and the law firm Kirkland Ellis advised Clearwire. Centerview Partners acted as financial adviser and Simpson Thacher Bartlett and Richards, Layton Finger acted as counsel to Clearwire’s special committee. Blackstone Advisory Partners advised Clearwire on restructuring matters. Credit Suisse acted as financial adviser and Gibson Dunn Crutcher acted as counsel to Intel.

Article source: http://dealbook.nytimes.com/2012/12/17/sprint-reaches-deal-to-buy-out-clearwire/?partner=rss&emc=rss

DealBook: Goldman Sachs Swings to Profit as Revenue Surges

Lloyd Blankfein, chief of Goldman Sachs.Mark Lennihan/Associated PressLloyd Blankfein, chief of Goldman Sachs.

Goldman Sachs said on Tuesday that it swung to a profit in the third quarter, a strong comeback from a year ago, when it reported a rare quarterly stumble in the wake of losses in its private equity portfolio and broader global economic issues.

For the quarter, the firm reported net earnings applicable to common shareholders of $1.46 billion, or $2.85 a share, compared with a loss of $428 million, or 84 cents a share, in the quarter a year earlier.

Goldman’s revenue more than doubled, to $8.35 billion, from $3.59 billion in the year-ago period. The results exceeded the consensus of Wall Street analysts surveyed by Thomson Reuters.

Related Links

“This quarter’s performance was generally solid in the context of a still challenging economic environment,” Lloyd C. Blankfein, Goldman’s chairman and chief executive, said in a statement.

The better-than-expected performance is welcome news for Goldman, which has had a tough year as it has struggled against both economic challenges at home and abroad and new regulations that have reduced profitability.

Goldman Sachs

Goldman is not alone in feeling the profit pinch, and this quarter its rivals were aided by revenue from a boom in mortgage refinancing, a corner of the market in which Goldman does not have a big presence.

Still, net revenue in Goldman’s powerful fixed income, currency and commodities unit came in at $2.22 billion, 28 percent higher than the third quarter of 2011. The company said the increase reflected “significantly higher” revenue from trading in mortgages as well as a bump in revenue from trading items like currencies and interest-rate products.

During the first half of the year the firm earned roughly $3 billion in profit, down 20 percent from the same period last year.

The results also included a bump in the firm’s quarterly dividend, which the board recently voted to increase by 4 cents, to 50 cents a share.

Goldman’s annualized return on equity, a critical measure of profitability which effectively measures the profits a bank was able to generate on its capital, was 8.6 percent in the quarter. This is roughly the same as this time last year and up from 5.4 percent in the second quarter.

Still, Goldman’s single-digit return on equity is a stark reminder of how much more difficult today’s operating environment is. In 2006, its return on equity was 32.8 percent.

The firm set aside $3.68 billion, or 44 percent of its revenue, to pay employees. This is in line with previous accruals. The firm does not actually pay much of that out until early 2013, after it knows the year-end performance.

At the end of September Goldman had 32,600 staff consultants and temporary workers on the payroll, down 5 percent from a year ago. Goldman and its rivals have been moving to cut staff to make up for revenue shortfalls in a number of areas.

Article source: http://dealbook.nytimes.com/2012/10/16/goldman-sachs-swings-to-profit-as-revenue-surges/?partner=rss&emc=rss

100-Watt Bulb on Its Way Out, Despite Bill

A rider attached to the omnibus spending bill passed Friday prohibits the Energy Department from enforcing new efficiency standards on light bulbs. The standards require bulbs to use 28 percent less energy to make as much light as the 100-watt staple.

The standards, which will still go into effect Jan. 1, affect only the 100-watt bulb in 2012, but will effectively phase out standard 40-, 60- and 75-watt incandescents by 2014. Under the law, merchants will be allowed to sell their remaining inventory but cannot replenish it.

It was not immediately clear what the practical effect would be of the new prohibition. The requirement that manufacturers stop making or importing traditional 100-watt bulbs remains the law of the land. The rider would simply prevent the Energy Department from assessing fines or stopping sales of scofflaw bulbs.

General Electric, a major bulb maker said it would continue to abide by the new standards despite the Congressional action.

“The provision in the bill does not repeal the lighting standards, but only removes funds for enforcement,” said David A. Schuellerman, a spokesman for the company’s appliances and lighting unit. “We are required to abide by the standards, and, of course, intend to comply with our legal obligation.”

The lighting industry and major retailers have already invested heavily in offering bulbs to meet the new standards, signed into law in 2007 by President George W. Bush, and are unlikely to shift course now.

“Bottom line, the standards are moving forward unabated,” said Noah Horowitz, a senior scientist at the Natural Resources Defense Council, which has been active in promoting the standards. Calling the delay in enforcement a “speed bump,” he added, “Incandescent light bulbs are not going away due to the standard, they are just getting better. The new ones that meet the standard will use 28 percent less power and look and perform exactly like the old one.”

Article source: http://feeds.nytimes.com/click.phdo?i=c5e8d5e432883bb1791ac3f81c37524f