Countries Without Doctors?

How Obamacare could spark the brain drain of physicians from the developing world.

Forget about all the members of Congress who are supposedly about to suffer from "Obamacare" blowback in the mid-term elections. Forget about the deficit, the bureaucracy, and any other critiques you might have heard about President Barack Obama's health-care reform passed earlier this year. There's a far bigger consequence looming abroad: U.S. health-care reform will exact an excruciating cost on the developing world. Here's why: Tens of thousands of doctors are about to leave their home countries -- where they are often desperately needed -- to come to the United States to meet America's growing demand.

That's right: America is about to induce massive medical brain drain. The historic passage of health-care reform legislation in March will provide an estimated 32 million uninsured Americans with health insurance. But the United States will need to rapidly grow its supply of doctors and nurses to meet the demand that creates -- a fact that will surely attract qualified doctors and nurses to America's higher salaries, better working conditions, and promise of a booming industry. There's nowhere for those health professionals to come from but overseas; the domestic education system simply won't produce enough. Enter brain drain.

Even now, the United States relies heavily on foreign-trained health-care workers. A full quarter of practicing physicians in the United States and 28 percent of U.S. medical residents come from abroad. Of these, 25 percent were trained in India and Pakistan, countries with health-worker crises so acute that the World Health Organization includes them on its list of countries with a "Human Resources for Health crisis." Each country has a mere 1.13 doctors per 1,000 inhabitants, while the United States enjoys 13.22 -- one of the highest ratios in the world. Other developing countries have already lost more than half their physicians to the United States. There are more Ethiopian physicians practicing in Chicago today than in all of Ethiopia, a country of 80 million and Africa's second-most populous country. Put otherwise, the United States is importing health workers from countries where polio still kills and paralyzes children. It is, in a word, unconscionable, and Obama's health reforms will only make things worse.

Why does the United States need so many foreign doctors? In part because the country's medical and nursing schools are turning away tens of thousands of qualified applicants for lack of places and funding to accept and train them. These young Americans are forever shut out of six-figure jobs in one of the country's fastest growing and arguably most socially rewarding sectors. Reversing this trend would take years of building new medical schools, particularly in areas where there is already a shortage of doctors. Meanwhile, demand is simply growing faster than the supply of homegrown doctors and nurses.

Look no further than Massachusetts and its experience with health-insurance reform to see why U.S. demand for foreign health workers will increase. The state's health-care bill brought an additional 340,000 people into the insurance system, and demand for health-care workers subsequently rose beyond capacity. Waiting times for new-patient appointments with an internist increased 58 percent -- from 33 days to 52 days -- and half of Massachusetts's primary-care practices closed their doors to new patients, the highest level ever recorded. Massachusetts, one of the U.S. states with the highest number of primary-care physicians per capita, experienced these shortages upon expanding its insured population by only 5 percent (by comparison, most predictions say that U.S. health-care reform will increase the number of insured nationwide by a whopping 12 percent).








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