How can 'medic brain-drain' be tackled?

What should G8 leaders do to tackle the "poaching" of overseas healthcare workers?

The British Medical Association and the Royal College of Nursing have called on the UK government to take action.

They say the exodus of staff from developing nations is claiming millions of lives and compounding poverty.

Does the developed world rely too heavily on staff from the developing world?

This debate is now closed. Read a selection of your comments below.

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The following comments reflect the balance of opinion we have received so far:

We all intend to return home sometime, if only there is something to go home for besides our families Olawale Olanrewaju, Dublin, Ireland

Economic migration is a phenomenon that has always existed and shouldn't be referred to as poaching. The voluntary emigration of health workers due to the provision of better incentives by the developed world can be reduced but will never be stopped. It is a great step that the G8 are willing to relieve debts owed by some of the African countries, as this would help create incentives for developmental projects (including health), which might attract technocrats and the highly-skilled to return home. We all intend to return home sometime, if only there is something to go home for besides our families.
Olawale Olanrewaju, Dublin, Ireland

Developing countries like my country should learn lessons from what is happening and try to encourage their health workers, including all civil servants, through better incentives, otherwise I am afraid the poaching of health professionals will continue.
Annan George, Accra, Ghana

Easy, if the doctor doesn't pay for his own education, sign a contract that requires them to work for their local health service for 5-10 years. If they do fund themselves, then we've no right to stop them going where they wish.
John, England

The UK government has made working in the health service an unpleasant and unattractive career option thanks to the overwhelming bureaucracy that it has been imposed. It is time that the government admits that its "management theory" is erroneous and damaging, and cuts the excessive bureaucracy.
DCA, Kent

Improve NHS and pay, and UK medics wont leave AR, Washington DC, USA

Truth is that medics follow the money and the resources available to do their jobs, and head to places like the US. The actual flip side is that we US consumers subsidize this with the world's highest pharmaceutical and health care costs. Improve NHS and pay, and UK medics wont leave. Increase the numbers of seats at medical schools, and you'll increase the UK's labour pool. Then you won't have to poach.
AR, Washington DC, USA

I'm in my second year of medical applications in the UK, so of all people I should be expected to tell them to "create new med-school places". Slight problem with that being, where? The London med-schools are already absolutely full and once the new schools start sending out clinical students there's going to be even more trouble. You can't just put people in lecture theatres and wards indefinitely, they need skilled tuition with a low teacher-student ratio. You can't just magic up a hundred or so new places.
Ant Hopkins, UK

This situation will continue for as long as we in the West expect free health treatment at the snap of our fingers. Doctors are already well paid and they're simply not choosing to do the hours we want them to because they can afford not to. Therefore the gap will be filled by doctors from abroad. The problem is due to the public's own making and the public should take the blame for a change and not point fingers at other people.
Bilal Patel, London, UK

This is western self-blaming gone mad. Skilled workers from developing nations (I am one of them) have been coming to the West to work for decades. We earn and send back a lot of money. More importantly, we learn new skills and transfer them back to our own countries. It is not like we would save our countries if we remained there. If you want to help developing countries 1) stop selling us arms, 2) stop interfering with our regional politics.
Anonymous, London/UK

Why should these people not work where they want to? Lianne, Manchester

Whilst it is bad news for developing countries, lets not forget that these doctors and nurses are choosing to work in the developed nations. The time, cost and dedication involved in training to be a medic is considerable. Why should these people not work where they want to? To stop it is to deny them the decent wages they deserve.
Lianne, Manchester

I feel that African countries should try more to retain their health professionals in their local country, I don't think that there are any professionals who leave their homeland if they feel they are being adequately rewarded. Political and social repression also plays its part.
Manzvengarufu, Harare, Zimbabwe

Does anyone care about the drain of engineers, scientists and doctors moving from the UK to USA, Australia, etc?
Ian Thomas, Miskin, Wales

This is a new tactic for those who have a fear of immigration. If medical staff here are really worried about the third world, they can go and work there themselves. Well-trained doctors and nurses, from any country, deserve the chance to offer their services to the British people.
Brendan Fernandes, London, UK

Easy, simply encourage more teenagers at school to take science subjects at GCSE & A Level, actually encourage them to go to University to take Science, Medicine & Engineering Courses (remove tuition fees). Problem solved. Instead of which the current government policy merely encourages people to take humanity subjects at all levels, so we are left with some very highly qualified media professionals with huge debts, all looking for jobs that aren't there, and having to give grants to foreign students to do science, medicine & engineering courses to fill in our jobs. It's a disgrace.
Tim, UK

It can't unless we stop being a democracy. People can work where ever they like.
Jon, UK

A year or so ago there was a BBC series about the use of foreign nationals in the NHS. In one of the programmes from the Philippines it was claimed that four times as many nurses are trained there than were required for their domestic needs. As with many other trades and skills the Philippines trains people to work overseas in places like the UK and Middle East as a way of providing foreign income for the country. Without it the Philippines would be much poorer than it is now.
David, Dubai

Surely this is the labour market working in its most efficient form. African Doctors should be welcomed into the UK as long as they are every bit as competent as any other Doctor. If their own country is not willing to pay the market rate for their skills then that is a matter for the government and ultimately the people who are being disadvantaged to address. Maybe the people in these countries should stand up and be counted against the government who is under funding their welfare and health service at the cost of their health or lives.
Graeme, Fife

In order to stem the reliance on medical personnel from developing countries, developed countries should come up with incentives that will attract people into the medical profession. A lot of people are reluctant to going into the medical profession because of the high cost of training. No-one wants to be stuck with school loans for a long period of time.
Omorodion Osula, Boston, USA

Simple, we need more doctors. How do we get it? Fewer hours, more pay. Perhaps give nurses with 10 years experience encouragement to train up to become a doctor. Perhaps full pay for several years while they train would help.
Ryan, Belfast, NI

We should focus on training our own medical staff. Our government is obsessed with pushing everyone into university to do Mickey Mouse degrees. Perhaps if the government instead focused on opening more places for doctors and nurses to train, along with reduced debts then we wouldn't need to poach foreign staff.
James, UK

So let me get this straight. If I were a nurse it would be okay for me to go to America for the higher salary I'd get over there but it's not okay for staff from poorer nations than us to do the same? Perhaps we should pay our healthcare staff even less so working here doesn't look so attractive to overseas workers.
Bill, London, UK

Stop thinking you need to take responsibility for the failings of other countries. Responsibility is a two way street Peter, Perth

Maybe the G8 should send doctors to work in these countries for free as part of charity organisations - oh, done it. Maybe they should pay the countries lots of money by say forgiving their debts - whoops, done that one already too. I have to ask, why should the G8 stop the "brain drain"? People have a right to work where they want. It is up to the countries they are leaving to make staying home more attractive than leaving. Stop thinking you need to take responsibility for the failings of other countries. Responsibility is a two way street.
Peter, Perth, Australia

If we are going to recruit medical staff from overseas, why don't we sponsor poor but intelligent candidates through their medical training? Then they can work over here and send money back to their home country to support the economy there.
Ed Kiernan, Edinburgh

Has anyone considered the fact that these people are coming here because they want to? If they wanted to stay in Africa they would. By stopping them coming here we will only redirect them elsewhere.
Andy S, Surrey, UK

We should be training our own but unfortunately too many training places are being taken up by people who do not intend to make medicine their life long profession. They opt for part time working and do not intend to climb the career ladder. Something for the universities to sort out at the entry stage. Only take on students who are committed to a career.
John, France

Job mobility has always been a feature of a medical career - so what's wrong with people flowing to the highest payer?
Stephen Fox, Sydney, Australia

In general overseas workers go back to their countries after a few years with considerable savings and a much increased knowledge. Few stay in their host countries forever. I don't think that in the long term this isn't an issue, since everyone benefits.
Jennifer, Netherlands (ex-UK)

It seems that at least some aid for the poorest countries needs to be aimed at supporting local medical staff and giving them good reasons to stay Jon G, Huddersfield

It is not just active poaching by the West that causes the problem. A friend of mine is involved in setting up the GP training curriculum for a hospital in Kathmandu, and most of the junior doctors there would, apparently, like to go and work in the West. Certainly, with the ongoing conflict in large parts of that country, I would not want to work in rural Nepal if I could avoid it.

And part of the frustration my friend has found as a doctor in Nepal is in not having the resources to achieve as much as she could. It seems that at least some aid for the poorest countries needs to be aimed at supporting local medical staff and giving them good reasons to stay in their own country. Remember the reports on this website of Sudanese refugees, including a doctor?

Click here to read the Sudan: Heading home feature

They were so keen to return home after the peace accord there, so it can be achieved.
Jon G, Huddersfield

Reduce junior doctors' unsafe working hours, introduce better flexible working arrangements for doctors with young children, create more medical school places and increase rates of pay for nurses and other practitioners to decent levels and there would be less need to go abroad to fill the skills-gaps here. Trouble is, it's cheaper to recruit abroad.
Dr Liz Saunders, Worthing

Invest in home grown talent and pay home grown talent a decent salary to keep our own medical talent from going to America etc where the conditions and salary reflect that valuable talent. I for one would gladly pay extra tax as long as it goes directly to the doctors and nurses pay packets.
Will, Darwen, UK

I spent five years in Guyana (South America) training nurses, most of whom were promptly recruited by foreign (mostly British) nursing agencies. All of those nurses had signed contracts with the hospitals in Guyana to work for them for a minimum period. All of them were encouraged illegally to break their contracts by the British nursing agencies involved. We had no way of enforcing those contracts in the UK. Therefore one simple but effective solution would be to permit overseas governments to enforce contracts in the UK and to claim compensation from British nursing agencies for breach of contract.
Desmond Persaud, Wimbledon, London

Until salaries in this country encourage the development of local skills the only ones who will work here come from abroad Matt, Derby

To accuse the West of poaching staff is a bit unfair. These professionals seek better salary and conditions abroad and we want the skilled labour. That is the nature of things. You cannot prevent people from working abroad for political reasons and create a skills shortage at home. Much of the funds earned in this country is sent back to families abroad so is helping to prevent poverty not compounding it. Until salaries in this country encourage the development of local skills the only ones who will work here come from abroad.
Matt, Derby

People will always move to areas that offer better opportunity. For example, many British doctors head to the USA (lured not just by cash, but also by more exciting medicine). The G8 can't make it illegal for doctors to emigrate from developing nations, nor can we bar specific nationalities from specific jobs. The best help the G8 can give is to increase the wealth and stability of developing countries so they become more attractive and keep their doctors. We need a concerted effort to help the industrial and agricultural sectors in developing countries with investment and fair-trade.
Mark Fulford, Southampton, UK

If we are going to compensate the third world countries for their loss of health workers, can we claim compensation for the UK doctors and nurses going to the USA, Australia, etc?
Andrew, Swansea, Wales

A completely unsolvable issue. All creatures gravitate towards the resources they need, not away from them. Hunters have always followed the game, wherever it goes. So people will always go where the money is. It's only natural. The only way to prevent this from happening is to ensure that every country has an equal economy to its neighbours, which of course will never happen.
Rob, London, UK

It is neo-colonial theft on a grand scale. Poor countries spend a lot more as a proportion of their GDP on training staff that they desperately need - only to see rich countries appropriate them without compensation. Ghana, for example, has lost £100 million invested in training medical staff. The UK saves a quarter of a million (the cost of training a doctor), people in Ghana die.
Peter, Liverpool, England

The flipside of the coin is that if we did not have the expertise and brilliance of Africans, Indians, Pakistanis - then where would we be? Waiting times would double and A&E would be like a bad episode of Casualty.
Brian, Newcastle

Put money in the sharp end Chris Kisch, Milton Keynes

Restart training programmes to recruit people to become doctors and nurses and not bureaucrats and managers. Put money in the sharp end. Currently only 2p in every £1 reaches the patient.
Chris Kisch, Milton Keynes, UK

We need to increase funding and conditions for our home grown staff and then maybe they wouldn't be leaving in droves forcing the NHS to recruit form overseas.
Naomi, England

I don't see what the problem is - people should be allowed to work wherever they feel like if there's a job available. It's not poaching, it's the free market at work - and it helps the developing nations because not only do the workers send money back home to their families, but they learn new skills.
Roger Price, Reading, UK

The majority of the G8 do not require universal codes of practice for recruiting overseas health staff - they train an adequate number of home-grown health staff. The poachers (UK and the US, the latter benefiting greatly from Canadian trained medical staff) must accept their systems' flaws and place the blame on themselves, in part, for the declining health care in the developing world.
Ryan Savage, Vancouver, Canada

The youth of today can't afford six years in medical school, and with our NHS in the state it's in, nobody wants to go and work for them anyway. No wonder we're crying out for overseas medics to plug the gap. So there is yet another way the west bleeds the third world of its resources.
Morris S, Burlington, UK

Healthcare workers from the developing world are individuals free to make up their own minds. Who are we to say that they shouldn't come to the UK for a better standard of living?
Ben, Durham

How about getting rid of the strict bureaucratic process for applying for NHS posts? There can hardly a shortage of doctors if they're making it so difficult for qualified and experienced local doctors to get posts.
Scott, Edinburgh

I have a sneaking suspicion that this more about protectionism rather than helping the developing nations. Trading in services is no different than trading in goods and trading is generally a good thing for both the party engaged in trading. Doctors and nurses who wish to come and practice here should be free to do so. The only way you can keep skilled people within a country is to create incentives for them to stay there.
Rana, Gloucester

It's just another aspect of globalisation Pat, London

Unfortunately it's just another aspect of globalisation - big companies get their goods from, and call centres in, cheaper countries. But then the cheaper countries on the other hand are also supplying trained medical staff for developed nations. Money talks - it's just the flip side of the coin.
Pat, London, UK

The medical profession and its unions have always sought to restrict the supply of medical staff in this country in order to inflate their own wages. Tony Blair recently boasted that GPs here are now paid twice as much as in France so we are paying well over the odds. Anything which increases supply and forces down exorbitant costs is a good thing.
HJ, Wokingham

What we can do is privatise the NHS. Rather than one huge monopoly and blanket pay rates in the medical profession a proliferation of providers would create a real job market and realistic salaries that would attract our own citizens into medicine rather than at the moment hunting the world for people willing to accept what the NHS has to offer.
Phillip Holley, UK, London

We should, for a start, begin reimbursing the African and other countries for the training of the nurses that have come here. Why should we be getting trained staff at their expense, and depleting their health services of both personnel and money?
Graham, Cobham, UK

To Graham, Cobham: What about all of the foreign staff who come and get trained in the UK at our expense and then go abroad? It cuts both ways.
Nigel H, Preston, UK

I think we need to be careful we do not get too patronising about this issue. If someone is talented enough then they should be able to work wherever the work is offered, be they African, Asian, American or even Suffolk-Born-And-Bred! It is rather arrogant to think that we should say, "now, now Mr African Doctor - your country needs you more than we do so you must stay there working for a pittance!" Fair trade is far more important in tackling World poverty, and to ban the recruiting of medical staff from certain countries is surely prejudicial and therefore illegal - or is it another case that some pigs are more equal than others?
Richard Stone, Lowestoft, UK

It's obvious what to do, but it will never happen. Why waste your own money training people when other governments can do it, and they'll come anyway as it's in their own financial interest? There are only about 10 places at British Universities for every 100 British students who would like to train to be medics. Allow more places and then there'll be less places for developing nations' medics. But what government would do this when it would cost them more?
Tracy, Watford