Insourced Book

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About the Book

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.

Reviews of Insourced

“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.


“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.


“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 powerful 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, MBA, President and CEO, IntraHealth

Many believe that the United States sits at the pinnacle of excellence in the global education of doctors and nurses. Dr. Kate Tulenko does not. Drawing on analytics, history, and her own experience as a physician, she paints a picture of antiquated traditions, confused regulations, underinvestment in human resources for health, and a policy morass that is as ill-suited to the needs of the developed world as it is injurious to health in the developing world. The global “market” for health workers is growing and changing rapidly. Insourced: How Importing Jobs Impacts the Healthcare Crisis Here and Abroad describes that phenomenon from the US and the global perspective. The arguments are strong, the insights revealing, and recommendations clear. Readers may not like everything that Dr. Tulenko prescribes, but they ignore her analysis at their own peril.
-Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy, The George Washington University


“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

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