Second Opinion: Brain Drain of Health Professionals

Brain Drain of Health Professionals

For years, the World Health Organization has raised concerns about a significant global shortage of health workers — particularly in the 57 nations with the lowest incomes. In the US, we have 260 doctors for every 100,000 people, in Europe, they have 400 doctors per 100,000. But in the Philippines, they have 37 doctors per 100,000, and in Uganda, they have four doctors for every 100,000 people.

Aside from a shortage of doctors, other forces combine to make healthcare delivery in those countries even worse. In many of these 57 countries, the disease burden is particularly high, and they have few universities to train health professionals. On top of this, there is a serious “brain drain”. By brain drain, I mean lower-income countries spending lots of public money to train health professionals — physicians, nurses, dentists, and the like. Once trained, the country guarantees them a job, but usually at a lower wage than they could get outside their country. So, health professionals from countries such as the Philippines, Nicaragua, and Uganda follow the money to earn higher income and practice in more modern settings. That leaves the lower-income countries without the health professionals they need.

Foreign medical graduates, or FMGs as they are known, are not just a part of the American healthcare system but are a vital part. They make up a quarter of all practicing physicians in the US, an indispensable contribution. Their presence is even more pronounced in some specialties, such as psychiatry and family medicine. And over half of the physicians caring for the elderly are FMGs. In many geographic areas, FMG doctors are the backbone of healthcare, serving low-income U.S. communities or underserved rural areas — areas that are often less attractive to American-trained doctors.

That raises some important ethical issues. The first is brain drain. Second is that FMGs may be exploited in the new country where they have chosen to practice. They may face difficult working conditions, especially if they're pressured to accept less desirable jobs or locations to keep their visas.

Countries with top-performing healthcare systems share key features: coverage for everyone, low patient costs, few administrative burdens, and enough doctors to care for the population. Despite its enormous resources, the US healthcare system ranks at the very bottom among developed countries in terms of healthcare quality.

Workforce shortages contribute to America’s reliance on foreign medical graduates. But it’s unfair to take doctors and nurses from more needy nations. Perhaps wealthier countries like the US and Europe that hire FMGs should compensate the source nations for their public investment in training professionals. An international planning group is needed to develop a high-quality global workforce that matches the needs and global resources to avoid brain drain.

– Dr. Michael Wilkes with a Second Opinion

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