While India may be lavishly spending to nurture medical graduates, they turn up practicing in the US causing financial loss to the country, says a new study.
The study by researchers from Stanley Medical Research Institute in Maryland, US, compared the investments made by lower-income countries like India and the Philippines in training medical graduates with the financial losses the countries face when these graduates serve in other countries.
They found more than 48 per cent (1,28,729) of all medical graduates (2,65,851) practicing in the US are from lower-income countries that have the least adequate health systems in the world. The numbers of these graduates serving in the US have increased from 10 per cent in 1965 to 32 per cent in 2012. About 41 per cent of these physicians are from India, 16 per cent from the Philippines and 10 per cent from Pakistan.
The cost of training one medical graduate in India is US $35,000, according to a report Commission on Education of Health Professionals 21st century. India has spent around US $1,850.6 million on 52,874 medical graduates who were practicing in the US in 2010, estimates the study published in the March 2012 issue of PLoS One.
Butterfly effect
In addition to the financial losses, the lower-income countries also lose role models for young people, mentors for physicians in training, employment for health service workers who would have been employed by the physician, and the physician’s medical services. “At the same time, loss of physicians by lower income countries makes it much more difficult for such countries to improve people’s health,” the authors write.
However, these medical graduates are beneficial to the US because they are more likely to be generalists, as opposed to specialists and practice in non-urban, primary care shortage areas, the study says.
“Physicians migrate to other countries for many reasons, including better salaries, working conditions, living conditions, safety, opportunities for advancement and participation in research,” write the authors.
The study notes that even though most of the lower-income countries get health-related aid from the US, it does not meet the losses incurred by these poor countries.
In 2010, India received US $87.2 million from the US as health related aid, bringing down the financial loss to US $1,763.4 million, notes the study.
Recognising that migration of medical graduates to the US and other countries for better opportunities is a worrying trend, Vinay Aggarwal, former president of the Indian Medical Association, the biggest association of doctors in India, says, “The trend is slowly changing. Earlier full batch of medical graduates used to migrate to other countries, but with improved infrastructure and mushrooming of corporate and multi-specialty hospitals, doctors are finding opportunities here.”
Meanwhile, concerns have been expressed by the US Institute of Medicine, the World Health Organization and independent commissions regarding the effects of physician losses on lower-income countries. Collaboration of international centres of excellence with the institutions in poor countries is one of the proposals being floated to retain medical graduates in their countries of origin. These partnerships could help develop the capacity of medical schools in lower-income countries and provide job and research opportunities, suggests the study. African countries have already partnered with leading American and Canadian medical schools to prevent brain-drain.