The 'Brain Drain' of Physicians: Historical antecedents to an ethical debate, c. 1960-79

Abstract

Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics.

Fellowship exit examination in orthopaedic surgery in the commonwealth countries of Australia, UK, South Africa and Canada. Are they comparable and equivalent? A perspective on the requirements for medical migration

“…International migration of healthcare professionals was initially recognized in the 1940s when medical doctors, mainly from Europe, emigrated to the UK (UK) and the USA (US) [1,2]. Common reasons for this migration movement included low wages, limited career opportunities and additional economic factors such as job security and professional development opportunities [1,3,4].…”

The dilemma of physician shortage and international recruitment in Canada

“…The top two 'source' countries of IMGs in the 1970s-United Kingdom (UK) and Ireland-have been replaced by South Africa and India (5,16,17). Parenthetically, the AIDS epidemic in South Africa has largely been attributed to a severe shortage of physicians due to 'brain drain' to developed countries including Canada and has fuelled global debates about whether it is ethically justified to recruit IMGs from countries which themselves are suffering from acute shortage of trained physicians (13,17,18). Further to this, in-migration of IMGs to Canada (and any other countries) is a multifaceted phenomenon.…”

Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives

“…1 Managing the inherent tension between these competing ethical principles requires leadership and effective health workforce management in both source and destination countries, but also a commitment by the latter to recognise the ethical imperatives of distributive justice (see below) that should not be sacrificed on the altar of expediency. An ethical perspective or lens, pointing to the need for an ethical response to the global inequities in health personnel distribution, was central to the WHO 2006 World Report 8,10 ; and is found in sociological analyses that suggest that recruitment and migration demonstrate that "the uneven global development of capital is at work. " 19 Aluttis et al, 6 discussing the consequences of market approaches, reported that there was an increase from approximately 40 to 270 companies engaged in international nurse recruitment in the United States between the late 1990s and mid-2000s.…”

“…Its consequences for the health systems of source countries became evident in a series of studies on the emigration of doctors from the United Kingdom, mainly to North America, published during the 1960s and 1970s. 8,9 The global scale and consequences of migration, in terms of the maldistribution of health workers, was synthesised in the 2006 World Health Report. 10 This report's statistics are still quoted 11,12 : 36 of the 57 countries with critical shortages are in Africa, which has 25% of the world's burden of disease, but only 3% of health workers worldwide and 1% of global economic resources.…”