How can developing countries get their doctors back?

When doctors from the developing world complete their residency programs in the US and UK, they rarely return home. In fact, they are often given strong incentives to stay: permanent-visa status and a valid license to practice medicine.

Low- and middle-income countries should thus provide more residency programs, and the US and the UK, which bear some responsibility for the current doctor-supply imbalance, should assist them with funding and know-how.

We also need to address the financial incentives that lure an unsustainably large number of developing-world doctors overseas in the first place, perhaps by obliging emigrating physicians whose home-country governments financed their medical-school training to pay the cost before allowing them practice medicine overseas.

Thus, doctors would become liable for the value of their subsidized training when they elect to work abroad.

This condition could be imposed through a well-constructed scholarship system that embodies the slogan: “pay it back if you don’t come back.”

Under this system, fewer students who intend to work permanently overseas will accept government subsidies, and more money will be available for students who wish to practice in their country of origin, or for investments in health-care infrastructure.

Trinidad has successfully implemented such a strategy – doctors who train overseas are required to return home for five years in exchange for their government scholarships – and the US has a similar program meant to encourage students to practice in particular geographical areas around the country.

At St. George’s University, where I am President and CEO, we have the CityDoctors Scholarship program, whereby New York City students who receive full-tuition scholarships to medical school must return to practice in New York City’s public hospital system for five years after their training. If they do not return, they must repay the scholarship as if it were a loan.

Medical-training programs in developing countries should also be considering how they can better direct future doctors toward meeting domestic needs.

Students overwhelmingly come from affluent backgrounds, which often means they are from the biggest cities. More should be recruited from rural areas – which often have the greatest shortages – and then be trained in the settings where they are most needed.

By broadening the geographical and socioeconomic talent base and identifying good candidates sooner, we could increase the likelihood that students will return to practice in their local communities.

We all have something to gain from globally sustainable medical-training practices, which will ensure that all countries’ health-care needs are met. For developing countries there is no other way forward.

By Richard Olds. This article was reproduced from Project Syndicate

Ed: Help us out. What is the percentage of Zimbabwean doctors now practising abroad? And how many physicians to 100 000 patients does Zimbabwe?

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