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Repayment for Training as an Optimal Solution to Medical Brain Drain

In an earlier post I offered two arguments for why wealthy nations have a moral obligation to address medical professional brain drain from resource-scarce developing nations. But once one acknowledges that wealthy nations have this obligation, a question remains as to what the best way to fulfill that obligation is.

Some have suggested that the solution is for wealthy nations to train an ample amount of doctors in their home countries so that they no longer need to take talent from developing nations to make up for the gap. This idea has intuitive appeal. After all, it allows more medical doctors to be trained in wealthy nations like the U.S. and results in more doctors being trained overall (assuming that developing nations would continue to train the same amount of doctors under such a model).

And given that many resource poor nations spend their own limited resources to cover the majority of the medical training expenses for doctors within their own borders, it seems fair to back off so that these countries can reap the rewards of their investment.

Despite the good sense and intuitive appeal of this proposal, I think there is a better solution on offer. To see why this is so, consider that the current system of wealthy nations luring away top talent medical professional does come with some benefits to the sending countries. The higher salaries and access to greater resources and new technologies that the medical professionals gain allow the developing countries from which the professionals leave to obtain certain benefits. These benefits include remittance payments and time, training, and knowledge from the doctors who leave but who choose to give back to their sending countries while residing abroad.

A more modest point is that the system of training enough doctors at home, while not actively harming developing nations, isn’t doing anything to help them either.

Consider instead a training repayment system, where either the hospitals or governments in countries which foreign medical practitioners come to for residency or permanent positions provide a repayment fee to the developing nation for the cost of training that medical professional. On such a system if the medical professionals who choose to leave still choose to pay remittances or give back to their home countries in terms of knowledge, training, or time, those benefits are accrued in addition to the repayment benefits.

This gives developing countries a fair, structured return for their investment in training medical professional whom are now primarily serving populations that are much wealthier and better off. But it also leave open the door for the sending countries to receive the additional benefits provided by the workers themselves.

As former Kenyan health minister, Charity Ngilu put it “[w]e trained them, we spend our meager resources—they should pay back what we spent.” This is indeed something we could do and it seems that it’s something we should do.

Mark Satta

Mark Satta

Mark Satta is an Assistant Professor of Philosophy at Wayne State University. He holds a JD from Harvard Law School and a PhD in Philosophy from Purdue University. His research interests include First Amendment law, health law, bioethics, and epistemology. He was a 2018-2019 Student Fellow at the Petrie Flom Center, where he completed a project entitled, "Spitting at Science: HIV Criminalization Laws and the Duty to Legislate in Accordance with Current Scientific Knowledge."

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