# 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:** 7\ **Page:** 2
**Author:** ![FlikTheBlue](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fliktheblue/32/10972_2.png) [@FlikTheBlue](https://boards.straightdope.com/u/FlikTheBlue)\ **Post date:** [February 11, 2024, 5:19pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/21 "2024-02-11T17:19:14Z")
> [@Frodo](#): > > 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. They could refuse to send certified diplomas and transcripts to any foreign medical board where one of their new graduates was applying for a license to practice medicine. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 12, 2024, 5:07am UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/22 "2024-02-12T05:07:42Z")
> [@Sitnam](#): > > What’s wrong with my perfect enlightened plan? Keeping to the specific of the insufficient number of providers in Africa for the need. Human Resources for health leaving Africa is definitely part of it (brain drain) and so is the relative paucity of medical schools. The region is producing too few and many of the professionals they create leave. Investing in the educational infrastructure that produces healthcare professionals, which your plan calls for, is part of any needed solution, but funding it is another thing. Then there is the why they leave. It isn’t only that they want to make more money elsewhere. Although incredibly poor pay is on the list, along with poor conditions, poor support, a lack of mentorship, poor infrastructure… > **[Down the brain drain: a rapid review exploring physician emigration from West...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294534/)** > > The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the “brain drain”, has been a topic of discussion in global health spheres for years. With the call ... Hard to know where X dollars would be most effective? But X is very finite. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 12, 2024, 5:39pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/23 "2024-02-12T17:39:20Z")
From DSeid’s link above: > ### Results > > A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs’ recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs. > > ### Conclusions > > The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain. If I may summarize with notes in parentheses: **Reasons Sitnamia Doctors Leave:** - Poor working conditions and poor pay - Limited career opportunities for Doctors in Sitnamia or else ware with the training they receive at my school - Low Standards of Living in Sitnamia - Socio-Political Unrest **Implications:** - Few Doctors - Weak Health Care System (So far we are firmly in, ‘No shit, Sherlock’ territory.) **Recommendations:** - Develop Policies so the 1st World stops hiring good hardworking qualified people who trained in the 3rd World. (Uh? Temporarily? Hope there is a follow-up to this.) - Figure out ways for the 1st World governments to financially compensate 3rd World governments. (Yeah, that’s the rub my chum) - Collaborative educational opportunities. (What?) - 1st World doctor livestreaming (Are yeah fucking kidding me?) ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 12, 2024, 5:52pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/24 "2024-02-12T17:52:44Z")
Actually I have elsewhere heard of telehealth for specialty consultative care at least, and the use of a not distant generation special focus generative AI to provide some basic advice and appropriate triage, as ways to leverage their in person human health resources most effectively. As good as having many more well trained in person providers with enough time and resources, no, but orders of magnitude better than trying to stretch out extant resources far beyond what is in the realm of the possible. Having all of more schools producing more providers at all levels, better pay and working conditions, and a relative requirement to stay (be it to pay off the education with public service in country or by other barriers), addressing the multiple push and pull factors, would be nice. But few of these countries can afford all of the items even with international help. Doing less than all is not likely enough. How well these items translate to rural America shortages and to other regions is also an interesting question. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [February 12, 2024, 6:06pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/25 "2024-02-12T18:06:15Z")
During COVID I had an impacted tooth and had to live stream a doctor visit to get a prescription for penicillin. This was an ordeal despite the fact I have a college education, we both spoke the same language as our first and she was stationed at her desk two miles from me. If this is meant to be anything like a solution for the dire needs of the people of Sitnamia I laugh heartily and your suggestion, sir. Indeed, I laugh heartily. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 12, 2024, 7:01pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/26 "2024-02-12T19:01:44Z")
Well the reality in this context is not quite the same as your circumstance, and is in active roll out for many areas of rural America with poor specialist coverage. A single tertiary care level specialist consultant can utilize more secondary or primary care level providers as their eyes and ears and hands, as well as having telemetry data and videoconferencing capacity, across a wide geographic swath and in a fairly efficient manner. A limitation in the African context is the information system infrastructure being up to the task but that is getting better. AI support may also be of benefit. Not quite yet but possibly quite soon, less time than it takes to get through medical training anyway! ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [February 13, 2024, 3:53pm UTC](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355/27 "2024-02-13T15:53:56Z")
Interestingly enough Nigeria does currently have a one year period of compulsory service before completing residency and recently had proposed a five year compulsory period after training. Proposed without otherwise adding any inducements. > **[Medical students reject Reps’ proposed five-year compulsory service](https://punchng.com/medical-students-reject-reps-proposed-five-year-compulsory-service/?amp)** > > The Nigerian Medical Students Association has opposed the Medical and Dental Practitioners Act (Amendment) Bill, 2022, which seeks to make it compulsory for graduates in medical and dental fields to render services within Nigeria for five years... [Previous page](https://boards.straightdope.com/t/medical-training-paid-with-service-to-stop-brain-drain/997355.md?page=1)