Re­vers­ing the med­i­cal brain drain

Financial Mirror (Cyprus) - - FRONT PAGE -

With physi­cians al­ready scarce world­wide, de­mand for for­eign-born doc­tors in the United States and the United King­dom is stretch­ing de­vel­op­ing and mid­dle-in­come coun­tries’ med­i­cal re­sources to the break­ing point. In the US, for ex­am­ple, the short­fall of physi­cians could grow to nearly 95,000 by 2025, equiv­a­lent to 43% of all doc­tors work­ing to­day.

When doc­tors are in short sup­ply, the US and UK turn to coun­tries like the Philip­pines to close the gap. But this leaves the Philip­pines with its own sig­nif­i­cant short­age of med­i­cal pro­fes­sion­als.

The sit­u­a­tion across Africa is no bet­ter. In Kenya, more than 50% of all doc­tors are now prac­tic­ing over­seas, leav­ing just 20 physi­cians per 100,000 in the population. By con­trast, the United King­dom has 270 doc­tors per 100,000 peo­ple.

To be sure, there is noth­ing wrong with doc­tors spend­ing time work­ing and train­ing over­seas; on the con­trary, prac­tic­ing in a va­ri­ety of health-care sys­tems is crit­i­cal for pro­duc­ing ex­pe­ri­enced, well-rounded physi­cians. The fun­da­men­tal prob­lem is that med­i­cal staff and stu­dents are leav­ing the de­vel­op­ing world en masse to train in coun­tries like the US and UK, and then never re­turn­ing to work in their own com­mu­ni­ties. More­over, sup­plier coun­tries of­ten pay for that med­i­cal ed­u­ca­tion di­rectly or in­di­rectly, with­out ever re­ceiv­ing any of the ben­e­fits.

To re­verse this trend, we must al­low med­i­cal stu­dents to train in world-class clin­i­cal set­tings, while en­cour­ag­ing them to re­turn to prac­tice in their home coun­tries. This will not be easy, in part be­cause prac­tic­ing in de­vel­oped coun­tries is far more lu­cra­tive than prac­tic­ing in the de­vel­op­ing world, and doc­tors over­whelm­ingly pre­fer to work in the coun­tries where they have trained. Any ef­fort to stop the one-way flow of med­i­cal tal­ent from de­vel­op­ing coun­tries will have to ad­dress these fac­tors.

For starters, we should fo­cus on where med­i­cal train­ing hap­pens. Stu­dents could com­plete their pre­clin­i­cal train­ing, and a por­tion of their clin­i­cal train­ing, in their coun­try of ori­gin, and then be given the op­tion of com­plet­ing a tem­po­rary clin­i­cal-train­ing stint in the US or the UK.

Res­i­dency pro­grammes are the last stage of the med­i­cal­train­ing process, and they of­ten de­ter­mine doc­tors’ pre­ferred prac­tice set­ting. When doc­tors from the de­vel­op­ing world com­plete their res­i­dency pro­grams in the US and UK, they rarely re­turn home. In fact, they are of­ten given strong in­cen­tives to stay: per­ma­nent-visa sta­tus and a valid li­cense to prac­tice medicine.

Low- and mid­dle-in­come coun­tries should thus pro­vide more res­i­dency pro­grammes, and the US and the UK, which bear some re­spon­si­bil­ity for the cur­rent doc­tor-sup­ply im­bal­ance, should as­sist them with fund­ing and know-how.

We also need to ad­dress the fi­nan­cial in­cen­tives that lure an un­sus­tain­ably large num­ber of de­vel­op­ing-world doc­tors over­seas in the first place, per­haps by oblig­ing em­i­grat­ing physi­cians whose home-coun­try gov­ern­ments fi­nanced their med­i­cal-school train­ing to pay the cost be­fore al­low­ing them prac­tice medicine over­seas. Thus, doc­tors would be­come li­able for the value of their sub­sidised train­ing when they elect to work abroad.

This con­di­tion could be i mposed through a well­con­structed schol­ar­ship sys­tem that em­bod­ies the slo­gan: “pay it back if you don’t come back.” Un­der this sys­tem, fewer stu­dents who in­tend to work per­ma­nently over­seas will ac­cept gov­ern­ment sub­si­dies, and more money will be avail­able for stu­dents who wish to prac­tice in their coun­try of ori­gin, or for in­vest­ments in health-care in­fra­struc­ture.

Trinidad has suc­cess­fully im­ple­mented such a strat­egy – doc­tors who train over­seas are re­quired to re­turn home for five years in ex­change for their gov­ern­ment schol­ar­ships – and the US has a sim­i­lar pro­gramme meant to en­cour­age stu­dents to prac­tice in par­tic­u­lar ge­o­graph­i­cal ar­eas around the coun­try.

At St. Ge­orge’s Univer­sity, where I am Pres­i­dent and CEO, we have the Ci­tyDoc­tors Schol­ar­ship pro­gramme, whereby New York City stu­dents who re­ceive full-tu­ition schol­ar­ships to med­i­cal school must re­turn to prac­tice in New York City’s pub­lic hos­pi­tal sys­tem for five years after their train­ing. If they do not re­turn, they must re­pay the schol­ar­ship as if it were a loan.

Med­i­cal-train­ing pro­grammes in de­vel­op­ing coun­tries should also be con­sid­er­ing how they can bet­ter di­rect fu­ture doc­tors to­ward meet­ing do­mes­tic needs. Stu­dents over­whelm­ingly come from af­flu­ent back­grounds, which of­ten means they are from the big­gest cities. More should be re­cruited from ru­ral ar­eas – which of­ten have the great­est short­ages – and then be trained in the set­tings where they are most needed. By broad­en­ing the ge­o­graph­i­cal and so­cioe­co­nomic tal­ent base and iden­ti­fy­ing good can­di­dates sooner, we could in­crease the like­li­hood that stu­dents will re­turn to prac­tice in their lo­cal com­mu­ni­ties.

We all have some­thing to gain from glob­ally sus­tain­able med­i­cal-train­ing prac­tices, which will en­sure that all coun­tries’ health-care needs are met. For de­vel­op­ing coun­tries there is no other way for­ward.

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