Doctors are not property and cannot be stolen

Relevant to the discussion Andrew and I had of “brain drain” in the developing world is this vehement yet brilliant piece by Michael Clemens, guest posting at

The whole thing is worth reading but I liked this quote the best:

Furthermore, African-trained members of the American Medical Association send home to Africa, on average, over $6,000 per year, even 20 years after arriving in the United States—including those who send no money. Far from being “scant compensation”, this means that the typical African-trained doctor coming to the United States has sent back much more than the cost of training another doctor in the country he or she came from.

Such large remittances make my whole discussion of public vs. private funding of medical education in the developing world moot.

Clemens has also made the claim that migration is the single most effective development tool the world has ever seen, an argument to which I am quite sympathetic.


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4 Responses to Doctors are not property and cannot be stolen

  1. Andrew Goldstein says:

    Of course doctors are not property.

    But that’s a silly place to start an argument and I do disagree this post.

    a) $6,000 over even 50 years isn’t that much. Just because the price to educate a doctor is so low doesn’t mean that from the country’s perspective the value of those remittances is more than the true value of (not price paid for) educating a doctor. It’s not like there’s some linear curve that if we only realize how much these brain drain doctors “contribute” through remittances then all of these countries will open more medical schools. Unfortunately there just is not the internal capacity to train any more physicians, so when the physicians that are trained do leave, it really hurts the ability of local governments and NGOs to hire medical professionals, and really hurts the people of countries because they have no access to the limited providers. Hey, if the US wants to send US physicians to train African medical students and then the US wants higher these new physicians, fine. But based on current capacity in Africa to train physicians, it really is “stealing” even if these are people.

    b) As to Jason’s point about migration being great for development, I half agree. It’s great development for the people leave, but for the people left behind, even if there are remittances, I think it is very hard to say they are better off. I would posit they are worse off, because the ambitious talent that existed in the community has left. Thus brain drain. Having seen this most recently in Liberia, where a weak economy exists because local talent either left during the civil war or currently is internally brain drained by the NGOs, you can become really fearful of brain drain.

  2. Jason Kerwin says:

    You make a great point about constraints to the number of doctors that can be trained. However, I’m still with Clemens on calling this “stealing”. These are people given the freedom to choose what they want, and taking advantage of that.

    It’s hard to generalize about remittances but for the Philippines, which has tons of overseas workers, remittances comprise a large share of family income and it’s tough to argue that migration is damaging to those who stay behind, at least for low-skilled workers. As Clemens notes the migration of nurses is also a net benefit to that country; I don’t know anything about how it might apply to doctors.

  3. Matthew Doye says:

    However much highly skilled professionals such as doctors send back in remittances the fact remains that, for person who emigrates, there is one less trained professional able to do that job in that country.

    Education systems spend time as well as money nurturing the talents of the small fraction of the population with the ability to pursue certain careers, one cannot teach and train anyone to be a surgeon. By tempting them away developed countries both reduce that pool of talent and reduce the effectiveness of the developing countries’ education system in improving the lot of the whole population, this, in turn, provides a disincentive for those countries to invest in education.

    I do not argue that we should act to prevent such migration however we must develop mechanisms that compensate, not only for the financial costs to the developing countries, but for the loss of talent and the societal effects as well.

  4. Pingback: Shout outs | MethodLogical

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