Why don’t we produce enough doctors?

by reestheskin on 15/06/2021

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The following excerpts are from a letter in the FT from Professor Rachel Jenkins from Kings College, London.

Letter: West’s wooing of medical staff weakens pandemic response | Financial Times

An effective pandemic response capability requires such a framework to give legal bite to the 2010 WHO code of practice on how health personnel are recruited globally — something with which rich countries, especially the UK, have singularly failed to comply.

The code recommends that member states discourage active recruitment from so-called low and middle income countries facing critical shortages of health workers; that they never recruit from the 57 poorest countries and create their own sustainable workforce through workforce planning, education, training and retention strategies.

The OECD club of rich nations recently reported that the number of migrant doctors and nurses from low and middle income countries working in OECD member states had increased by 60 per cent over the last 20 years. This trend has been further exacerbated by the pandemic, as rich countries have deliberately loosened their health worker recruitment requirements.

The UK’s long standing failure to train adequate numbers of medical students and to show global leadership in reversing this enormous subsidy of skilled health workers from poor countries to rich countries is not only a national disgrace.

I have thought about this issue for years. Thought might not be the right word, however, as I have never worked out the ‘why’ of what is going on. I do not know the correct figure, but from memory perhaps 40% of UK practising doctors trained overseas. Why? A few thoughts.

  1. People argue that it is extremely expensive to train doctors. I do not find this a convincing argument. First, I do not believe the government’s figures which are top-down flows, rather than costs identifiable at the coal-face. Second, even if I did believe the government’s figures, a crucial question remains: does it need to be this expensive? I don’t think it does. Of course, that the argument is mistaken, doesn’t mean that it cannot be widely quoted or used for political purposes.
  2. The more doctors you have, the higher health care expenditure will be. I suspect that is something to this argument, and it will appeal to chancellors. But of course, the issue is not that we cap doctor numbers, but that we don’t train enough to begin with. Still, I wouldn’t dismiss this line of thinking out of hand.
  3. I don’t think you can predict how many doctors you need. Not just for the future, but for any time-point. Sorry. But of course you can make mistakes of varying size and direction.
  4. Pace the late Henry Miller, I would encourage medical graduates to look at the possibilities of working outwith the UK. Some might like it.
  5. I wonder why people think this whole topic has anything to do with the government. They may be the problem rather than the solution. Besides, if we gave the ‘tuition’ money directly to the students, it might be spent more prudently.