A reappraisal of the “brain drain”—With special reference to the medical profession

Abstract

The “brain drain” problem is not so much a question of the numbers who migrate as the distortion in training systems and economic structures that their mobility implies. The persistence of the problem reflects the ineffectiveness of the policies so far implemented to reduce it. This ineffectiveness stems largely from the inadequacy of the standard neoclassical framework of analysis, which also misrepresents the effects of the “brain drain”. The fundamental inadequacy of this analysis derives from the fact that it deals with the response of individuals to a number of variables without taking account of the structure within which individual decisions are made and of the relevant interdependencies and dynamic effects. The most important aspect of this structure is the existence of an international market in professional skills into which the educated elite of the Third World is more or less integrated, to the benefit of their salary levels and, in a process of institutional determination of salaries, those of all who can plausibly claim “compatibility” with them. The condition of integration into this international market is the possession of internationally negotiable qualifications and international negotiability implies, to a varying degree, lack of relation to local needs. The question of international (medical) migration is of interest not so much in itself, but because of what it reveals about the nature of particular (health care) systems and the socio-political structures in which they operate. If everything else were to stay much the same the reduction of (medical) emigration would probably make no difference at all to the welfare of most of the population of the Third World. In the same vein, the solution to the problem raised by these international movements are not to be found within the movements themselves but in necessary changes within the framework of specific national (health care) systems and, of course, the social, political and class structures in which they exist.