Dr. Andy

Reflections on medicine and biology among other things

Friday, July 15, 2005

Immigrating docs and nurses

The BMJ and Lancet have had a flurry of articles about the migration of health care workers migrating from the developing to the developed world. Apparently, this is rampant (no surprise to anyone in health care in the US) and leads to a substantial hardship in areas like sub-Saharan Africa where there are inadquate numbers of medical professionals.

The situation is compounded by the fact that countries like the U.K. and U.S. depend on immigration as they don't train enough docs and nurses.

As the spouse of an immigrant (from the Philippines) who has a number of physicians in-laws I can certainly understand the appeal of living and working in the US, described in this letter:

While working in your own country you were used to fashioning a chest drain from a discarded drip set; you had to buy the catheter for that patient because otherwise he or she could not go to theatre; and you had to buy drugs on occasions when your salary hardly lasted a week.

Then, given the opportunity to either study or work in the West, you start to enjoy your work, although you work longer hours. You can get a chest x ray film within an hour, and you don't have to worry about your salary running out before the end of the month. You start to re-evaluate your life. You look at the priorities of the society you left behind—often it is not so poor that it cannot afford these things, but greed, corruption, and a total lack of political will has stopped any form of growth in health care. Even senior doctors are oblivious to what the world is about, and you despair.

I think his point about the difficulty and frustration working in a corrupt society is particularly well taken.

I don't have any brillant insights. My libertarian instincts say we shouldn't prevent people immigrating as they wish and that the market will work out the best solution, but in this case that solution is pretty clearly with a lot of foreign born and educated RNs and MDs practicing for high salaries in the US while the poor in the developing world lack care.


At 8:38 PM, Anonymous jb said...

A minor point, but an important one, in my opinion: I grow weary of the PC term "developing" when referring to these 3rd world hellholes. For the reasons you note, "development" does not occur in the presence of corrupt, greedy, incompetent governments. They're not "developing," they are "not developing." If they were truly developing, there would be a sense of hope, of progress, of potential that would entice their citizens to stay.

At 12:46 PM, Anonymous DML said...

"while the poor in the developing world lack care."

What about the poor here in the U.S. that lack care? If you're going to start to worry about people who lack health care, it's not just people in
poor countries.

Perhaps the reasons are not the same, and yes, the poor here can usually get emergency care for critical situations, but that's not the same type of care that others can access and it's certainly not a cost-effective solution.

I once witnessed a situation here in the U.S. where an infant was about to be taken to surgery to have his leg amputated. Had he received antibiotics weeks earlier, his leg would probably have been saved, but he was the son of illegal immigrant migrant workers who had no insurance. My son, who was in the same hospital room, got thousands of dollars worth of excellent care, including a helicopter ambulance trip, and I paid a $25 deductible. If I'd had the same lack of insurance that the other parents had, my son would have likely died.

So, while the reasons may be different and the levels of care in poor countries may be very different than what is available here, there are still huge problems of access to appropriate and TIMELY health care in the US and abroad.

I don't know how to fix it, but I think it's just a different flavor of the same problem. I know that life can never be made to be fair, but we can certainly improve on how medical access is currently allocated, I would think.

At 11:06 AM, Blogger Dr. Andy said...

Two good comments.

I'd say this problem extends well outside "3rd world hellholes" to countries like India and South Africa that clearly are developing. There may also be a "replacement" phenomena where South African doctors and nurses move to the UK and docs and nurses from poorer African countries move to SA to replace them

I agree we have problems with access to care here, but I'm less sure those are do to lack of trained medical professionals. Our problem seems to be more with getting access for patients to see them

At 6:35 PM, Anonymous Anonymous said...

As a patient, I have little patience with medical personnel I encounter in hospitals who do not understand English, or choose not to understand English, when American kids can't get into med school.



Post a Comment

<< Home