Doctors Without Borders

Letting medical professionals and other skilled workers from the developing world emigrate is a good deal for everyone.

BY CHARLES KENNY | OCTOBER 11, 2011

Immigration may be deeply unpopular with electorates throughout the developed world, but that hasn't deterred immigrants themselves: The foreign-born share of the population of high-income countries doubled between 1985 and 2005, to nearly 9 percent. And the percentage who were college graduates increased fourfold between 1975 and 2000. That's great news for the rich countries that benefit from their skills, of course. But as it turns out, it is also great news for the poor countries the migrants leave behind.

It is hard to find a more confused discussion than that surrounding brain drain. Opposition to unskilled migration is usually based on perceived self-interest, the threat of stolen jobs -- a misguided fear, but at least a rational one. But certain well-meaning Westerners call for immigration restrictions on educated workers from the developing world for the opposite reason: If you let them leave, they'll abandon their home countries to poverty and deprivation. In 2008, the respected medical journal The Lancet carried an editorial on the medical brain drain of doctors and nurses from low- to high-income economies, complaining that "richer countries can no longer be allowed to exp[l]oit and plunder the future of resource-poor nations"; the same issue carried an op-ed calling for those who recruited African workers abroad to be sent to the International Criminal Court. (Never mind that the ability to leave the country of one's citizenship is considered a human right by the United Nations.) As a result of such thinking, Britain's National Health Service has a code of practice that bans recruitment from 150 developing countries, and there have been calls for something similar in the United States.

Certainly, most skilled migrants make more money abroad than they would at home. John Gibson at the University of Waikato and David McKenzie of the World Bank document salary increases ranging from $40,000 to $60,000 a year for skilled emigrants from developing countries across a range of professions. But the money these workers make abroad doesn't stay there: The average Africa-trained member of the American Medical Association sends home $6,000 a year in remittances, often for two decades or longer. Indeed, remittances from immigrants are an incredibly powerful force for development in any number of African countries -- more than the amount of foreign aid to Ivory Coast, triple that given to Togo, quadruple that to Nigeria, and nearly six times the aid to Mauritius. And the money is put to good use. One estimate from the U.N. Conference on Trade and Development suggests if you doubled remittances to a developing country, you could reduce poverty by nearly a third.

Perhaps more importantly, countries that swap people also swap goods, ideas, and investment. Doubling the number of people who have migrated between two countries raises trade between those countries by 10 percent. And if the number of skilled immigrants doubles in a recipient country, subsequent foreign direct investment to their countries of origin climbs 25 percent. William Kerr, an economist at Harvard Business School's Entrepreneurial Management Unit, even finds that migrants transfer back knowledge about increasing manufacturing efficiency -- so productivity increases in the home country as a result. Economists Hillel Rapoport at Bar-Ilan University and Frédéric Docquier at the Catholic University at Louvain report that about half of the Indian diaspora in Silicon Valley, which ran nearly one in 10 start-ups in the late 1990s, traveled back to India on business at least once a year. They were central to the creation of India's booming IT industry, which now employs around 2.5 million people. Another idea that appears to travel along with migration is democracy -- an International Monetary Fund study found that the more students a country sent for schooling in democratic countries, the more likely the home country was to become or remain a democracy.

But what about high-skilled migrants starving their home economies of vital human capital needed for development? Actually, Rapoport and Docquier conclude that the more high-skilled people leave low-income countries, the higher educational enrollments there climb. The opportunities presented by moving abroad spur people to stay in school and learn more. Surveying the brightest students in Tonga and Papua New Guinea, Gibson and McKenzie find that nearly all of them contemplated migration, and it led them to take on additional classes.

Similarly, Michael Clemens at the Center for Global Development finds no evidence that medical brain drain from developing countries leads to shortages of medical staff back home, probably because the opportunity to migrate is one of the things that attracts people to medical school in the first place. For years, nurses have left the Philippines in huge numbers to work abroad, but the country still has more nurses per person than Britain.

And finally, of course, lots of migrants return with valuable skills and contacts -- including many of those now working in the Indian IT industry. Economists William Easterly of New York University and Ariell Reshef of the University of Virginia carried out an informal survey of the entrepreneurs behind African global export successes and suggested that one factor many had in common was experience living abroad -- usually in the country they subsequently exported to.

All of this suggests those well-meaning folk in rich countries keen to put a travel ban on anyone from a developing country with a degree might want to reconsider their position. But it also contains a lesson for American economic policy. The United States benefits immensely from its talent imports -- immigrants account for over 60 percent of Ph. D. software engineers and more than half of its medical scientists, suggest McKenzie and Gibson. The country should do all that it can to ensure that inflow continues. And it could also do considerably better when it comes to talent exports. The most recent data suggest the United States had less than a third the number of high-skilled emigrants that Britain had -- despite having a population five times larger -- and half the number of Germany. If having a large high-skilled emigrant base in other countries is a powerful source of trade and investment links, the United States ought to be finding ways to encourage more of its best and brightest to spend some time elsewhere.

But in fact, the United States is heading in the opposite direction, on both sides of the trading equation. International applications to U.S. graduate schools only last year returned to their levels in the 2002-2003 academic year after a post-9/11 slump, a function of the stagnant economy and toughened immigration procedures. And at the other end of the degree process, there is growing concern about a "reverse brain drain," as more foreign graduates from U.S. schools decide to return home rather than find jobs in America -- again, often on account of byzantine immigration rules. Meanwhile, the U.S. House Appropriations Committee has proposed deep cuts to State Department international exchange program budgets that support the Fulbright program, among others. This shortsightedness regarding a program that promotes the talent trade in both directions isn't just bad news for the development prospects in Africa or Asia; it's likely to convert into a further erosion of America's long-term productivity.

SEYLLOU DIALLO/AFP/Getty Images

 

Charles Kenny is a senior fellow at the Center for Global Development, a Schwartz fellow at the New America Foundation, and author, most recently, of Getting Better: Why Global Development Is Succeeding and How We Can Improve the World Even More. "The Optimist," his column for ForeignPolicy.com, runs weekly.

FLOATINGPOINT

7:56 PM ET

October 11, 2011

I wonder if the author can fabricate some benefits

I wonder if the author can fabricate some benefits for the poor countries on the practice of immigration with investment. Some rich countries suck capital from poor countries by allowing people immigrate as long as they carry enough cash for "investment." Many of the "investors" are corrupted officials or wrong-doing businessmen. The rich countries should try harder to stop this kind of immigration close to money laundry.

 

CAMUS10

10:38 PM ET

October 11, 2011

rebutal

this report is stuck with shallow facts such as the high volume of foreign-born phd candidates. Innovation in research and development requires the US grow its own talent, we are indeed better at it. The author seems to suggest because the numbers favor the immigrant view somehow our R&D benefit from graduates generally well versed in rote memorization and poor basic skills

Further, immigrant graduate trainees and teaching assistants have become a cheap crutch for poor undergraduate and graduate instruction in US higher education. The views of this author have been corrupted by commercial sectors such as msn google and the healthcare industry who want to lower labor standards and professional payscales and for decades they have been lobbying for easier visa restrictions.

http://seattletimes.nwsource.com/html/opinion/2011980262_guest29hagopian.html

 

MARCIAFLORES

10:33 AM ET

October 12, 2011

The author can fabricate some benefits

I Agree in wonder if the author can fabricate some benefits for the poor countries on the practice of immigration with investment. Some rich countries suck capital from poor countries by allowing people immigrate as long as they carry enough cash for "investment." Many of the "investors" are corrupted officials or wrong-doing businessmen. Thanks for Sharing!
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KUNINO

11:12 AM ET

October 12, 2011

Fair deal for whom, exactly?

A bright foreign national decides to study medicine, turns out brilliant at it, learns how much more he or she can earn in the United States than in his own mud-brick capital, and immigrates to America. How exactly is that a great deal for the fellow nationals he or she has abandoned for, with luck, a Cadillac or Mercedes in California?

 

FRANKLYFRANK

7:55 PM ET

October 12, 2011

I agree that this article is

I agree that this article is overlooking the lure of higher pay for the majority of immigrant doctors. But at least some of them have more in mind than just money. Doctors without Borders is the charity organisation I have the most trust and respect for. It does not surprise me that it is very hard to efficiently deliver aid in a country like Somalia, where pirates year after year can high jack ships and kidnap crew while the world is watching, mostly helpless. At this point those places are so wrecked, sending aid to those places in whatever form, from books to food and medicine to womens jeans is necessary and worth the trade off if it can just help "stop the bleeding" so to speak.

 

CHRISAK

8:30 AM ET

October 13, 2011

I agree with the author (I think): Migration is Trade!

The logic is clear. Poor countries rarely have the capital to provide sufficient cutting-edge training and/or to exploit the skills of their most able workers most efficiently and effectively. To do so at any rate, they are still too dependent on incoming foreign assistance. So migration becomes for them one form of outgoing venture capitalism, in which they trade the limited short-term benefit of having able men and women stay home with the long-term but risky benefit of having them leave to gather enough tools and foreign contacts to accelerate development and global integration.

What this author tells us I think is that this logic WORKS not just in theory but in practice! Which is not surprising to anyone with enough intellectual good faith to think of the entire dynamic and of all its alternatives. Having potential doctors or inventors move abroad seems like a loss only if we adopt a static point of view and forget that this potential is considerably decreased at home where there is little capital. Capital is like a rich soil, or a soil full of seeds. If you don't have it, I don't how care how imaginative or "able" you are: you will never grow!

 

DODOBIRD

8:34 AM ET

October 13, 2011

law of average apply regardless.

Few immigrants w/ special skills and/or rare talent will become star in his chosen professions regardless. People like that will always find one way or another to gain entry into Europe, Canada, or US.

However, majority of immigrants scientists, engineers, or doctors, are just mediocre , and be rated at either slightly above par or more likely below par of average US persons.

Sad commentary for 9.1% unemployment rate in US, when skilled US jobs gone begging for lack of qualified US person, in search of foreign born applicants regardless of any semblance qualifications/skills/experience for US residency;
recent immigrants don’t have much working experience in US if any at all, except having a credential as newly minted degrees from US universities round of routine paper mills anyway, due to lack US persons interested in graduate schools or cannot afford past three decades).

Now US must resort to trade protection policy to claw back one or two millions blue collar/wages grade manufacturing jobs from China.

National debt continue to balloon for the next decade - 25 trillions??, and Federal reserve printing of phony money to re-inflate housing collapsed price and depressed stock, will simply driving up living cost of everyone in the world – sowing social unrest everywhere; this is how Egypt crumbled, go tell how 50 millions plus Egyptians to live w/o any kind of oil revenue and little commerce except tourism, or to Greece.

 

ALLTHINGSGOOD

10:07 AM ET

October 13, 2011

Not all bad

I like the fact that the medical migrants have to send back about 10% to their own countries. Like the article said it helps both sides financially and relationally. I personally think it would be good for them to go back to their own countries for a period of time and serve there. That should be a requirement.
We have experience with National Jewish hospital which has a lot of foreign interns and it seems to work out well for the doctors, the interns, and patients. America is the land of opportunity after all. These foreigners are over here LEGALLY and that should make a big difference, I would think. Alot of people are saying no no to regular colleges so they are having less enrollment cause the tuition is so stinkin high and people are going to trade schools instead so I bet they are welcoming those foreign students to make up for that financial loss.

 

INKA987

5:33 AM ET

October 17, 2011

How about we send ours and take care of our own.

With the apperant and wishful thinking that comes in mind when thinking of the single soul thriving and developing, It would come in mind that the thriving countries that assit greatly to 3rd world contries would, and should, grant a respected amount of monetary assistance to those doctors who choose to immigrate to 3rd world contries for a specific period - now thats heroic!

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RNIELSEN

8:08 AM ET

November 4, 2011

Doctors without Borders

I'm a nurse anesthetist schools student who is currently going for my RN to BSN degree. I would like to know if anyone is familiar with the Doctors Without Borders program? I have always taken an interest in working overseas short term but would like to learn more about the program and what courses I should take know to prepare for the future.

 

YARINSIZ

4:55 AM ET

November 7, 2011

It does not surprise me that

It does not surprise me that it is very hard to efficiently deliver aid in a country like Somalia, where pirates year after year can high jack ships and kidnap crew while the seslichat world is watching, mostly helpless. At this point those places are so wrecked, sending aid to those places in whatever form, from books to food and medicine to womens jeans is necessary and worth the trade off if it can just help "stop the bleeding" so to speak