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The Hinged World: Doctors and Diseases on the Move

The Hinged World: Doctors and Diseases on the Move

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The Hinged World: Doctors and Diseases on the Move

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  1. The Hinged World:Doctors and Diseases on the Move Fitzhugh Mullan, MD The Murdock Head Professor of Medicine and health Policy George Washington University St. George’s University 30th Anniversary Symposium November 10, 2007

  2. A Linked World and Medical Migration • Disease Mobility • Economic Disparities • War/HIV/Corruption • Human Ambitions • Aging of the Population in the West/North • Health Educational Policies in the West/North

  3. The South

  4. Pulls to the North and West • Training Opportunities • Practice Opportunities • Better Remuneration • Better Technology • Family Opportunities

  5. Push Factors from the South • Lack of Post Graduate training Opportunities • Insufficient Practice Opportunities • Poor Remuneration • Security Concerns • HIV/AIDS

  6. Life Expectancy Crisis

  7. Workers Save Lives

  8. More Wealth, More Workers

  9. Health Worker Migration

  10. Characteristics of Physician Workforces of US, UK, Canada, and Australia.

  11. Regional Emigration Factors in 8 Regions of the World

  12. Emigration Factors of Selected African Nations

  13. Emigration Factors of Selected Caribbean Nations

  14. Emigration Factors of Selected Indian Sub-Continent Nations

  15. The North

  16. Supply of Active Physicians (MD & DO) and Ratio to Population Actual 1950-1990 and Projected 2000-2020 Physicians Per 100,000 Population Population is U.S. civilian population including possessions

  17. Applicants to Allopathic Medical Schools and Enrollment Source: AAMC

  18. Number of Residents in U.S. Allopathic Training Programs from 1993-2007 Source: AMA

  19. Number of Residents in U.S. Allopathic Training Programs According to the Type of Medical School Attended from 1993-2007 Source: AMA

  20. DEFICIT WITH NO ADDITIONAL USMGs or IMGs ~2020-2025 Deficiency ~200,000 physicians (~20%) Demand Supply You are Here Source: RA Cooper

  21. Background/Climate Era of medical school expansion New schools – allopathic and osteopathic Increased class sizes Branch campuses AAMC predicts  17% increase in enrollment by 2012 AACOM AAMC predicts  25% increase in enrollment by 20011

  22. Source: AAMC

  23. Current allopathic schools Planned allopathic schools

  24. Current osteopathic schools Planned osteopathic schools

  25. Northern Strategic and Moral Role in Global Workforce Stability

  26. Health Workforce Stability • Bedrock of health system development • Requirement for HIV treatment and prevention • Prerequisite for public sector health reform • Essential for global health security

  27. Health Worker Migration as a Business Proposition • The MD/RN degrees as passports • The privatization of education • The global health professional education “industry”

  28. The Success Quandary of Developing Nations • Established Example – The Indian Subcontinent • Emerging Examples -- Nigeria, South Africa, Ghana

  29. Previously Proposed Responses • Ethical Recruitment Codes • Emigration/Immigration Regulation • Bonding/Community Service • “Reparations”

  30. Emerging Stability Strategies • Domestic Post Graduate Training • Salary Support • Ancillary Support • Car Loans • Housing • Schooling • Creative Use of Mid-levels • WHO/PEPFAR Task Shifting Project

  31. What To Do At Home • Move rapidly toward self sufficiency in physician training in the North…5,000 more first year medical school positions in the US • Keep cap on government support for GME positions

  32. What To Do Abroad • Support capacity building and twinning in developing countries • Track immigration and set benchmarks of good practice • Promote “reverse flows” • Create and support a US Global Health Service

  33. African Proverb • The best thing to do is to have planted a tree twenty years ago • The next best thing to do is to plant a tree today