Immoral for rich countries to benefit from immigration?

[madd0ct0r]

listening to http://www.bbc.co.uk/programmes/b03nbsgd

Some interesting points, with one being raised that it's immoral for the UK to recruit trained health workers from poor countries, as it harms the people in the poor country more than it helps.

[Simon_Jester]

This boils down to the 'brain drain' question, and the main complaint I have against that is that I've never heard of a satisfactory way to solve it. If a physician trained in India would rather move to the US or Britain and enjoy a higher standard of living than is possible in India, how exactly do we stop him?

I am, at least, supportive of the idea that developed countries should work harder to train the technical specialists they need out of their own population. At a time when unskilled labor in the First World is drying up, we really should be enthusiastic about expanding our supply of doctors, along with any other educated profession unlikely to be replaced by automation.

[Eternal_Freedom]

As nice as it would be for more people to become doctors (for example), not many people are wired that way. Yes, it's a job with a very attractive salary, a nice title and a great deal of respect, but not everyone can do that job.

Yes, it would be fantastic if (for instance) the UK could fill all it's consultant, surgeon, GP, etc. posts with British-trained British citizens. But it just won't happen, no matter how attractive you make the job. And it's pretty damned attractive to start with.

[mr friendly guy]

As Simon said, it comes down to the brain drain. However a Doctor moving from Australia to work in the US most probably isn't causing as much "harm" to Australia as say a Doctor moving from Pakistan to a developed nation. The "harm" would be disproportionate because Pakistan has relatively lower standard of living, healthcare etc vs Australia. For a developing nation with a high number of trained doctors, eg Cuba, India, this most probably isnt' that harmful.

Someone once said he didn't mind Australians going overseas to work, as long as most of them come back. The idea behind that is they gain experience and bring the expertise back to the country. To that end, when developing nations become richer, they may be able to attract ex pats back to their country who can then bring their new found experience to strengthen the developing country. An example of a country trying (and having some success) with doing this is the PRC. Unfortunately in the interim, its a problem for the developing nation.

[Simon_Jester]

As nice as it would be for more people to become doctors (for example), not many people are wired that way. Yes, it's a job with a very attractive salary, a nice title and a great deal of respect, but not everyone can do that job.

Yes, it would be fantastic if (for instance) the UK could fill all it's consultant, surgeon, GP, etc. posts with British-trained British citizens. But it just won't happen, no matter how attractive you make the job. And it's pretty damned attractive to start with.

Perhaps we should stop and rethink how we handle the profession then. Could the job be altered a bit, so that more of it can be done by a broader class of people? Could altering the educational system make it easier to create the kind of people who consider becoming a doctor, so that even if 5% of well educated people become doctors the total number still increases? Could the way we train doctors be altered so that we wind up with more people who actually know how to do it, while putting those people through less pain/stress/paperwork?

I mean seriously, this is a problem throughout the developed world already and is only going to get worse over time. The only class of jobs which have survived the economic transition of the last 30 years without getting worse pay or reduced employment are the highly educated ones. If we have a situation where demand for a highly educated type of worker (doctors) is increasing, then it's a matter of common sense to think about how we can train people in our society to help fill that demand, not just rely on immigration to do it for us.

[Deebles]

It's a bit more complicated than just needing to train more people at medical school...

After successfully graduating medical school (under the current system in the UK), new doctors enter a "foundation" post. There has been a bit of a shortage of such posts for the last few years, and it looks like this year, there will yet again be not quite enough of these for those students currently graduating who wish to remain in medicine (there's some attrition to research and to the city). Partly this is because trusts under current funding squeezes, PFI repayment burdens etc. are looking to budget wherever they can. To manage this shortage of posts, the British gvt is currently restricting places at medical school (med students are very expensive to train). So it looks like the brain drain's only going to get worse.

One thing to note about the brain drain, however, is that it's very unequal across different specialities. After the foundation programme, doctors start to specialise one way or another. Popular specialities are capable of being filled pretty well by new doctors from within the UK. Those that are less popular, however, tend to recruit more from abroad.

(And the UK also experiences a certain brain drain, because Canada, Australia, and various other countries pay doctors more and give
them better hours).

Could the job be altered a bit, so that more of it can be done by a broader class of people?

Actually, something like this has been done by many developing countries (through various systems pioneered by Tanzania, China and other countries), who've focused on training a large number of healthcare professionals to do the basic diagnosis and treatment of anything very commonplace that comes through the doors. Only when these first-line healthcare workers are stumped do patients go on to see a doctor, and that way, you need many fewer doctors. Such training is a relatively cheap and easy process to set up and participate in, and the qualifications that they provide the firstline workers with aren't enough to give them marketable skills in the West, so you get much less brain drain.

Could altering the educational system make it easier to create the kind of people who consider becoming a doctor, so that even if 5% of well educated people become doctors the total number still increases?

The problem isn't the number of people who'd like to be a doctor, either. Plenty of students with straight As at A-level never make it into medical school.

Could the way we train doctors be altered so that we wind up with more people who actually know how to do it, while putting those people through less pain/stress/paperwork?

There's not much you can cut from the current curriculum and still have a proper doctor at the end of it. The UK's training is relatively short compared to some countries: it's possible to graduate in just 5 years, or 4 if you have a previous degree and make it into an (even more competitive) accelerated programme, whereas in many countries, medicine is always a 6 year degree. There's been a move at a European level to shut down the 4 year accelerated option too...

I mean seriously, this is a problem throughout the developed world already and is only going to get worse over time. The only class of jobs which have survived the economic transition of the last 30 years without getting worse pay or reduced employment are the highly educated ones. If we have a situation where demand for a highly educated type of worker (doctors) is increasing, then it's a matter of common sense to think about how we can train people in our society to help fill that demand, not just rely on immigration to do it for us.

More foundation posts and then more places at medical school would be pretty helpful here. But first we need to sort out what's happening to the NHS...

Of course, all of this is just speaking for the UK, which is what I know. Other developed countries have their own issues, but some at least are likely to be similar...

[Simon_Jester]

The US, too, has an artificially restricted supply of doctors due to the limits on medical school, but here it's the AMA (a professional association) that's doing it.

EDIT: Also, when I say 'figure out how to train more doctors or make training less onerous' that doesn't necessarily mean 'dumb down the curriculum.' It could just mean 'make the training less insanely competitive.' There is no obvious reason why medical school should be a place of cutthroat competition; it's not as if all historical doctors were perfect people, and it's hardly intrinsic to the nature of medicine to be trying desperately to outcompete a bunch of rivals.

It might well be possible to reform the system so that medical students are admitted in larger numbers and trained without so much sheer grinding brutality, so that they're less likely to emerge with burnout.

[Zaune]

Or maybe we should just raise the total pool of people with the necessary education and skills to even contemplate signing up for medical school.

[Simon_Jester]

Yep.

"Could altering the educational system make it easier to create the kind of people who consider becoming a doctor, so that even if 5% of well educated people become doctors the total number still increases?"

[Deebles]

The US, too, has an artificially restricted supply of doctors due to the limits on medical school, but here it's the AMA (a professional association) that's doing it.

EDIT: Also, when I say 'figure out how to train more doctors or make training less onerous' that doesn't necessarily mean 'dumb down the curriculum.' It could just mean 'make the training less insanely competitive.' There is no obvious reason why medical school should be a place of cutthroat competition; it's not as if all historical doctors were perfect people, and it's hardly intrinsic to the nature of medicine to be trying desperately to outcompete a bunch of rivals.

This there's definitely some mileage in - partly because the culture here in the UK is completely different. There really is a lot less cutthroat behaviour, and there's no reason why it should be in any way conducive to good medicine that there should be cutthroat behaviour between medical students.

A friend of mine who did an exchange with Harvard tells me how a medical student there told her he was looking for patients with some particular characteristics for a study. When she stumbled upon one, she went to go tell him - and he was amazed that she'd go even a little out of her way to help him out with his study, whereas mutual support and help is the norm over here.

It might well be possible to reform the system so that medical students are admitted in larger numbers and trained without so much sheer grinding brutality, so that they're less likely to emerge with burnout.

No reason why not.