The great brain robbery

In the October 27th issue of New England Journal of Medicine, Fitzhugh Mullen’s article “The metrics of the physician brain drain” offers some fresh measurements of the extent of physician migration from less-developed to more developed nations. One of the more striking figures is the percentage of ‘international medical graduates’ from low-income countries estimated to be in the United States medical workforce: of the 25% of working physicians who have graduated abroad, 60% of them come from low-income countries. United States is not alone in luring foreign physicians to its shores: of the 28.3% of physicians in the United Kingdom who have graduated from medical school ‘elsewhere’, 75.2% come from resource-poor nations. Canada and Australia are also significant importers. In absolute numbers, India is the greatest exporter nation of medical professionals, while sub-Saharan Africa sees the largest percentage of its medical workforce leave for greener (or at least other) pastures.

This development has its benefits: overseas physicians wire much needed remittances to extended families in their home countries, and the move abroad opens opportunities for them as individuals. But the social burdens outweigh these benefits: the exodus of physicians have significantly weakened the ability of low-income countries to face the great health challenges posed by HIV/AIDS, malaria, tuberculosis and other serious conditions. And the exodus is not slowing down: Canada is adding residency positions to allow for more medical professions from overseas and is busy streamlining immigration and training requirements to insert them into medical practice. Australia and the United States have their own plans to make medical work in their countries more attractive to foreign-trained practitioners.

The British Medical Association has at least recognized that the brain drain phenomenon is largely the responsibility of developed countries and that they therefore have an obligation to do something about it. In May of this year, BMA issued a call to action on the healthcare skills drain that elaborated four key points:

1) All countries must strive to attain self-sufficiency in their healthcare workforce without generating adverse consequences for other countries.

2) Developed countries must assist developing countries to expand their capacity to train and retain physicians and nurses, to enable them to become self-sufficient.

3) All countries must ensure that their healthcare workers are educated, funded and supported to meet the healthcare needs of their populations.

4) Action to combat the skills drain in this area must balance the right to health of populations and other individual human rights.

Fine sentiments, but it remains to be seen whether the individuals and nations who profit from the skills drain are willing to do the ethically right thing. And what is the ethically right thing anyway? If it would be wrong to forbid physician immigration, what other means would be appropriate to stop the brain drain?