"Immigrants from poorer countries will do anything for a buck. It becomes a race to the bottom. As long as conditions here don't get worse than where they came from they'll be happy. But for us, its just down, down down in terms of quality of living." would you be open to mass immigration from europe and east asia, in that case? some of the countries have even higher standards of living, so logically those immigrants will demand better and raise our standards of living. Also, most cities like san diego, miami, dallas, atlanta etc have all become safer, cleaner, and the QoL has increased dramatically from 30-40 years ago. These cities have all become increasingly immigrant populated relative to 30-40 years ago, many of these immigrants coming from latin america or asia.

"If rural hospitals need to pay doctors even more than so be it. I want that job going to an American."

the crux of the issue is that there literally aren't enough american doctors. med schools giving recruitment preferences to doctors willing to work in rural areas + a much higher salary + a much lower COL still aren't enough to attract american doctors there. I don't know what magical solution you have to make thesecommunities desirable destinations but I am all ears.

"Is it concerning because I don't care about what society thinks? Is it concerning that I don't care about getting an attaboy (e.g. karma) for towing society's latest groupthink?"

no? There are many valid arguments to heavily restrict immigration, largely based on middle class incomes and cultural attrition, i just don't see how any of those apply to doctors in rural areas. and i was responding to how you openly admitted that you dislike it because wall street likes it. seems like a bad way to approach policy!