Fatal Flows - Doctors on the Move

The article below is from one of the world's most prestigious medical journals but displays a grade-school level of thinking. Their solution to the problem of third-world doctors migrating to richer countreies? More aid! Throw dollars at it! It shows how cretinous people can be when speaking outside their own narrow field of expertise. That the USA and other Western countries could improve their educational systems so that they themselves trained all the doctors they need is glided over. That aid will only buy golden bedsteads and Swiss bank accounts for the corrupt ruling elites of the poor countries concerned is CERTAINLY not mentioned

"The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing. As underscored in the article by Mullan in this issue of the Journal, today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia. Many of these graduates come from poor countries with high disease burdens - precisely those nations that can least afford to lose their professionals.

The plain truth is that medical systems in the United States and other wealthy countries are heavily dependent on imported workers - for hospital staffing, coverage of underserved areas, and meeting gaps in skill levels. U.S. medical schools turn out a relatively stable 17,000 graduates annually, but the demand for residency staffing exceeds this number by 30 percent. This gap is filled by international medical graduates, most of whom will attain citizenship or permanent residence and remain in the United States to practice medicine. Medical coverage of disadvantaged Americans also depends on U.S. federal waivers for international medical graduates to enter primary care practice in underserved areas. The dependence is not confined to doctors, since nurses and other medically skilled workers are in equally high demand.

International professional mobility is inevitable when persons have skills they can sell in a global marketplace. The migration of medical professionals reflects a balance of supply and demand - but it has ethical implications, too. Demand in affluent countries pulls health care workers from poor countries as low salaries, limited career prospects, poor working environments, family aspirations, and political insecurity push them out. The beneficiaries are the importing countries and, of course, the migrants themselves. Countries that intentionally export skilled workers tolerate "brain drain" in exchange for financial remittances, relief from high unemployment rates, and the possibility of scientific connections. Markets for medical labor operate in and across all of the major world regions, with Asians moving into North America, Egyptians into countries with oil-exporting economies, and Eastern Europeans into an expanding European Union.4 South Africa exports health professionals to wealthier countries while simultaneously importing them from neighboring African nations.

Emigration from the poorest countries is unquestionably damaging. More than a dozen countries in sub-Saharan Africa have plummeting life expectancies mostly as a result of the epidemic of human immunodeficiency virus infection and AIDS.5 With just 600,000 doctors, nurses, and midwives for 600 million people, African countries need the equivalent of at least 1 million additional workers in order to offer basic services consistent with the United Nations Millennium Development Goals. Instead, these countries are moving backward, with the hemorrhaging of clinical and professional leaders crippling the already fragile health care systems. These failures have been characterized as "fatal flows," because poor people are left vulnerable to devastating diseases and avoidable death. The exodus also constitutes a silent theft from the poorest countries through the loss of public subsidies for medical education, estimated at $500 million annually for all emigrating skilled workers from Africa.

Moral outrage over the "poaching" behavior on the part of rich countries has reached a crescendo. Yet simply blocking migration is neither effective nor ethical, since freedom of movement is a basic human right. The challenge is to advance human health while protecting health workers' rights to seek gainful employment. The first responsibility for action belongs with each country to "train, retain, and sustain" its workforces through national plans that improve salaries and working conditions, revitalize education, and mobilize paraprofessional and community workers whose services are demonstrably more cost-effective and who are less likely to emigrate. Since such urgent actions must be pursued in the world's poorest nations, much will depend on the global community's provision of appropriate financial and technical aid".


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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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