ICYMI – Douglas Todd: Canada’s thirst for foreign-trained doctors leads to brain drain from poorer countries

Important consideration and a reminder of our largely self-interested immigration program:

It’s frustrating for many Canadians to lack access to a family physician.

And politicians understand the discontent.

That’s why B.C. Premier David Eby, Ontario Premier Doug Ford and others have been announcing they want to address the national health-care “crisis” by smoothing the way for potentially thousands of foreign-trained physicians to work in Canada.

However, while such a push will create some winners in Canada, there will be some losers: The people in countries that the physicians leave behind. Those who end up having to saying goodbye to the homegrown physicians their tax dollars paid to train tend to be in low- and moderate-income countries.

It’s an ethical dilemma, inherent in globalization, that virtually never gets mentioned in Canada.

The self-interest shown by Canadian politicians, and much of the public, in wooing offshore-trained physicians overrides the needs of the citizens of countries that produce them, which tend to have a far lower supply of doctors.

Of course, many internationally trained physicians are hungry for the chance to practise in Canada. One study showed 60 per cent of physicians taught in Pakistan, for instance, want to use their skills in another nation, with most citing how it would be more satisfying and lucrative.

The World Health Organization is trying to address the “geographic maldistribution” of health care workers.

It has developed a global protocol for the international recruiting of health personnel, which attempts to limit the often-detrimental effects of the brain drain. But while the WHO “strongly encourages” all nations to follow the code, it’s voluntary.

In effect, say some, needy countries that lose their health-care workers to places like Canada are providing an inadvertent aid program to richer nations.

It’s a poignant problem, including at a personal level. One of my friends, raised in Zimbabwe, trained as a physician in Africa, immigrated to Canada and had his abilities validated here. He rose high in medical ranks, offering his exceptional care to thousands of Canadians.

Recognizing his good fortune, he frequently returned to Africa to temporarily provide medical aid. Despite that, he was painfully aware he had, in effect, won the immigration lottery, which countless other Africans without adequate health care had not.

A major Canadian study of hundreds of foreign-trained physicians bluntly concludes: The “brain drain has obvious negative consequences” on low-income and middle-income countries.

The often-struggling nations not only lose crucial health-care workers, many of the migrating physicians themselves end up victims of so-called “brain waste,” according to the report led by the University of Toronto’s Aisha Lofters and others.

Since many foreign-trained doctors have run into far more barriers to actually practising medicine in Canada than they expected, they began to lose their skills and, when they returned to their homelands, were not as effective in providing health care.

While the survey was conducted before B.C. and Ontario promised this year to streamline the approval protocol, they authors of it warned “high-income countries like Canada need to ensure that the immigration process clearly outlines the relatively low likelihood of obtaining a career in medicine after immigration.”

The ideal, according to the World Health Organization, would be for all countries, rich and poor, to educate their own physicians and medical workers to meet their nation’s own needs. While the WHO doesn’t call for a ban on recruiting foreign-trained doctors, at the least it wants the process to be less misleading.

The issue of foreign-trained physicians ties into the larger challenge of the brain drain, which University of Oxford economist Paul Collier spells out in his book, Exodus: How Migration is Changing Our World.

A specialist on Africa and other developing regions, Collier understands the complexities involved when rich nations welcome the most-educated inhabitants of poorer countries.

He starts with some upsides. One is that people who emigrate to a richer country often send money back home. Their remittances can be a huge benefit to left-behind families. That’s the case despite studies showing the wealthiest emigrants send home the least money.

In addition, says Collier, successful emigrants “become role models to emulate.” They encourage more people in their country of origin to aspire to an education. Since some of those newly educated people don’t end up departing their homelands, it can improve local economies.

A disturbing side-effect, however, is that when too many trained people leave poorer countries, it can cause governments to put less money into public schooling, Collier says. In an extreme case, Haiti, 85 per cent of the educated class have already departed, many for Quebec and Ontario.

Overall, the brain drain from poorer countries causes Collier to conclude the global case for compassion does not lean so much to Canadian citizens ending up, in large part because of population growth, without a family physician

The strongest moral onus, in many cases, is on rich countries to do more to educate people in poor countries who will stay home.

There are ways that could be done, separate from countries restricting how many people can leave. Delanyo Dovlo, the WHO’s representative to Rwanda, suggests all countries contribute to incentives, such as improved working conditions, to encourage health-care workers to practise in their home countries.

The WHO also emphasizes training more people to provide health care in rural areas, because they are less likely to migrate away. Lisa Nguyen, of the University of Washington’s medical school, maintains financial encouragement should be offered to expatriate physicians to return home.

In general, WHO offers the common sense advice that nations, including the likes of Canada, should “strive to meet their health personnel needs with their own human resources, as far as possible.”

Such national self-reliance might not be the cheapest route for governments, which will have to educate more doctors, but it points to a long-term solution.

Source: Douglas Todd: Canada’s thirst for foreign-trained doctors leads to brain drain from poorer countries

About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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