The Metrics of the Physician Brain Drain

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Abstract
As African physicians who have experience in both the developing and the developed worlds, we believe that Mullan (Oct. 27 issue),1 like others who have written about the metrics of the physician brain drain,2 overlooks three important points. First, given the limited number of residency positions in the source countries, if the migrating physicians who are described in this article had stayed home, they might not have attained the qualifications they now hold. This would have left a workforce of minimally trained doctors with even fewer jobs befitting their qualifications. Second, a reversal of the “fatal flows” of doctors from poor to rich countries, as touted by Chen and Boufford in the accompanying editorial,3 would not necessarily lead to an effective increase in the number of practicing physicians, given the unequal geographic and socioeconomic distribution of physicians within source countries. Anecdotally, we know many such physicians who, out of frustration, have left medicine altogether. These internal losses buttress our third point: the real effects of physician migration cannot be captured by static (stock-of-manpower) indicators.4 We need to quantify the effects on flows and distribution of physicians within the source countries. These countries must actively contribute to crafting ethical and effective solutions. We hope that the World Health Report 2006 will encourage such developments.5