“How Should International Training Programs Respond to Medical ‘Brain Drain’?”
An ethics case in the AMA Journal of Ethics delves into the ethics surrounding human resources in low resource settings
The movement of health care workers from countries with resource scarcity and immense need (“source” countries) to areas of resource abundance and greater personal opportunity (“destination” countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to “brain drain” in different but complementary ways.
After presenting a case about Dr. R, a physician from Nigeria, Dr. Karan, Dr. DeUgarte, and Dr. Michele Barry dive into commentary:
The ethical dilemma in this case has much to do with the rights of an individual physician (or health care worker) with respect to his or her own life, personal needs, and goals compared to that person’s obligations to his or her community and country. Moreover, it brings to light the possibility that current frameworks in the United States for health systems strengthening might have unintended consequences.
To contextualize the importance of the problem, the World Health Organization (WHO) estimates that 23 health care workers per 10,000 people is the minimum ratio needed to maintain a health system—and as of 2013, 80 countries worldwide fell short of this threshold level of care . The disparity is most pronounced in sub-Saharan Africa, which is home to 14 percent of the world’s population but only 3 percent of its health care professionals . A study of the world’s medical schools found that the majority of countries with the greatest need for physicians (almost all of which were in sub-Saharan Africa) had only one medical school . Perhaps the most concerning aspect of medical brain drain is its self-reinforcing impact on health care systems that are already weak: as a health care system weakens, bright physicians and health care workers tend to leave; the more who leave, the more the health care system is weakened.
A number of studies have quantified factors that propel physician migration from source countries: access to better training opportunities, higher salaries, need to escape political instability and corruption, poor quality of facilities and equipment, and plans for raising children [5-8]. Conversely, factors that influence physician retention in the destination countries include strong and robust health systems and political stability, which tend to facilitate improved lifestyles and opportunities for physicians and their families.