Welcome to the third world

This might be a good moment to look at the actual breakdown of countries most affected by the medical brain drain. As mentioned by far the biggest exporting countries are India, followed by the Phillipinnes and Pakistan. Of the top twenty donor countries contributing physicians to the US, only one (Nigeria) is from SubSaharan Africa, contributing less than 0.3% of the US total. The figures overall are much lower for Australia and Canada, but again South Africa is the only SubSaharan nation to make it onto the list. Furthermore none of these countries can be classified 'failed states' or subject to the kinds of extreme abuse of their citizens so colourfully identified by the opposition as the reason for their flight. The full list is published here: [http://content.nejm.org/cgi/reprint/353/17/1810.pdf] In reality, therefore, the primary cause of the medical brain drain is not, as the Opposition continue to assert, motivated by desperation, fear, extremes of poverty, crime or corruption, it is the mundane economic migration of Indians, Filippinos, Poles and Mexicans, Egyptians and Italians, looking to maximise their earning potential, rather than fleeing some despotic tyrannical regime. In practice, therefore compensating these countries for the cost of training doctors and nurses runs no risk of sponsoring corruption of the kind the Opp's febrile imaginations envisage. However, we would be prepared to run this risk, even if the donor countries were as the Opps imagine them to be, because we fundamentally disagree with their assertion that 'since a correlation can be perceived between transparency and GDP per capita, transferring resources from richer to poorer nations roughly amounts to transferring resources from less corrupt to more corrupt countries...' What would they have us do, then, transfer resources from poorer to richer? Opps next assertion is the pivot upon which, in our view, this entire debate turns: 'There is the direct link between bad governance and people migrating, now, if you add the plan of the proposition that incentives the brain drain, the situation will worsen because of a further deficit, as we explained in our 4th argument.' As the facts quoted above demonstrated the characteristic feature of the main donor nations in the medical brain drain is not bad governance, these are, in the main, mature democracies and stable sovereign states. Leaving this aside we now turn to the substance of the Opps entire case: that as they put it our plan 'incentives the brain drain..' '... as we explained in our 4th argument.' We went back to Opps 4th 'argument', and we have to say that the most persuasive thing about it is the assertion in the title (that our model 'exacerbates the brain drain'). But, of the 726 words dedicated to this issue, only 43 (contained in the penultimate paragraph) even address this subject at all. Here they are: Our model... 'motivates governments in poor countries to open their doors for doctors to leave, and eliminates the moral incentives of doctors to stay (because they may now think "Hey, the rich country paid for me to leave, I don't owe anything to my country anymore"). As we've said, in the status quo the door to doctors and nurses leaving is already wide open, that is the problem, you can't open a door twice, so our model has no bearing here. (Except, of course, in the Opps imaginary scenario where corrupt dictators force their medical trainees out of the country for the cash they elsewhere depict as derisory. We are prepared to live with this risk.) So, in effect, their entire argument boils down to the notion that requiring richer countries to compensate poorer ones for the cost of training medical personnel they recruit, 'eliminates the moral incentives of doctors to stay...' Even if this were true, and it doesn't give these fledgling medics a great deal of credit, but even if it were true that some less committed graduates would abandon their intentions to help the sick of their own countries simply on this account, this is only half of the equation - the supply half. But there are already more foreign doctors from poorer countries applying for training posts than there are vacancies in richer countries. In the UK, for example, there were three applicants for every training post and 20 for more desirable specialties such as surgery. [The Times, Feb 7, 2008] This is the reality of the labour market for medical personnel as things stand. When the British Government, after years of encouraging foreign medical graduates to apply for jobs in the UK through the Highly Skilled Migrants Programme, found it had more doctors than jobs, it attempted to rescind this legislation in order to protect the prospects of UK trained doctors. Who do you imagine challenged this move? The British Association of Physicians of Indian Origin, which argued (and won) in the courts for the rights of their physicians to work in the UK. These kinds of lurches from glut to shortage, from putting up tarrifs to creating incentives, are symptoms of market inefficiency crying out for exactlythe solution we advocate.