Shortages in the US

The Associate Press reports on the situation of physician shortages in many rural areas in the US . Several factors were raised including working conditions and post 9-11 visa situation. No discussion on the implications on brain drain from other countries though.

Excerpt:

"The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force."

"J-1 visa waivers allow foreign doctors to work in underserved areas for three to five years, with a shot at eventually obtaining permanent residency. Over each of the past three years, about 1,000 practicing physicians have come to the U.S. on J-1 visa waivers. Many of them are from unstable or undeveloped countries and come here in search of better training, working conditions and pay. Yet, since 9-11, the federal government has made it more difficult to qualify for the special visas and to obtain permanent residency."

Another news piece on physician migration and shortages

Another piece on physician shortage from the Associated Press.

Excerpt from http://www.iht.com/articles/ap/2007/07/20/america/NA-GEN-US-Doctor-Drain.php

"Dr. Fitzhugh Mullan of George Washington University believes the U.S. — which is facing a shortage of doctors — must stop looking elsewhere to fix its problems. He compares the practice to "poaching" and said it amounts to poor citizenship in the world community.

Every doctor drawn to the U.S, Britain, Australia and Canada from poorer nations leaves a hole that likely will not be filled, he said.

Mullan's research shows that areas such as sub-Saharan Africa (13.9 percent), the Indian subcontinent (10.7 percent) and the Caribbean (8.4 percent) lose large numbers of doctors to the big four nations. But there is little reciprocation. The U.S. exports less than one-tenth of 1 percent of its doctors abroad, for example.

"That creates enormous problems for the (source) country and for the educational and health leaders in the country who are attempting to provide healers," he said."

The loss of doctors in Africa, where millions have been infected with HIV and AIDS, is especially acute.

Dr. Kgosi Letlape, president of the South African Medical Association, said doctor migration creates a trickle-up effect, of sorts.

"What goes around comes around," he said. "We are in a continuum. What South Africa loses to the developed world, to the United States say, we gain from Uganda."

UNCTAD emphasizes needs to address braindrain

The UN Conference on Trade And Development (UNCTAD) Secretariat released the "Least Developed Countries Report 2007" highlighting the role of knowledge and technology in trade and development. The report also addresses the issue of braindrain and proposes a number of policy actions for destination and home countries and donors.

For destination countries:
• Favouring temporary entrance rather than permanent immigration;
• Establishing development assistance programmes that help LDCs to retain their professionals;
• Creating programmes of assistance for skilled emigrants returning to their home countries; and
• Refraining from recruiting LDC professionals with clear negative consequences for home countries.

For home countries:
• Retention - offer job opportunities, better working conditions and career paths
• Return - focus more on the short-term return of emigrants which can eventually lead to permanent return.
• Diaspora - maintaining contact with them and attracting them to specific activities and projects

For donors, international organizations:
• Supporting LDCs in attracting back emigrants;
• Providing assistance to LDCs in enhancing the gains from diaspora links; and
• Establishing regional initiatives that facilitate temporary movement of professionals so as to enable LDCs to benefit from brain circulation.

Click here for full report
Click here for Chapter 4 on International Emigration

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The Guardian Unlimited (UK) also published an article on this report". Excerpt from the newspaper below:

"Seeking health care in Ethiopia can be a difficult task. For every hundred thousand people, only two doctors are available as many of the country's physicians flock to the west.

Many of the world's least developed countries are losing large parts of their already shallow pool of skilled professionals to western countries - hindering their ability to pull themselves out of poverty, a report by the UN said today.

The UN's development arm warned that countries such as Ethiopia could see their long-term growth prospects damaged if the "brain drain" is not addressed

....

The health sector, in particular, has suffered from a large loss of trained workers, which UNCTAD said often had a severe impact on the standard of service available to the poor.

In Bangladesh, 65% of all newly graduated doctors seek jobs abroad and the country loses 200 doctors from the government sector each year."

Donor countries should ensure donated funds reach health workers

A news article in the BMJ this week (14 Jully) reports on the comments from Gareth Thomas, UK International Development Minister, to the UK parliamentary meeting on AIDS, TB, Malaria that donor countries should invest on HRH.

The article also cites recently released report from AMREF entitled People first: African solutions to the health worker crisis. The report proposes how UK and other donor governments should work to strengthen health workforce. Key recommendations include increase investment, working in partnership, involvements of local African governments. It also calls for African governments to follow their commitment to invest at least 15% of national budgets on health and to explore possibilities of task shifting as a mean to address critical shortages.