Suppose you grow up in a poor part of town with bad schools, poor health care, and not many opportunities. But you are lucky enough to get a good education, go through medical school, and become a doctor. Once you survive the long hours of medical school and become a doctor, you are able to serve your community by helping hundreds of patients in your town. You work 15 hour days and see hundreds of patients a day. But the shortage of health care professionals and health services in the town make you feel like you are fighting an uphill battle.
Then you meet a doctor traveling from a bigger city who offers you a job in the city, with fewer hours, better pay, and better living conditions. You realize you now have the opportunity to practice medicine AND spend time with your family AND give your kids a chance to grow up with a higher standard of living. What would you do?
This is the story of the Brain Drain. The expert Brains are being Drained from many of the communities that most critically need more health care professional, engineers, etc. The Iraq Study Group Report explains that many of the top engineers and experts left Iraq because of the recent war. This brain drain is one of the reasons that Iraq is having trouble rebuilding.
This story asserts that rich countries are "poaching" doctors from poor countries and that the practice should be illegal. While the poorer country has invested money and resources training its doctors, the rich country then "steals" the doctors. But don't good, hard-working doctors deserve a better lifestyle?
The brain drain is phenomenon that is seen across the world - not only between rich and poor countries, but also between rich and poor areas; often urban areas have more doctors than rural areas since urban areas typically offer better pay and more opportunities for doctors' families.
How do you think the "brain drain" should be addressed? Should "doctor poaching" between countries be illegal? What benefits or opportunities should be offered to doctors working in harsher conditions, and who should provide the compensation?
Friday, February 22, 2008
The Brain Drain
Labels:
global issues,
health
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6 comments:
I don't really see how they could make it illegal. It seems like all of the developed countries that are engaging in this practice would have to agree to stop- perhaps through an international treaty. That doesn't sound feasible to me. However the other suggestion made in the Lancet journal that takes the international aid approach-- to offer training, building and staff new health schools, and provide ways for health workers to stay in their own countries sounds more feasible to me. The U.S. and other developed countries could also offer more incentives for our doctors to go overseas for a few years of service through programs like the Peace Corps and Doctors without borders.
I definitely think we should ramp up our international programs and "share" our doctors and professionals. I know the cultural transition probably takes a long time, so I don't know that it is an efficient process, but the global awareness that results probably compensates for the inefficiency. But how to get a large proportion of our professionals to do service abroad....?
I think if doctors were to travel through established programs then the inefficiency would be very manageable. We could really ramp up groups like Doctors without borders, and I think there should be a specific program for doctors through the Peace Corps. (If there already is, then I stand corrected and it should be expanded.) Then they should recruit heavily at medical schools. There are a lot of students in med school because they really want to make a difference in people's lives. If they learned about the programs and there were some incentives to participate then I think it would be popular. Perhaps the government could forgive some of their loans. Also, I would think the field experience would be important to a young physician. I don't think you'll ever get a 'large proportion,' but a modest proportion would be invaluable.
Yeah, I think you're totally right about an "established program". It would have to be part of the standard process, kind of like residency - or maybe more like interning at a law firm is practically standard for law students.
But I kind of feel bad suggesting that med students/doctors spend even MORE time preparing to practice medicine. And I imagine that by the time doctors make it through schooling and residency, they are so in debt that they are ready to pay off their loans, maybe start a family, and definitely start to enjoy a salary and reap the benefits of their hard work. It almost seems wrong to make them 'volunteer' even more time before they get to settle into "normal life". On the other hand, like you say, some might appreciate the opportunity to practice abroad before settling down. I would love it if I had to practice engineering abroad and there was an established program that helped me do it. The hard part is getting enough really good, experienced professionals to lead those programs.
To clarify: I don't think they should *have* to volunteer, but I think it should be an option and some incentives and an established program should be offered. I worked as an Americorps 'volunteer' and I got free housing, food, a stipend, mileage paid on my car, and a scholarship.
I think IBM read our blog:
http://www.nytimes.com/2008/03/26/technology/26blue.html?_r=2&oref=login&oref=slogin
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