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Public Health Ethics Advance Access published online on June 27, 2008
Public Health Ethics, doi:10.1093/phe/phn026
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The Author 2008. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org

Physician Brain Drain: Can Nothing Be Done?

Nir Eyal*

Harvard University

Samia A. Hurst

Geneva University

* Corresponding author: The Harvard University Program in Ethics and Health, 651 Huntington Avenue, 6th floor c/o HSPH, François Xavier Bagnoud Building Boston, MA 02115, USA. Email: Nir_Eyal{at}hms.harvard.edu


  Abstract

Access to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical brain drain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases and practice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries.


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