Thoughts on the brain drain

First of all, thanks to all who came to the fundraising dinner on Saturday night! We had a great time and hope that you did as well. Thanks also to Dr. Ansa for delivering an excellent keynote address.

I wanted to offer some thoughts on the so-called "brain drain," which we began discussing a little bit at the dinner during Dr. Ansa's Q&A. As a disclaimer, I'm not an expert on this issue, nor have I done any research on the topic. Allison and I have, though, had a few first-hand discussions about the topic during our time in Ghana.

For those who were not present at the dinner, I'll give a little background. "Brain drain" is defined by Wikipedia as "human capital flight" or more specifically, "the large scale emigration of a large group of individuals with technical skills or knowledge" (Accessed 4/30/12). Many young doctors leave developing nations to pursue additional training or higher incomes in developed countries and end up staying there. This has led many to believe that policies and incentives need to be set in place to encourage young physicians to stay in their countries of origin. That being said, the issue is quite complex and there is no simple solution.

I have two observations in particular that I want to add to this conversation - one comes from a conversation in Ghana and one comes from my origins in rural Virginia.

First - it is easy to look from the outside and say to the ex-pat professional, "You should go back home to serve your people." However, in one conversation with our friend Gideon in Ghana, we learned that the families of these professionals often want, even demand, that they stay in developed nations to earn higher incomes, send money back home, and provide a connection for future family members to earn citizenship in the developed nation. These family pressures are enormous. Ghanaian people grow up calling their cousins their brothers and sisters and calling their friends' parents aunt and uncle. Once one "makes it" to another country the demands of providing for people back home are extensive and this essentially requires the individual to stay in the developed country.

The second thought I will offer is this: Do we apply the same standard to graduating doctors in the US? I am from rural southwest Virginia which is a medically underserved area, but there seems to be no requirement that I go back there to practice. The same can be said of other professions - there are fewer lawyers, engineers, and health professionals in rural areas all over the US. The problem of professionals moving to urban areas is an old one. Fortunately, in the States there are programs and policies in place to encourage individuals to take their professional skills to rural areas.

Few would argue with the idea that there is a moral imperative in within medicine to serve the poor/underserved. However, I think the issue of "brain drain" brings up a finer question - is there a moral obligation to serve the poor/underserved who are in/from one's home area? That is a complex question that deserves a thoughtful and nuanced answer that I won't attempt here. IF it were true and taken very simply, though, it seems it would render international aid programs (such as R4G!) morally wrong, because we would not be able to proceed to help people in other countries until everyone in our country had been helped (there are areas of the US that are just as poor as developing nations).

Ghana (and many other countries) have actually adopted a policy that implies a moral obligation that all people ought to serve in rural/underserved areas, at least for a time - the National Service. Through this program, high school and college graduates are matched to rural/underserved areas to teach in schools, work on government projects, and promote health programs. Though the program does not apply to physicians, it is at least addressing the key structural issues that will combat disease through prevention.

Broadly speaking, there are noble reasons to want to return to one's home area and serve. However, it seems there could also be noble reasons to go away from one's home area and serve. There is a place for government policies that encourage people to go to the areas that have the most need. But I think that ultimately, the individual should assess his/her skills, gifts, talents, abilities, and passions, and through personal reflection, advice from trusted associates, and prayer/meditation, decide where he/she should serve.