The International Physician Brain Drain

[dianahsieh]

By Paul from NoodleFood,cross-posted by MetaBlog

For some reason, far more physicians are choosing to come to the US from Canada, Australia, and the UK than the other way around:

From "The Metrics of the Physician Brain Drain", New England Journal of Medicine, Volume 353:1810-1818, Number 17, October 27, 2005. (The PDF version is here.)

The article does not state any conclusions about the factors that give rise to this result. Of course, my own guess is that the medical practice is relatively more free (i.e., less socialized) in the US than in those other three countries, thus making it a more desirable place for doctors to work and live.

http://ObjectivismOnline.com/archives/003198.html

[Tenure]

I'm very interested in this issue, because I recently discovered that the average General Practitioner (we're talking about the kind of Doc you go see in a regular walk-in clinic) earns 100,000 GBP (or 200,000 USD) per year. I'm trying to figure out what exactly it is that makes Doctors leave the NHS. I mean, it's a terribly bureaucratic system and that has it's own problems, but as a Health Service, it isn't that bad. I'm just wondering if you have any sites that link to the factors that explain why there is this huge shift towards America, which has less regulation - is the actual working place itself better?

[KendallJ]

I mean, it's a terribly bureaucratic system and that has it's own problems, but as a Health Service, it isn't that bad.

"isn't that bad" relative to what?

[Tenure]

Well, I was talking to a friend of mine, who often acts as an antithesis to anything I say, who was saying there was a recent report in The Economist on the NHS, showing that they were doing fairly well, considering cost-benefit ratios (i.e. they were getting their money's worth for what they spent on procedures and equipment). I have no idea how well grounded this study was.

I guess I should open it up as just a wider question: is there any good study of public healthcare, in the UK or otherwise?

[KendallJ]

I haven't read the study but look at the basis for the argument. It does not address the question at hand. When you ratio cost and beneift, you immediatley negate any discussion about the absoute magnitude of the cost, or the benefit, ie of price and supply.

One could be said to be getting your money's worth standing all day in a Russian bread line, as long as the bread was veeery cheap. However, this doesnt say anything about whether there is ample supply of bread or whether bakers can afford to produce and sell bread (or hell, even if they want to) at that price. Also, regardless of how much doctors make there, whether there are places that pay them more.

[Moebius]

The article does not state any conclusions about the factors that give rise to this result. Of course, my own guess is that the medical practice is relatively more free (i.e., less socialized) in the US than in those other three countries, thus making it a more desirable place for doctors to work and live.

Well considering all the other brain drain phenomenons in the past has been due to the fact that the US simply pays better, I would guess that physicians come to the US because they receive bigger pay checks. Other than that there is also the fact that the US is the most powerful nation on Earth and hence a desirable place for immigration considerations.

[KendallJ]

Well considering all the other brain drain phenomenons in the past has been due to the fact that the US simply pays better, I would guess that physicians come to the US because they receive bigger pay checks.

That is essentially saying the same thing.

Other than that there is also the fact that the US is the most powerful nation on Earth and hence a desirable place for immigration considerations.

Yeah, stick with your first assertion. People emigrate here because we are the most powerful? How about because we pay better.

[punk]

I'm very interested in this issue, because I recently discovered that the average General Practitioner (we're talking about the kind of Doc you go see in a regular walk-in clinic) earns 100,000 GBP (or 200,000 USD) per year. I'm trying to figure out what exactly it is that makes Doctors leave the NHS. I mean, it's a terribly bureaucratic system and that has it's own problems, but as a Health Service, it isn't that bad. I'm just wondering if you have any sites that link to the factors that explain why there is this huge shift towards America, which has less regulation - is the actual working place itself better?

I'll wager that most of the people moving are specialists and that specialists make more in the US than they do in those countries.

I don't believe general practitioners typically make quite that much in the US.

[Capitalism Forever]

as a Health Service, it isn't that bad.

Something tells me you've got private health insurance.

[aequalsa]

I'll wager that most of the people moving are specialists and that specialists make more in the US than they do in those countries.

I don't believe general practitioners typically make quite that much in the US.

That must be the case because it seems that general practitioners make about the same here as they do in England.

http://www.studentdoc.com/family-practice-salary.html

[Tenure]

Something tells me you've got private health insurance.

Eh, I'm on the NHS actually. I rarely get sick though, and the worst anyone in my family suffers from, is migraines. I guess the real test will be when it comes to actual serious illness or emergency aid. That said, my Grandmother died due to conditions and waiting times in an NHS hospital. The only real experience I have with the NHS so far is my Dentist really. And he's a really nice guy.

But yeah, your average GP gets paid the same here as he does in the US, which really makes me question: what is the attraction of the U.S? I'd also like to see this 'Brain drain' next to 'Brain drains' from other professions which are regularly imported/exported. Unless my maths is wrong, it's about 7% of Doctors shifting from the UK (that's not to the US, that's overall; the US figure is about a 1/3 of that). How many of those are GPs? How many specialists? How many nurses, actually? Because nurses are actually the ones who are really screwed over in the NHS - not Doctors.

Notice, also that almost as many Physicians go to the United Soviet States of Canada as the US from the UK. So again, I ask, what is it exactly that is the attraction? I mean, if it's a matter of certain specialists being paid more, thus attracting people to move to a country... well... that's not really in the brain drain, in any 'Shrugging' sense - that's just specialists going where they're more needed (i.e. paid more). If they weren't in such a high demand, they wouldn't go there. I think we need more corroboration here, to show that we aren't just dealing with supply/demand, rather than some eschewing of Socialised Medicine.

Addendum: I really wish this weren't the case, but with the spate of retards that flock to this board, it's become almost mandatory for me to now mark any critical posts with a 'I don't support Socialism/Religion/Bovril on toast' so I'm not mistaken for someone who's just trying to rattle bird cages for the hell of it.

This isn't me saying 'Hey, Socialised Health Care ain't that bad', I'm just saying, I would have appreciated Diana's post far more if she had corroborated her story with other sources and such. She says the creators of this graph don't state any conclusions, then proceeds to create her own (on what basis?) and then even titles the whole thing 'The International Physician Brain Drain', giving the false impression of what's going on here, or at the least, an ungrounded one.

Edited January 22, 2008 by Tenure

[KendallJ]

Addendum: I really wish this weren't the case, but with the spate of retards that flock to this board, it's become almost mandatory for me to now mark any critical posts with a 'I don't support Socialism/Religion/Bovril on toast' so I'm not mistaken for someone who's just trying to rattle bird cages for the hell of it.

This isn't me saying 'Hey, Socialised Health Care ain't that bad', I'm just saying, I would have appreciated Diana's post far more if she had corroborated her story with other sources and such. She says the creators of this graph don't state any conclusions, then proceeds to create her own (on what basis?) and then even titles the whole thing 'The International Physician Brain Drain', giving the false impression of what's going on here, or at the least, an ungrounded one.

You should put that in your sig. Disclaimer, I ain't no socialist!

[softwareNerd]

... your average GP gets paid the same here as he does in the US, which really makes me question: what is the attraction of the U.S?

If it true that both earn $200,000, then the U.S. one is probably better off. The last few years -- with the drop in the dollar -- might be anomalous; but, in general, $1 in the U.S. buys a better standard of living than does $1 in the U.K.

Notice, also that almost as many Physicians go to the United Soviet States of Canada as the US from the UK.

An important piece of data was missing from that article: i.e. how many of the physicians immigrating from the U.K. were already immigrants to the U.K. The article says that Indian doctors make up 12% of UK doctor population. I know of Indian doctors who preferred the U.S., Canada or Australia, but who immigrated to the U.K. if they got a position there (or if immigration proved easier). Some of them still see the other three countries as a more desirable destinations, and end up doing a second immigration.

I'm well aquainted with one such physician. So, next time I can, I'll ask him his reasons. However, if I were to guess, in his particular case he's making significantly more money here. He's a pediatrician, so that's still primary care, like a GP. After doing a stint in someone else's practice, earning an "average" doctor's pay, he launched out. He "hung up his shingle" (his words) in an area where a lot of new sub-divisions were coming up -- new families moving in. The first couple of years were difficult; but, now he has a good practice. If he were in the U.K., I don't know if he'd have a chance to do anything more than earn an average pediatrician's pay.

It definitely would be nice to see some research that actually went into reasons. Sometimes,. the non-quantifiable factors -- e.g. not having to report to an overseeing NHS bureacracy -- can be part of the motivation.

Edited January 22, 2008 by softwareNerd

[Inspector]

I don't believe general practitioners typically make quite that much in the US.

Oh yes they do. In fact that number must include rural docs, because it seems a bit small to me. But believe me: they earn it.

As just a small illustration - not that I think any of you doubt the above - a doctor must go through 4 years of undergrad (paying tuition), 4 years of med school (paying even more tuition), 3-5 years of residency (making basically minimum wage, given that they work 60-100 hours a week), and possibly additional years of fellowship before they start making that money.

Edited January 22, 2008 by Inspector

[Capitalism Forever]

That said, my Grandmother died due to conditions and waiting times in an NHS hospital.

I'm sorry to hear that. What clearer indication do you need that something is terribly wrong with the NHS? In other countries, this would be an absolute outrage, while in the U.K., it's business as usual...

[Tenure]

I think I see what you mean. It is business as usual to me. I honestly have never thought about it that much, since it just seemed one of those things that can happen in a hospital, not some worse case scenario. Are US hospitals that great, by comparison, that they don't have patients like my grandmother?

[Inspector]

I think I see what you mean. It is business as usual to me. I honestly have never thought about it that much, since it just seemed one of those things that can happen in a hospital, not some worse case scenario. Are US hospitals that great, by comparison, that they don't have patients like my grandmother?

They are much better than that, but are quickly sinking to that level as more socialism is shacked upon us.

[DarkWaters]

I think I see what you mean. It is business as usual to me. I honestly have never thought about it that much, since it just seemed one of those things that can happen in a hospital, not some worse case scenario. Are US hospitals that great, by comparison, that they don't have patients like my grandmother?

The U.S. hospitals are definitely much better than this. In fact, given the litigious nature of the United States, this would lead to a serious lawsuit.

[punk]

Oh yes they do. In fact that number must include rural docs, because it seems a bit small to me. But believe me: they earn it.

As just a small illustration - not that I think any of you doubt the above - a doctor must go through 4 years of undergrad (paying tuition), 4 years of med school (paying even more tuition), 3-5 years of residency (making basically minimum wage, given that they work 60-100 hours a week), and possibly additional years of fellowship before they start making that money.

Well my wife is a general practitioner so I have some idea what they make, and I say $200 000 is on the high end of what they typically make.

[Inspector]

Well my wife is a general practitioner so I have some idea what they make, and I say $200 000 is on the high end of what they typically make.

If you don't mind my asking, what area does she practice in? Is it fairly rural? I imagine it can vary a bit by region.

If you do mind my asking then please disregard.