Sunday, March 11, 2012

The International Medical Brain Drain – Are we to blame?

I read an interesting New York Times article today addressing the shortage of doctors in the developing world. There are some disturbing statistics:

- In the US, there is 1 doctor for every 416 people vs. 1 for every 23,000 in Zambia

- The median salary of a surgeon in New Jersey is $216,000 in New Jersey vs. $24,000 in Zambia

- One in 4 doctors in the US is trained overseas

Is America to blame for the shortage of doctors in sub-Saharan Africa? There is a great demand in the US for doctors, especially primary care physicians: statistics project a shortage of 200,000 doctors in this country in 10 years. With high salaries, innovative technology, and enticing immigration laws, the US attracts more foreign doctors every year than Britain, Canada, and Australia combined. Some states have legislation that allows foreign doctors to stay in the US after residency if they would practice in underserved or rural communities here. So far, more than 8,500 doctors have done so. But what is a gain to one country is a loss to another.

A 2008 article in the Lancet suggested that that the active recruitment of medical professionals from Africa be viewed as a human rights violation. It described recruitment agencies that woo medical workers through advertisements, workshops, e-mails, and even text-messages.

But for some doctors, it is the plain reality of practicing in their homeland that causes them to leave. Dr. Kunj Desai, from Zambia, now a resident in surgery in New Jersey, described repeated instances of senseless death due to lack of resources. “We were just pretending to be doctors,” he said of his time at University Teaching Hospital in Lusaka, Zambia.

There is some international funding for training and retention of local doctors but Western aid agencies often hire local talent to do research, not see patients, contributing to an “internal brain drain.”

The solution probably involves a combination of more high-quality training programs and hospital resources, higher salaries, and better working conditions for foreign physicians in the developing world. What the US can do instead of recruit foreign physicians is to contribute to the existing infrastructure for the delivery of medical care in other countries. On the issue of teaching, I am particularly interested in exchange programs for residents, which allow both parties valuable training experiences.

Check out the full article at:

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