# Medical Training paid with service to stop Brain Drain **URL:** \ **Category:** Great Debates\ **Created:** [February 9, 2024, 3:34pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355 "2024-02-09T15:34:33Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 9, 2024, 3:34pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/1 "2024-02-09T15:34:33Z")
**The Democratic Republic of Sitnamia** is a poor African Nation. We have few natural resources to exploit and the only thing in abundance here is crime, illiteracy, and poverty. The IMF and G#'s sometimes toss us a couple of shekels worth of medical supplies every now and again and once and awhile an optimistic but egotistical do-gooder will volunteer through Doctors Without Borders or some such, but it’s all the same: Western Money buys Western Goods and Western Professionals to dump overflow on our shores to no lasting effect. We have a new medical school now but everyone we train in the medical field gets the hell out of dodge the moment they can to maximize their own return on investment for they and theirs. I get it, but it’s still a challenge. All this is why I, Sitnam Humble and Esteemed Dictator For Life, have made the call to change how medicine is practice and the training is paid for in our nation. _Sitnamia Medical School_ is free, to those that can pass the exam, and anyone can go to it (foreigners, migrants, our minority cultures) the catch is you pay either in installments or on a commitment bases and what you give is your time in a post somewhere in Sitnamia. Don’t know where, wherever we need you. The better the grades the more choice you’ll have so hit those books. Bonus points for learning obscure languages we will need. When this is all over, say, 10 years, they can go anywhere they would like, but the hope is also with a decade of their 20’s over they may be looking to settle down with a local wife/husband and not move on at all. Now if foreign governments want to help Sitnamia for the catchy soundbite on the evening news I will tell them they can! By donating to my school. What’s wrong with my perfect enlightened plan? ---
**Author:** ![Odesio](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/odesio/32/20003_2.png) [@Odesio](https://boards.straightdope.com/u/Odesio)\ **Post date:** [February 9, 2024, 3:43pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/2 "2024-02-09T15:43:48Z")
Wasn’t this the premise for that television _Northern Exposure?_ ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 9, 2024, 3:44pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/3 "2024-02-09T15:44:43Z")
Fleishman was a criminal and being posted to Alaska was punishment. This is an opportunity for smart kids with nothing but brains and a nation that needs them. ---
**Author:** ![Frodo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/frodo/32/302_2.png) [@Frodo](https://boards.straightdope.com/u/Frodo)\ **Post date:** [February 9, 2024, 3:45pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/4 "2024-02-09T15:45:51Z")
Seems like a good idea in principle to me, but I’d kibble with some details: 1. 10 years seems excessive 2. Do not give a choice of where to go to the better grades, that way lies inequality However the point on which everything will hinge is enforcement, how do you force the graduates to actually fulfill their service? may be hit them with a bill if they don’t? you’ll need to find them in foreign countries and somehow made them pay. The whole enterpise would probably flounder on that. ---
**Author:** ![griffin1977](https://avatars.discourse-cdn.com/v4/letter/g/977dab/32.png) [@griffin1977](https://boards.straightdope.com/u/griffin1977)\ **Post date:** [February 9, 2024, 3:46pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/5 "2024-02-09T15:46:36Z")
I think this is not hypothetical. My wife is Guyanese and has a large family both in the diaspora, and back in Guyana. A _very_ large percentage of them here in the US and in the UK are nurses or doctors (incluidng some who were actually trained in the soviet union while Guyana was allied with the soviet bloc during the cold war 🙂 ), those who are still in Guyana doing higher education are required to work in Guyana after they graduate (one of her cousins was even required to return to Guyana for a certain number of years after she graduated uni in the UK) ---
**Author:** ![Pork\_Rind](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pork_rind/32/111_2.png) [@Pork\_Rind](https://boards.straightdope.com/u/Pork_Rind)\ **Post date:** [February 9, 2024, 3:54pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/6 "2024-02-09T15:54:58Z")
> [@Sitnam](#): > > Fleishman was a criminal and being posted to Alaska was punishment. What? No, that’s not right. From Wikipedia, which aligns with my memories… > Joel Fleischman is a neurotic young Jewish physician from New York City. Fresh out of family medicine residency, he is legally contracted to practice medicine for four years in Alaska according to the terms of a student loan underwritten by the state. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 9, 2024, 3:56pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/7 "2024-02-09T15:56:26Z")
You’re right. Been a long time since I watched that show. Strange as I recall, wonder if it holds up. Most VHS recordings from the era do not. No one watching remastered Full House. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 9, 2024, 3:58pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/8 "2024-02-09T15:58:35Z")
> [@Frodo](#): > > Seems like a good idea in principle to me, but I’d kibble with some details: > > 1. 10 years seems excessive > 2. Do not give a choice of where to go to the better grades, that way lies inequality > > However the point on which everything will hinge is enforcement, how do you force the graduates to actually fulfill their service? may be hit them with a bill if they don’t? you’ll need to find them in foreign countries and somehow made them pay. The whole enterpise would probably flounder on that. We’ll have a sliding scale of training and commitment to pay for it. Obviously, we don’t need everyone to be Orthopedic Surgeons. The Midwife course only requires 2 years, you see. ---
**Author:** ![TriPolar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tripolar/32/3008_2.png) [@TriPolar](https://boards.straightdope.com/u/TriPolar)\ **Post date:** [February 9, 2024, 3:59pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/9 "2024-02-09T15:59:14Z")
There are federal and state programs to do this. [Paying for Medical School Through Service](https://students-residents.aamc.org/premed-navigator/paying-medical-school-through-service) > [@](#): > > Nearly 40% of graduating medical students in 2015 planned to participate in a program that would enable them to have a portion or all of their medical education debt forgiven in exchange for their service. These programs included Public Service Loan Forgiveness (PSLF), National Health Service Corps, Indian Health Service Corps, Armed Services (Navy, Army, Air Force), Uniformed Service (Centers for Disease Control and Prevention, Department of Health and Human Services), state and private loan forgiveness programs, and hospital programs (e.g., sign-on bonus). ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [February 9, 2024, 3:59pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/10 "2024-02-09T15:59:21Z")
Similar programs exist in the US to encourage doctors (and other health-care professionals) to work for government/non-profit orgs or in underserved communities. PSLF is one, but there are many programs: [Medical School Loan Forgiveness: 8 Programs for Doctors - NerdWallet](https://www.nerdwallet.com/article/loans/student-loans/medical-school-loan-forgiveness-programs) The enforcement mechanism is that you have a loan, and it’s repaid if you complete the service obligations. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [February 9, 2024, 4:05pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/11 "2024-02-09T16:05:43Z")
Sometimes [you have to be careful](https://mg.co.za/article/1998-02-06-the-angel-of-mercy-who-turned-out-to-be/) about foreign doctors willing to work in poor African nations. > [@](#): > > “We thought he was an angel of mercy come to save people when he first arrived, because we were so short of doctors,” said a Sister Hove. “But it was not long before we saw that this was not a very nice man. He turned out to be an angel of death.” ---
**Author:** ![What\_Exit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/what_exit/32/10652_2.png) [@What\_Exit](https://boards.straightdope.com/u/What_Exit)\ **Post date:** [February 9, 2024, 4:06pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/12 "2024-02-09T16:06:06Z")
That is completely wrong. A state program of Alaska paid for his education and he was obligated to work for 4 years in Alaska as I recall. This is a real thing with Nurses especially. Lots of programs that pay for the Ed in exchange for some term of service. My niece was in one of those. ---
**Author:** ![What\_Exit](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/what_exit/32/10652_2.png) [@What\_Exit](https://boards.straightdope.com/u/What_Exit)\ **Post date:** [February 9, 2024, 4:08pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/13 "2024-02-09T16:08:25Z")
**Moderating** Including myself: ## Drop the Northern Exposure sidebar. This is GD, not The Cafe or MPSIMS. ---
**Author:** ![Frodo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/frodo/32/302_2.png) [@Frodo](https://boards.straightdope.com/u/Frodo)\ **Post date:** [February 9, 2024, 4:08pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/14 "2024-02-09T16:08:50Z")
Here in Frodonia (a country that some insist in calling Argentina for some reason) what we did is to have very good (at least for south america) absolutely free universities and medical schools. That attracts people from neighboring countries who want to study, a surprising number of which then stay here. How long that will last now that we elected a libertarian president is anybody’s guess unfortunately. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 9, 2024, 5:13pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/15 "2024-02-09T17:13:25Z")
> [@What\_Exit](#): > > **Moderating** > > Including myself: > > ## Drop the Northern Exposure sidebar. This is GD, not The Cafe or MPSIMS. We can incorporate this. I was wrong about a tv show. Sitnamia will take the 90’s-cropped-mullet wearing New Yorker. We aren’t picky. If this IS a thing, and my OP thesis is already wrong, why hasn’t doing something like this program for any technical field stopped The Brain Drain? ---
**Author:** ![TriPolar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tripolar/32/3008_2.png) [@TriPolar](https://boards.straightdope.com/u/TriPolar)\ **Post date:** [February 9, 2024, 5:44pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/16 "2024-02-09T17:44:06Z")
> [@Sitnam](#): > > If this IS a thing, and my OP thesis is already wrong, why hasn’t doing something like this program for any technical field stopped The Brain Drain? Because you aren’t paying them enough to make it worthwhile. I’ll bet a medical degree in Sitnamia costs way less than here in the US. So they can move here, get paid premium rates, and have little debt. Why should they go back to Sitnamia? ---
**Author:** ![Horatius](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/horatius/32/3572_2.png) [@Horatius](https://boards.straightdope.com/u/Horatius)\ **Post date:** [February 9, 2024, 6:00pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/17 "2024-02-09T18:00:28Z")
> [@Sitnam](#): > > If this IS a thing, and my OP thesis is already wrong, why hasn’t doing something like this program for any technical field stopped The Brain Drain? Because you’re not stopping the Brain Drain, you’re just delaying it for however many years you require them to work for you. Once they cross that threshold, the forces that make working elsewhere still exist, and now they’re even better fits for the jobs - they have X years of real world experience on top of their educations. Trained professional will always be in great demand, and a lot of them will go where the money is. You could get more value by making the term of service longer, but in doing that, you also make the whole program less desirable. I’m sure there’s an optimum value of X that would maximize your value, but again, that just delays the brain drain. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [February 9, 2024, 8:18pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/18 "2024-02-09T20:18:32Z")
Seems like I’d extend it to not just physicians - I’d maybe create a Sitnamian Business School and invite top-notch faculty and then maybe extend some sort of break to entepreneurs who go to your school - tax breaks, guaranteed loans, grants, etc… for starting up new businesses in Sitnamia. Or whatever field you like; the point would be to grow the economy, which is something the doctor scheme might not really achieve. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [February 9, 2024, 8:38pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/19 "2024-02-09T20:38:37Z")
> [@Frodo](#): > > Seems like a good idea in principle to me, but I’d kibble with some details: > > 1. 10 years seems excessive My college roommate had her medical education paid for in return for going where Uncle Sam posted her. It’s one way the Federal government is trying to get doctors to severely under-served communities. Her term of service was 7 years so… 10 doesn’t doesn’t seem outrageously longer to me. And it’s a real world example of the concept, or one close to it. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 11, 2024, 3:23pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/20 "2024-02-11T15:23:46Z")
> [@TriPolar](#): > > > [@Sitnam](#): > > > > If this IS a thing, and my OP thesis is already wrong, why hasn’t doing something like this program for any technical field stopped The Brain Drain? > > Because you aren’t paying them enough to make it worthwhile. I’ll bet a medical degree in Sitnamia costs way less than here in the US. So they can move here, get paid premium rates, and have little debt. Why should they go back to Sitnamia? As I understand it, Cuba has many current issues but one area they do not struggle with is the quantity of nurses who can treat tropical diseases. They offer help to the US every time Yearly Surprise Big Wind comes only to be denied. They have achieved this result with a large pool of locally trained nurses in part by cutting through bureaucratic red tape and removing some quasi-medieval guild mindset gate keepers of Western Medicine. They can do this with the aid of restricted immigration on one end and social and financial controls of a dictatorial regime on the other. We can do it with cash incentives paid in work for labor that begins with little value but with communal effort grows for the betterment of all (I do these speeches all the time on Sitnam Radio, I could go all day). I don’t believe it is controversial to declare some measure of Residency faff is to ‘to separate the wheat from the chaff’. Do these kids want this enough? Can they work hard enough and remember enough? We can do that in a ‘Journeyman-like’ situation where they will learn on the job skills with the direct community they would have to help in an occupation. Look, think of the effort the US GOVT spends on training combat medics. We do that here, only with less bang bang and more heal. I am not advocating creating a workforce of unqualified quacks handing out pills after only hitting people with the reflex hammer, but as Most Serine Humble Dictator for Life I feel it is my duty to cut through SOME bullshit. People are dying. [Next page](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355.md?page=2)