Even measures in the health-care bill meant to boost the population of domestic physicians might do more harm than good. Congress has proposed providing funding to increase the number of U.S. residency positions by 15,000 to meet the anticipated increased demand for doctors. Yet these bills do not increase the number of medical-school slots. So those added residency positions will have to be filled by more than doubling the country's annual importation of foreign-trained doctors.
The apparatus to bring in these overseas professionals is well oiled, with no consideration for the potential impact of an immigrant's exit from his or her country of origin. Nurses are drawn to American soil through a well-organized, billion-dollar, private-firm-based nurse recruitment industry. Physicians tend to either apply directly to the U.S. National Residency Matching Program or be recruited by residency programs or immigration lawyers. Despite consistently being among the highest paid professionals in their homelands, foreign doctors are drawn to the United States by the pull of even higher salaries and better training and facilities.
But though the prospects for emigrating physicians might be good, the consequences for the countries they leave behind are grave. Mortality rates for infants, children, and expectant mothers are especially sensitive to health-worker shortages, with child mortality tripling as communities go from five health workers per 1,000 population to less than one per thousand, according to a 2004 Rockefeller Foundation report.
Medical brain drain affects education systems, too. Only the best and brightest can pass the U.S. certification exams, meaning that those who emigrate are often top university professors. A recently released study funded by the Gates Foundation found that migration to wealthier countries is the No. 1 cause of loss of African medical school professors -- accounting for a full 25 percent, with most going to the United States. Not surprisingly, the same study also revealed that lack of professors was one of the main barriers to training more health workers in Africa.
Even in the absence of health reform, brain drain was destined to be a growing problem for poor countries. According to studies by the U.S. Bureau of Health Professions and the Association of American Medical Colleges, conducted before the passage of health-care reform, the aging U.S. population would have needed at least 40 percent more primary-care providers by 2020, and the United States would have experienced a shortage of 124,000 physicians by 2025. With little chance of the United States meeting that demand domestically, it's likely the needed nurses and doctors will come from abroad.
Ironically, while the United States is recruiting thousands of doctors to its shores each year, it is simultaneously spending billions trying to build health systems in precisely the countries whose physicians it is stealing away. In recent years, major U.S. overseas development programs have failed to meet their goals due to a lack of health workers, and funding has started pouring into training in this sector. But what's the point, if those same doctors will later just be recruited away?
The answer is clear: Until the United States is self-sufficient in the education of its own health workers, it will continue to risk the health of the most vulnerable people in the United States and abroad. The Obama administration has made a major commitment to improving the health of the poorest people in the world through the $63 billion Global Health Initiative. But much of this effort will be wasted if the United States continues to take from developing countries the very thing health systems need most: the people needed to run them.
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