As with other professions, the international migration of doctors and nurses is growing. The OECD and WHO have tried, as far as is possible given highly inconsistent data, to track the presence of foreign medical personnel in developed countries. Recent data show just how extensive the use of foreigners has become in this area, with over one-quarter of doctors in the US, the UK, Ireland and New Zealand having been trained abroad. Moreover, existing data also suggest that the trend is accelerating: the US, Canada, Australia and Switzerland have all seen substantial growth in the arrival of new doctors.
Typically, these figures raise concerns about poaching by the rich of medical personnel from poorer countries. The situation is actually more complex. Within the EU, many of these professionals are from other European countries. In Germany in 2005, for example, over 40% of all foreign doctors were from other EU states, and most of these from the old EU15.
That said, a substantial percentage of foreign medical personnel in developed countries do come from developing nations. The impact can be striking, especially on small, very underdeveloped countries. According to a WHO report from 2006, the number of national trained doctors from a sampling of Sub-Saharan states working abroad represented an average of 23% of those working at home. As the report noted, “losing its workforce can bring a fragile health system close to collapse.”
Smaller countries often face the biggest problems—for some Caribbean island states the figure rises to 50%. The issue is important for larger ones as well, especially India (the largest exporter of doctors) and the Philippines (the biggest source of nurses). In 2004, the Philippines' National Institute of Health found that in the previous decade over 100,000 Filipino nurses had left to work abroad. The country has known it was training for export for some time, but this figure even included 3,500 doctors who had taken conversion courses in nursing in order to join the exodus. Meanwhile, there are more than 50,000 Indian physicians in the US—the group of foreign doctors in that country—which means that Americans have more Indian doctors per person than do rural Indians.
However, putting an end to this kind of migration would accomplish little. Aside from the issues of the personal rights of the practitioners, which must be balanced against their duty to those who paid for their education, the OECD estimates that if all the doctors trained in Sub-Saharan Africa returned home, it would address only 12% of the existing shortage in these countries. Instead, medical migration points to a bigger problem that requires a broader solution: everybody needs to invest in training more personnel.
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