Issues Involving the Recruitment and Placement of International Medical Graduates in the United States Matthew D. Taber William B. Stroube

Outline Brain Drain - Medicine (Physician/nurses) Other Professions - Eng/Science Migration Internal & External Migration Examples: USA and UK (data) Ethical Issues: distribution Economics: salaries, Government’s role International Efforts - UN, WHO

Brain Drain - Medicine (Physician/nurses)

Other Professions - Eng/Science

Migration

Internal & External Migration

Examples: USA and UK (data)

Ethical Issues: distribution

Economics: salaries,

Government’s role

International Efforts - UN, WHO

The Brain Drain What is the Brain Drain? “ the migration of scientists; the movement of highly skilled people to a country offering better opportunities” (Encarta.com)

What is the Brain Drain?

“ the migration of scientists; the movement of highly skilled people to a country offering better opportunities”

(Encarta.com)

Causes of the Brain Drain Better job opportunities Proper infrastructure needed A system of merit should be adopted (www.dawn.com)

Better job opportunities

Proper infrastructure needed

A system of merit should be adopted

(www.dawn.com)

Migration Factors Effects of Migration on Service Delivery Policy Recommendations Migration Data WHO EB114/5 (2004)

Factors

Effects of Migration on Service Delivery

Policy

Recommendations

Migration Data

WHO EB114/5 (2004)

Factors of Migration There are many factors that affect health professional’s decision to migrate These factors include: -better management of health services -continuing medical education training -conductive working environment -better and realistic remuneration WHO EB 114/5 (2004)

There are many factors that affect health professional’s decision to migrate

These factors include:

-better management of health services

-continuing medical education training

-conductive working environment

-better and realistic remuneration

WHO EB 114/5 (2004)

Effects of Migration on Service Delivery Loss of human resources can provoke a shortage Difficult working conditions, lack of equipment and supplies, and poor salaries Quality of education is declining WHO EB 114/5 (2004)

Loss of human resources can provoke a shortage

Difficult working conditions, lack of equipment and supplies, and poor salaries

Quality of education is declining

WHO EB 114/5 (2004)

Policy On Migration Developing countries experiencing extreme shortages need to intervene Individual rights to move but developing countries have no compensation for the loss of investment made in Ethical codes such as the Commonwealth Code of Practice for International Recruitment of Health Workers should be followed Trade agreements should be made WHO EB 114/5 (2004)

Developing countries experiencing extreme shortages need to intervene

Individual rights to move but developing countries have no compensation for the loss of investment made in

Ethical codes such as the Commonwealth Code of Practice for International Recruitment of Health Workers

should be followed

Trade agreements should be made

WHO EB 114/5 (2004)

Recommendations Establish and maintain information systems on human resources Use resources accrued for debt relief and used to augment salaries Strive to create a sociopolitical environment for provisions of health services that can easily contribute to retention Adopt and follow Commonwealth Code of Practice for International Recruitment of Health Workers WHO EB 114/5 (2004)

Establish and maintain information systems on human resources

Use resources accrued for debt relief and used to augment salaries

Strive to create a sociopolitical environment for provisions of health services that can easily contribute to retention

Adopt and follow Commonwealth Code of Practice for International Recruitment of Health Workers

WHO EB 114/5 (2004)

Migration Data India is the largest exporter of physicians to the U.S. -over 50,000 in U.S. currently Pakistan produces 4,000 med grads annually -6,424 left country in past 5 years Bangladesh 65% of new physicians get jobs abroad Migration of Nurses and other health workers U.S. and U.K. recruit significant proportion of nurses from lower income countries 80% of foreign nurses in U.S. are from developing countries China, India, and Pakistan have 99, 45, and 34 nurses per 100,000 of the population, still supply to U.S. Regional Health Forum – Volume 10, Number 1, 2006

India is the largest exporter of physicians to the U.S.

-over 50,000 in U.S. currently

Pakistan produces 4,000 med grads annually

-6,424 left country in past 5 years

Bangladesh 65% of new physicians get jobs abroad

Migration of Nurses and other health workers

U.S. and U.K. recruit significant proportion of nurses from lower income countries

80% of foreign nurses in U.S. are from developing countries

China, India, and Pakistan have 99, 45, and 34 nurses per 100,000 of the population, still supply to U.S.

Regional Health Forum – Volume 10, Number 1, 2006

Ethical Issues Distribution -is it right to take physicians away from medically underserved areas? -rural vs. urban

Distribution

-is it right to take physicians away from medically underserved areas?

-rural vs. urban

Government’s Role Immigration Law Licensing -USMLE Public Hospitals Public Health

Immigration Law

Licensing

-USMLE

Public Hospitals

Public Health

Immigration Law Nursing Relief for Disadvantaged Areas Act of 1999 Visas J-1 Waiver Visa H -1B Visa

Nursing Relief for Disadvantaged Areas Act of 1999

Visas

J-1 Waiver Visa

H -1B Visa

Licensing Credentialing All states in U.S. require all physicians to be properly licensed to practice medicine including those in residency or fellowship programs Physicians must be board certified in their field of practice (i.e. pass boards for pediatrics, radiology, internal medicine, cardiology, etc) Physicians also must pass one of the required medical exams: -Federation Licensing Examination -National Board of Medical Examiners -United States Medical Licensing Examination (http://www.workpermit.com/us/employer_h-1b_doctor.htm)

Credentialing

All states in U.S. require all physicians to be properly licensed to practice medicine including those in residency or fellowship programs

Physicians must be board certified in their field of practice (i.e. pass boards for pediatrics, radiology, internal medicine, cardiology, etc)

Physicians also must pass one of the required medical exams:

-Federation Licensing Examination

-National Board of Medical Examiners

-United States Medical Licensing Examination

(http://www.workpermit.com/us/employer_h-1b_doctor.htm)

Summary UN and WHO monitored issue for awhile The issue is a continuing concern to both countries losing and gaining medical personnel Individual efforts have also been involved This issue should be continued to be monitored globally

UN and WHO monitored issue for awhile

The issue is a continuing concern to both countries losing and gaining medical personnel

Individual efforts have also been involved

This issue should be continued to be monitored globally