Pakistan’s
Physician Exports
December
02, 2005
Recently the New England Journal
of Medicine published an illuminating article
on “The Metrics of the Physician Brain Drain”,
which looked at the flow of doctors out of Third
World countries and to the West. Needless to say,
Pakistan figured prominently in the numbers.
Looking at the English-speaking countries of the
US, Canada, Britain, and Australia, the researchers
collected reams of statistics. In the US, for
example, out of 830,000 physicians, 208,000, or
25%, are international (foreign) medical graduates
(IMG’s). In Britain, there are 39,000 IMG’s
making up 28% of the workforce. Australia and
Canada have 15,000 each, making up about 25% of
their physician manpower. In Canada and Australia,
22-33% of these IMG’s come from Britain
or America, but IMG’s from developed countries
are only 6% of the US workforce.
Most of the IMG’s come from poor, Third
world countries. In the US, the biggest sources
are India, with 40,000, the Philippines, with
18,000, and Pakistan, with 10,000. It is interesting
to note that Indian immigration to the US is probably
seven times Pakistani, but in terms of doctors,
it is only four times. In Britain, there are 15,000
Indian doctors and 2,700 who were trained in Pakistan.
For Pakistan overall, there are 12,800 doctors
who went to medical school in Pakistan but now
work abroad. Meanwhile, there are 97,000 doctors
working in Pakistan, so the country has lost 11.7%
of its doctors to emigration. India has lost 10.6%
of its doctors, while Sri Lanka has lost 27% of
its doctors. In Africa, Ghana has lost 30% of
its physicians while South Africa has seen 18.5%
of its doctors leave.
Training doctors is a very expensive task. It
involves huge costs in creating and sustaining
medical schools, and the gifted and intelligent
manpower that becomes doctors is not available
to serve other needs in the society. For poor
countries in which many children do not attend
even primary school, the training of a physician
at the national expense is a huge investment of
resources into a small number of people. So when
these people choose to leave, it would appear
to be a large blow to the country.
On one level this is true. The loss to Pakistan
of over 12,000 physicians, in a country which
still has very poor health standards, must be
seen with grave concern. But I think the issues
are more complicated than that.
There is a strong argument to be made that Pakistan
has too many physicians. Adjusted for population
size, Pakistan already has 25% of the physician
manpower that America has. This suggests that
there are too many physicians in the country for
its level of development. Pakistan has substantially
more doctors per person than India. It would seem
that Pakistan can safely export this physician
surplus. The real shortage in Pakistan in healthcare
is not doctors, but nurses. In American medicine,
the doctor leads and directs a team of health
care professionals such as nurses, pharmacists,
therapists, and medical assistants. This army
of ancillary personnel is the real key to a functioning
healthcare system.
Pakistan’s physician exports are useful
in two other ways to Pakistan. First is economic.
Remittances, charity, and investments from Pakistani
expatriates flow back to Pakistan and provide
significant assistance to the country’s
development. Secondly, the large number of successful
Pakistani-American physicians have helped create
the base for the Pakistani-American community.
They play a key role in giving voice to the political
concerns of Pakistani-Americans, and Pakistan’s
governments have clearly seen this as desirable
and beneficial to Pakistan. So the “brain
drain”, while lamentable on one level, is
potentially beneficial. But only if all those
doctors trained by Pakistan remember who gave
them the opportunities they now enjoy in the US,
and give back to the country that reared them.
Comments can reach me at Nali@socal.rr.com.
