Matt McAllester of the New York Times Magazine has an article there headlined, “America Is Stealing The World’s Doctors.” Unfortunately the actual text of the article is only a little more nuanced than the headline, which is a shame, because I think the subject is far less simple than is let on initially.
McAllester’s argument runs something like this: the U.S. is the world’s biggest importer of medical talent; he cites statistics that show that, currently, one in four doctors practicing in America is trained overseas. (He notes that there’s a shortage of primary care doctors but leaves that statistic alone.) This is a remarkable set of statistics, considering the difficulty that foreign doctors have in coming to the U.S.: as I’ve mentioned before, regardless of your previous qualifications, you will have to complete residency before getting your license to practice medicine in the U.S. Doctors who come from poor or developing countries abroad are generally depriving those countries of their services, where the need for care is more acute. In fact, since those countries subsidized the training of these doctors, it’s a double debit: they lose the services and the time and money spent on their training. (One administrator quoted in the article says it’s a “show of dishonesty and betrayal” for a doctor to emigrate.) The article doesn’t propose any solutions to this problem, but given its citations of medical journal articles calling the brain drain “looting”, it’s pretty easy to imagine what sorts of things the author has in mind.
As I said I think the article is insufficiently nuanced and gains quite a bit of its rhetorical force from the framing: it starts with the patients affected by the decision, and makes a compelling argument that they need the care the most. But the decision of a doctor to leave is a much bigger story. For one, the doctor is not a robot—she has desires of her own. She may have become interested in research while studying in school and want to do something about, we’ll say, malaria. Is it not possible that she could make the greatest impact in blunting malaria—perhaps the greatest scourge to Africa’s health—in a richer, more developed country where she could leverage much greater resources there? Once in a richer, more developed country, she might well send money home to her family, which might well use the money to upgrade its life or to start a business that employs additional people. And our original researcher might well be able to use connections gained in the more developed country to steer business or other resources to her home country. And after some time during her career she might decide she wants to return home, where, having acquired additional skills, resources, and connections she is a more effective doctor and leader than she would’ve been had she stayed in her home country the entire time. This is another story that could’ve been told about this alleged looting, one that doesn’t ignore that the thing being stolen is a person with agency.
That said, the specific situation of doctors leaving poor countries for richer ones is best changed by two things: first, making poor countries richer and second, changing the U.S. health care system so that there’s less demand for doctors, whether trained abroad or domestically. The author himself notes: “Doctors from Ghana once fled to the United States almost as a matter of course. But its retention rates of doctors and nurses in recent years have greatly improved as salaries rose enough to weigh the scales in favor of staying.” The author doesn’t note that Ghana has had a strong economy, one of the strongest economies on the continent—it had double-digit GDP growth in 2011. No solutions needed for the health care market as such.
Solving the demand for doctors in the U.S. means solving the problems of overconsumption in the health market, or at least figuring out how to leverage the existing labor force better—perhaps by making individual doctors more productive (e.g. telemedicine) or perhaps by expanding scope of practice regulations.
So I think by framing the situation as “America looting the world’s doctors,” you’re likely to be looking in the wrong places for your progress.
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