At the beginning of the month, the Health Secretary, Jeremy Hunt, made reference to an ongoing crisis in global healthcare. In a speech to the Conservative Party Conference, he asked "is it right to import doctors from poorer countries that need them?" In an increasingly globalised world, it is vital that this question is carefully considered.
The medical profession faces many challenges, but one of the biggest - from the largest hospital in London to a community clinic in rural Kenya - is a shortage of skilled staff. A study earlier this year by the Association of American Medical Colleges, predicts that the US will have a shortfall of between 61,700-94,700 physicians affecting both primary and specialty care by 2025.
For developing nations, the problem is exacerbated by the allure of high-income countries, with greater income potential, better working conditions, bigger budgets for equipment, and more effective resourcing. Put simply, doctors from low- and middle-income countries are flocking to the US and UK, with disastrous consequences for their own healthcare systems.
To put the problem into perspective, while the UK's skills shortage leaves 270 doctors per 100,000 people, Kenya must make do with just 203.
The one-way flow of clinical practitioners from developing nations needs to stop, and there are measures that can be put in place now to benefit the entire healthcare community.
One of the realities of the medical profession is that the majority of trainee doctors come from affluent families; a fact as true in Kenya as in the UK. We need a system that increases economic diversity among medical students. Not only does this widen the net of available talent, but it will also help address the issue of doctor migration. Doctors recruited from rural areas in developing countries are more likely to want to work in these environments to begin with.
Research also suggests that doctors tend to practice where they complete the final stages of their medical training. With this in mind, I'd like to see postgraduate education and residency training programmes either enhanced or set up in countries like Kenya and The Philippines - as well as enhancing exchange programmes in places like Russia, South Africa, and Cuba. This could be done in conjunction with postgraduate courses in high-income countries, providing opportunities for collaboration between medical institutions.
Exchange programmes can result in a steady flow of talented students from countries like the US and UK working and training in the developing world. At the same time, students from these countries could train in world-leading healthcare systems before returning home to complete their education. Programmes that encourage them to do so must be part of the solution.
The brain drain problem is made all the worse by the fact that it is predominantly financed by low- and middle-income countries. The Philippines is still the world's biggest 'exporter' of nurses; however, a recent OECD report shows that large numbers are also coming from Zimbabwe, Vietnam, Ghana, and Kenya. Russia is also suffering an exodus of trained medical staff; the number of nurses leaving the country has quadrupled in 10 years to nearly 40,000. These health professionals have their training entirely subsidized by their government and if they immigrate to the US or UK that investment is lost.
There are possible solutions to this with medical schools, governmental agencies, and interested parties working together towards the same end. In the US, medical graduates can have their debt burden lessened or even forgiven after a certain time period if they work in an underserved area or in public service.
At St. George's University, with a medical school devoted to training students from around the world, we have worked with various governments who pay for their citizens to attend the MD programme to help ensure that students return home upon graduation. We encourage fourth-year (elective) training in hospitals in the home country, work with the ministries in charge of students to track success and to advise accordingly, and even, in certain cases, holding graduation ceremonies in the home country. The more the student trains in and is bonded to the home country, the more likely he or she will return to practice medicine.
It is unfair that developing nations should invest large sums of money into training doctors, only for them to vanish into more developed healthcare systems on the other side of the world. Recovered money could be used by governments to fund the training of more medical students, or be reinvested into their health infrastructure.
To this end, we have a CityDoctors Scholarship Programme where students receive full- or partial-tuition awards in the name of a hospital or hospital system. They commit to work at that hospital for the number of years an award was granted. The University has agreed to convert the scholarship into a loan that must be repaid - to the hospital - if the student does not return to the hospital after postgraduate training. This kind of partnership solution can be used between medical schools and governments in countries with great medical need.
In order to be successful, these solutions must be translated into detailed policies. This requires careful planning and international collaboration between institutions and governments. It is vital that we address the global imbalance in healthcare so that future generations - everywhere in the world - can realise their human right to health.
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