<DIV>hi,</DIV>
<DIV>TIME FOR INTROSPECTION: I present both sides of the coin !!!!</DIV>
<DIV> </DIV>
<DIV>Courtesy: BMJ recent issues</DIV>
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<DIV>Warmth,</DIV>
<DIV>Anant.</DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV>
<H2>Recruiting doctors from poor countries: the great brain robbery? </H2></NOBR><STRONG><STRONG><FONT style="BACKGROUND: #ffffff; COLOR: #cc0000" color=#cc0000>Vikram</FONT></STRONG> <STRONG><FONT style="BACKGROUND: #ffffff; COLOR: #cc0000" color=#cc0000>Patel</FONT></STRONG>, </STRONG><I>senior lecturer</I></STRONG><SUP>1</SUP></NOBR>
<P><FONT size=-1><SUP>1</SUP> London School of Hygiene and Tropical Medicine, London WC1E 7HT </FONT>
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<P><FONT size=-1>Correspondence to: V <STRONG><FONT style="BACKGROUND: #ffffff; COLOR: #cc0000" color=#cc0000>Patel</FONT></STRONG>, Sangath Centre, 841/1 Alto Porvorim, Goa 403521, India <A href="mailto:vikpat_goa@sancharnet.in">vikpat_goa@sancharnet.in</A></FONT>
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<P><EM><FONT size=+1>An important impediment to achieving health for all in developing<SUP> </SUP>countries is the shortage of doctors and nurses. Can the NHS<SUP> </SUP>justify schemes to recruit staff from these countries?<SUP> </SUP>
<P></FONT></EM>
<P>An enormous gap in health staffing exists between the United<SUP> </SUP>Kingdom and India. India has fewer than 3000 psychiatrists for<SUP> </SUP>its one billion population compared with one psychiatrist for<SUP> </SUP>every 9000 people in the United Kingdom, a 27-fold difference.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF1">1</A></SUP><SUP> </SUP>Despite this inequality, the NHS has launched a scheme to recruit<SUP> </SUP>senior psychiatrists and other specialists from India and other<SUP> </SUP>developing countries. This scheme will worsen the brain drain<SUP> </SUP>and inequities in global health unless it is explicitly linked<SUP> </SUP>with measures to enable the flow of doctors back to developing<SUP> </SUP>countries.<A
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<TD bgColor=#eeeeee><FONT face="arial, helvetica" size=-1>Waiting for treatment: shortage<SUP> </SUP>of medical staff is an important barrier to health in India
<P>Credit:<SUP> </SUP>MARK HENLEY/PANOS PICTURES
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<P><FONT color=#63ceff size=+2><STRONG>Opportunities or opportunism?</STRONG></FONT>
<P>Overseas recruitment schemes are marketed primarily as an opportunity<SUP> </SUP>for doctors to experience one of the world's best healthcare<SUP> </SUP>systems. Yet it is obvious that the NHS is trying to fill jobs<SUP> </SUP>in specialties where there is a shortage of staff. Although<SUP> </SUP>shortages are acknowledged in the promotional material for the<SUP> </SUP>new NHS international fellowship scheme, the difficulties that<SUP> </SUP>doctors will face when they attempt to return home are ignored.<SUP> </SUP>Experience with previous schemes, such as the overseas doctors'<SUP> </SUP>training scheme, suggests that few doctors returned to their<SUP> </SUP>home countries. Indeed, when I finished my training in psychiatry<SUP> </SUP>in the United Kingdom in 1992, I found that few routes were<SUP> </SUP>available to facilitate my return to India.<SUP><A
href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF2">2</A></SUP> My work in developing<SUP> </SUP>countries over the past decade has been entirely funded by research<SUP> </SUP>grants, mainly from the Wellcome Trust.<SUP> </SUP>
<P><FONT color=#63ceff size=+2><STRONG>NHS international fellowship scheme</STRONG></FONT>
<P>Whereas earlier schemes recruited junior doctors, the new NHS<SUP> </SUP>scheme is taking highly experienced specialists, reflecting<SUP> </SUP>the changing requirements of the NHS. The international fellowship<SUP> </SUP>scheme invites psychiatrists, clinical oncologists, radiologists,<SUP> </SUP>histopathologists, cardiac anaesthetists, and thoracic surgeons<SUP> </SUP>to work in the United Kingdom for up to two years. Doctors will<SUP> </SUP>be paid a consultant salary and given up to £46 000 to<SUP> </SUP>assist with relocation and housing.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF3">3</A></SUP> Although the available<SUP> </SUP>materials do not specify how many specialists will be appointed,<SUP> </SUP>there have been over 400
applications in the first round, with<SUP> </SUP>psychiatrists accounting for the largest proportion of recruitments.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF3">3</A></SUP><SUP> </SUP>The promotional material includes a letter from the British<SUP> </SUP>prime minister inviting doctors to take up the new opportunities<SUP> </SUP>that are being created as a result of a "dynamic expansion programme"<SUP> </SUP>in the NHS.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF4">4</A></SUP><SUP> </SUP>
<P>Recruitment is being promoted using the obvious advantages the<SUP> </SUP>NHS has over employers in developing countries. The code of<SUP> </SUP>practice for international recruitment explicitly states that<SUP> </SUP>"there should be no NHS advertising in developing countries<SUP> </SUP>unless that country has specifically invited the UK to undertake<SUP> </SUP>a recruitment programme" and that recruitment "should only be<SUP> </SUP>undertaken as part of an inter-governmental cooperation agreement...<SUP> </SUP>encouraging the exchange of healthcare personnel, healthcare<SUP> </SUP>information, and guidelines."<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF5">5</A></SUP> The promotional material for<SUP> </SUP>the scheme does not indicate
that either condition has been<SUP> </SUP>met.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/926?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&author1=Vikram+Patel&searchid=1066638270332_771&stored_search=&FIRSTINDEX=0&sortspec=relevance&fdate=8/1/2003&resourcetype=1,2,3,4,10#REF4">4</A></SUP><SUP> </SUP>
<P>Apart from the immediate effects of the scheme on human resources<SUP> </SUP>in developing countries, the scheme could perpetuate global<SUP> </SUP>health inequalities for generations. Consider, for example,<SUP> </SUP>a country that must import expatriate doctors using scarce foreign<SUP> </SUP>exchange. Most doctors in developing countries have been trained<SUP> </SUP>in public funded medical schools. The cost of training is borne<SUP> </SUP>by the poor country and the rich country reaps the benefits.<SUP> </SUP>In effect, the people of poor countries are paying for the health<SUP> </SUP>care of those who live in one of the richest.<SUP> </SUP>
<P><FONT color=#63ceff size=+2><STRONG>Stemming the brain drain</STRONG></FONT>
<P>The opportunity to work in different societies is a rich experience<SUP> </SUP>with benefits that go beyond financial gains. There is no place<SUP> </SUP>for creating new barriers to the movement of peoples between<SUP> </SUP>countries. What is needed is an acknowledgment that institutions<SUP> </SUP>in developed countries have an ethical obligation to facilitate<SUP> </SUP>the return of health professionals to developing countries (box).<SUP> </SUP>
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<TD vAlign=top align=left bgColor=#ffffff><B>Requirements for ethical recruitment from overseas</B>
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<LI>Flexible<SUP> </SUP>training schemes that permit doctors from developed countries<SUP> </SUP>to work in developing countries<BR>
<LI>Long term partnerships, including<SUP> </SUP>funding and training, to strengthen the research, clinical,<SUP> </SUP>and teaching infrastructure of institutions in developing countries<BR>
<LI>Grants<SUP> </SUP>to enable returning doctors to establish personal and professional<SUP> </SUP>lives<BR>
<LI>Audit of the outcome of overseas doctor training schemes<SUP> </SUP>in terms of proportion of doctors who return home<BR></LI></UL>
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<P>Institutions in developed countries must engage with those in<SUP> </SUP>developing countries to facilitate an attractive environment<SUP> </SUP>for returning doctors to work in. Doctors from developing countries<SUP> </SUP>who go abroad to train and work have a key role in this process.<SUP> </SUP>The opportunity to choose the country we live and work in is<SUP> </SUP>the result of the opportunities that were available to us in<SUP> </SUP>the country of our birth. Doctors going to work overseas must<SUP> </SUP>search for ways to share their expertise and resources—for<SUP> </SUP>example, by partnering their new institutions with the ones<SUP> </SUP>in which they trained.<SUP> </SUP>
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<TD vAlign=top align=left bgColor=#ffffff><B>Summary points</B>
<P>The developing world has fewer doctors per population<SUP> </SUP>than developed countries
<P>Schemes to recruit doctors from developing<SUP> </SUP>countries risk damaging their fragile health systems
<P>Working<SUP> </SUP>and training in another country provides valuable experience
<P>Partnerships<SUP> </SUP>between institutions in developed and developing countries are<SUP> </SUP>needed to encourage doctors to return
<P>Institutions in developed<SUP> </SUP>countries need to reform to provide more rewarding professional<SUP> </SUP>environments
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<P>Institutions in developing countries must acknowledge that doctors<SUP> </SUP>leave not only for monetary gain but also to escape from stifling<SUP> </SUP>hierarchies and bureaucracies. In India, for example, doctors<SUP> </SUP>who want to attend scientific meetings often have to obtain<SUP> </SUP>a "no objection certificate" from the head of their institution.<SUP> </SUP>Promotions are more likely to be determined by the number of<SUP> </SUP>years of service than academic skills and achievements. Institutions<SUP> </SUP>must reform to allow professional environments to flourish by<SUP> </SUP>rewarding achievements—for example, by reducing routine<SUP> </SUP>clinical load and by providing alternative paths for career<SUP> </SUP>progression, honorariums, and training opportunities.<SUP> </SUP>
<P>Ultimately, all concerned parties need to define the obligations<SUP> </SUP>and responsibilities of institutions in rich and developing<SUP> </SUP>countries. Unless these steps are taken urgently, the brain<SUP> </SUP>drain will continue to fuel the huge inequities in global health.<SUP> </SUP>
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<A name=""><!-- null --></A>I thank Gauri Divan for the title of this article.<SUP> </SUP>
<P><A name=""><!-- null --></A>Contributors and sources: VP is a psychiatrist, originally from<SUP> </SUP>India, who is presently working on public health aspects of<SUP> </SUP>psychiatry in India as a full time researcher from a UK institution,<SUP> </SUP>funded entirely by a UK agency.<SUP> </SUP>
<P><A name=""><!-- null --></A>Competing interests: None declared.<SUP> </SUP>
<P><FONT color=#63ceff size=+2><STRONG>References</STRONG></FONT>
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<OL><A name=REF1><!-- null --></A>
<LI value=1><SUP></SUP>World Health Organization. <I>Atlas country profiles of mental health resources</I>. Geneva: WHO, 2001.<!-- HIGHWIRE ID="327:7420:926:1" --><!-- /HIGHWIRE --><SUP> </SUP><A name=REF2><!-- null --></A>
<LI value=2><SUP></SUP><STRONG><FONT style="BACKGROUND: #ffffff; COLOR: #cc0000" color=#cc0000>Patel</FONT></STRONG> V, Araya R. Trained overseas, unable to return home: plight of doctors from developing countries. <I>Lancet</I> 1992;339: 110-1.<!-- HIGHWIRE ID="327:7420:926:2" --><A href="http://bmj.bmjjournals.com/cgi/external_ref?access_num=10.1016/0140-6736(92)91010-6&link_type=DOI">[CrossRef]</A><A href="http://bmj.bmjjournals.com/cgi/external_ref?access_num=A1992GZ15600014&link_type=ISI">[ISI]</A><A href="http://bmj.bmjjournals.com/cgi/external_ref?access_num=1345829&link_type=MED">[Medline]</A><!-- /HIGHWIRE --><SUP> </SUP><A name=REF3><!-- null --></A>
<LI value=3><SUP></SUP>Goldberg D. The NHS international fellowship scheme for consultant psychiatrists. <I>Newsletter of the Faculty of General and Community Psychiatry</I> 2003;6: 5-6.<!-- HIGHWIRE ID="327:7420:926:3" --><!-- /HIGHWIRE --><SUP> </SUP><A name=REF4><!-- null --></A>
<LI value=4><SUP></SUP>National Health Service Careers. Opportunities for doctors in England: NHS international fellowship scheme, 2002. <A href="http://www.nhs.uk/fellowships">www.nhs.uk/fellowships</A> (accessed 22 Aug 2003).<!-- HIGHWIRE ID="327:7420:926:4" --><!-- /HIGHWIRE --><SUP> </SUP><A name=REF5><!-- null --></A>
<LI value=5><SUP></SUP>Department of Health. <I>Code of practice for NHS employers involved in the international recruitment of health care professionals</I>. London: DoH, 2001. <A href="http://www.doh.gov.uk/international-recruitment/codeofpract.pdf">www.doh.gov.uk/international-recruitment/codeofpract.pdf</A> (accessed 22 Aug 2003).<!-- HIGHWIRE ID="327:7420:926:5" --><!-- /HIGHWIRE --><SUP> </SUP></LI></OL><I>(Accepted August 7, 2003) </I>
<H2>Recruitment is ethical </H2>
<P></NOBR><STRONG>Debbie Mellor, </STRONG><I>head of NHS employment policy</I></STRONG><SUP>1</SUP></NOBR> </P>
<P><FONT size=-1><SUP>1</SUP> Department of Health, Leeds LS7 2EU <A href="mailto:international.recruitment@doh.gsi.gov.uk">international.recruitment@doh.gsi.gov.uk</A> </FONT>
<P>
<P>NHS international fellowships were launched by the Department<SUP> </SUP>of Health in February 2002 to give experienced consultants the<SUP> </SUP>opportunity to come and work in the NHS in England for two years.<SUP> </SUP>This is in addition to the campaign we launched in August 2001<SUP> </SUP>to recruit consultants and general practitioners from around<SUP> </SUP>the world into substantive posts. So far, 304 doctors have been<SUP> </SUP>recruited through the campaigns, 82 of whom come from India.<SUP> </SUP>
<P>Most doctors have been recruited as international fellows and<SUP> </SUP>are using the opportunity to sample living and working in England<SUP> </SUP>for a relatively short period. The feedback we have received<SUP> </SUP>shows that they value the opportunity to work in a different<SUP> </SUP>health system, acquire new skills, get wider work experience,<SUP> </SUP>pursue research interests, and develop their teaching skills.<SUP> </SUP>
<P>We operate an ethical recruitment policy, with all NHS trusts<SUP> </SUP>working to a code of practice approved by the Department of<SUP> </SUP>Health. We are committed not to recruit from a country if its<SUP> </SUP>government has any concerns about the effect on its workforce<SUP> </SUP>and work only with recruitment agencies that comply with the<SUP> </SUP>code of practice. This list can be obtained from the international<SUP> </SUP>recruitment website.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/928#REF1">1</A></SUP><SUP> </SUP>
<P>It is wrong to suggest that the health service is targeting<SUP> </SUP>health staff from struggling countries. Most of the staff we<SUP> </SUP>are recruiting come from Europe, with others from the United<SUP> </SUP>States and Australia.<SUP> </SUP>
<P><FONT color=#63ceff size=+2><STRONG>Working with developing countries</STRONG></FONT>
<P>We have worked closely with the Indian Ministry of Health in<SUP> </SUP>the development of the campaign in India, and it has been supportive<SUP> </SUP>of the opportunities we are offering doctors. The Indian minister<SUP> </SUP>of health and family welfare responded to a parliamentary question<SUP> </SUP>in July 2003 by saying that the overall availability of doctors<SUP> </SUP>in India is sufficient.<SUP> </SUP>
<P>We are working with India and other developing countries to<SUP> </SUP>support them in developing programmes to retain their staff.<SUP> </SUP>In some cases, we are assisting them in offering fixed term<SUP> </SUP>placements in the NHS as part of career planning for healthcare<SUP> </SUP>professionals.<SUP> </SUP>
<P>In addition, individual NHS trusts are putting a great deal<SUP> </SUP>back into developing countries. Much of this work is voluntary<SUP> </SUP>and receives little publicity. Many NHS volunteers spend considerable<SUP> </SUP>time and resources developing and providing diverse services<SUP> </SUP>in countries such as India, Ghana, Russia, Iran, and China.<SUP> </SUP>In India, for example, volunteers are providing services in<SUP> </SUP>mental health, leprosy prevention, neonatal resuscitation, women's<SUP> </SUP>health, sexually transmitted infections, and HIV.<SUP><A href="http://bmj.bmjjournals.com/cgi/content/full/327/7420/928#REF2">2</A></SUP><SUP> </SUP>
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<P><A name=""><!-- null --></A>Competing interests: None declared.<SUP> </SUP></P>
<P><FONT color=#63ceff size=+2><STRONG>References</STRONG></FONT>
<P>
<OL><A name=REF1><!-- null --></A>
<LI value=1><SUP></SUP>Department of Health. International recruitment agencies. <A href="http://www.doh.gov.uk/international-recruitment/agencylist-nhs-ref.htm">www.doh.gov.uk/international-recruitment/agencylist-nhs-ref-htm</A> (accessed 22 Sep 2003).<!-- HIGHWIRE ID="327:7420:928:1" --><!-- /HIGHWIRE --><SUP> </SUP><A name=REF2><!-- null --></A>
<LI value=2><SUP></SUP>Department of Health. Compendium of the NHS's contribution to developing nations. <A href="http://www.doh.gov.uk/internationalhumanitarianandhealthwork/">www.doh.gov.uk/internationalhumanitarianandhealthwork</A> (accessed 22 Sep 2003).<!-- HIGHWIRE ID="327:7420:928:2" --><!-- /HIGHWIRE --><SUP> </SUP></LI></OL>
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<TD align=left><FONT face=verdana,arial,helvetica,sans-serif size=+1><STRONG>The brain drain debate: Is it too simplified?</STRONG></FONT></TD>
<TD vAlign=bottom align=right><FONT face=verdana,arial,helvetica,sans-serif size=-1>17 October 2003</FONT></TD></TR></TBODY></TABLE></TD>
<TD noWrap><IMG height=17 src="http://bmj.bmjjournals.com/icons/spacer.gif" width=16> <A href="http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#38154"><IMG alt="Next Rapid Response" src="http://bmj.bmjjournals.com/icons/misc/grayDOWN.gif" border=0></A> <A href="http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#top"><IMG alt=Top src="http://bmj.bmjjournals.com/icons/misc/sectionTOP.gif" border=0></A> </TD></TR>
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<TD vAlign=top width=125><FONT face=verdana,arial,helvetica,sans-serif size=-2>Godwin S.K, <BR>Researcher <BR><EM>sree chitra tirunal institute for medical sciences and technology, Trivandrum, Kerala, India 695011</EM>
<P>Send response to journal: <BR><A href="http://bmj.bmjjournals.com/cgi/eletter-submit/327/7420/928?title=Re%3A+The+brain+drain+debate%3A+Is+it+too+simplified%3F">Re: The brain drain debate: Is it too simplified?</A><BR>
<P><A href="mailto:godwinsk@yahoo.com?subject=Re%3A+The+brain+drain+debate%3A+Is+it+too+simplified%3F">Email</A> Godwin S.K <BR></FONT>
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<TD><FONT face=verdana,arial,helvetica,sans-serif size=-1><!-- article ID: 327/7420/928 -->
<P>Dear sir,
<P>The article of Vikram Patel highlights the concerns of a sincere citizen of a third world whose country government spends a handsome amount of its already thin medical budget on training of medical professionals. But the argument that availability of doctors and health professionals itself will make health care accessible to all the population is another day light robbery. If it is so, why the city called Mumbai has 60 per cent of the doctors in the State, but only 12 percent of the State's population, because the nature of private practitioners is that they will be concentrating mostly on "islands of purchasing power". The reply by the Indian Minister about the "self-sufficiency" of doctors is also hiding the most unpalatable truth that large number of primary health centres and rural areas are starved of doctors as revealed by the government data.
<P>Let's go back to the brain drain issue, whether this outgoing professionals are going forever or coming back to their country and also how much monetary resources they are sending back to compensate for their "loss" to the mother country is a moot question? To find an answer to bring brain drain to halt is as difficult as making the "market" work for the poor. The controversy of "brain drain" in the articles is still standing at the periphery by saying that this can be cured by steps like intergovernmental agreements or conventions. The most important reason for forcing the third world professionals to fly out is, I feel, is the amasing difference in the nominal and actual purchasing power of the different currencies of the world in different countries. If we take an example by Vikram Patel, an amount of £46000 in U.K which a specialist can earn in one year is worth about Rs.3450000 in India,(£1=Rs.75 at current exchange rates)which is beyond the imagination of the same doctor,
had he/she practiced in the country of origin within, say, 5 years. That is also the reason why professionals are not migrating to those countries whose nominal purchasing power is low compared to the mother country, and unfortunately majority are third worlds. The theoretical reasons for jumping out of the counrty are not far to seek, as individuals are utility maximisers he/she will be looking forward to maximise his/her utility subject to the consraints of thier material and spirirtual relations or conceptions and the society's rules and regulations. From the point of view of an individual who had been on the boiling point of exams and frowning teachers, he/she wants to compensate the "loss" by earning and enjoying the maximum, which opportunity may not be available in third world countries, for which the third world heirarchical system is to be blamed for. It is also obvious that the professionals attach special weightage to other aspects of the work culture in developed
countries.
<P>The reason why the relative wages are high in developed countries is that their input prices like rent, cost of living etc are also high and that gets reflected ultimately in the compensation package through DA hike etc, which often does not take place in the third world where majority of the occupation is unorganised and non monetised. My point is that unless policies which do not take into account the difference in the real and nominal purchasing power of the currency, there is possiblity of further worsening the inequality. Intergovernmnetal agreements should take into account this factor while formulation of policies and there should be close monitoring by the authorities of the mother country over the migration of such highly qualified personnel and atleast the training cost plus some minimum costs of loss is to be recovered from the individual migrating abroad.
<P>Competing interests: None declared</FONT></P></TD></TR><BR>
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<TD align=left><A name=38154><!-- null 2 --></A><FONT face=verdana,arial,helvetica,sans-serif size=+1><STRONG>Ethical Recruitment</STRONG></FONT></TD>
<TD vAlign=bottom align=right><FONT face=verdana,arial,helvetica,sans-serif size=-1>18 October 2003</FONT></TD></TR></TBODY></TABLE></TD>
<TD noWrap><A href="http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#38026"><IMG alt="Previous Rapid Response" src="http://bmj.bmjjournals.com/icons/misc/grayUP.gif" border=0></A> <A href="http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#38176"><IMG alt="Next Rapid Response" src="http://bmj.bmjjournals.com/icons/misc/grayDOWN.gif" border=0></A> <A href="http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#top"><IMG alt=Top src="http://bmj.bmjjournals.com/icons/misc/sectionTOP.gif" border=0></A> </TD></TR>
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<TD vAlign=top width=125><FONT face=verdana,arial,helvetica,sans-serif size=-2>Andrew D Lawson, <BR>Hon Clinical Teacher, Medical Ethics Unit, ICSM <BR><EM>London W6</EM>
<P>Send response to journal: <BR><A href="http://bmj.bmjjournals.com/cgi/eletter-submit/327/7420/928?title=Re%3A+Ethical+Recruitment">Re: Ethical Recruitment</A><BR>
<P><A href="mailto:a.lawson@imperial.co.uk?subject=Re%3A+Ethical+Recruitment">Email</A> Andrew D Lawson <BR></FONT>
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<P>Editor- Am I alone in finding it laughable that the head of the NHS employment policy writes an article on the ethical nature of recruiting from developing countries and then declares "no conflict of interest?' This piece should be on the DoH website not in a peer reviewed journal.
<P>Competing interests: None declared</FONT></P></TD></TR><BR>
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<TD align=left><A name=38176><!-- null 2 --></A><FONT face=verdana,arial,helvetica,sans-serif size=+1><STRONG>Is the NHS recruitment policy really ethical?</STRONG></FONT></TD>
<TD vAlign=bottom align=right><FONT face=verdana,arial,helvetica,sans-serif size=-1>18 October 2003</FONT></TD></TR></TBODY></TABLE></TD>
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<TD vAlign=top width=125><FONT face=verdana,arial,helvetica,sans-serif size=-2>Sindhu Ashim, <BR>Specialist Registrar in Psychiatry <BR><EM>Royal Oldham hospital, Oldham, OL1 2JH</EM>, <BR>Bettadapura Ashim
<P>Send response to journal: <BR><A href="http://bmj.bmjjournals.com/cgi/eletter-submit/327/7420/928?title=Re%3A+Is+the+NHS+recruitment+policy+really+ethical%3F">Re: Is the NHS recruitment policy really ethical?</A><BR>
<P><A href="mailto:drsindhu@hotmail.com?subject=Re%3A+Is+the+NHS+recruitment+policy+really+ethical%3F">Email</A> Sindhu Ashim, et al. <BR></FONT>
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<P>Ms. Mellor states that the international fellowship scheme was launched for the purpose of providing experienced overseas consultants the opportunity to work in the NHS. (1) Surely then all specialties should be represented? It is very clear that the scheme exists to recruit to vacancies in the NHS for shortage specialities (like Psychiatry) so that trusts do not have to spend huge amounts on Locum cover.
<P>I do not think anybody, let alone the Indian Minister for Health, would believe that the British need 27 times more psychiatrists than the Indians do. Isn’t it clear to the head of the NHS employment policy that the Indian government’s position is farcical? The Indian Government’s position definitely does not provide moral justification for the scheme.
<P>It is ironic that the UK government invites doctors on one hand to manage shortages and on the other hand should support programmes to retain doctors in the developing countries. Any number of such programmes will not help a country that is deprived of thousands of doctors and nurses every year (over a thousand junior doctors enter the NHS each year through the PLAB exam alone).
<P>Ms Mellor speaks about the voluntary sector putting a 'great deal back into developing countries'. Can voluntary work alone make up for the amount of skill that is imported? Is this a fair exchange? Will the voluntary sector be able to provide healthcare for millions of people that these overseas doctors would have provided otherwise?
<P>I am shocked that the head of the NHS employment policy would put forth such futile arguments. It would be worthy of her to acknowledge the moral dilemmas and engage in developing solutions as suggested by Dr Patel in his article.(2) Dr. Patel presents a valid and balanced view of the current state of recruitment of overseas doctors. I also agree with Dr. Godwin’s view that health care policies which do not take into account the difference in the real and nominal purchasing power of the currency in the third world leads to a worsening the inequality.(3)
<P>References
<P>1.Debbie Mellor. Recruitment is ethical BMJ 2003;327:928
<P>2.Vikram Patel. Recruiting doctors from poor countries: the great brain robbery? BMJ 2003; 327: 926-928
<P>3.Godwin S.K. The brain drain debate: Is it too simplified? http://bmj.bmjjournals.com/cgi/eletters/327/7420/928#38026
<P>Competing interests: None declared</FONT></P></TD></TR></TBODY></TABLE><BR clear=all></P></DIV>
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