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usdreams wrote:
Hi Xenopus,

Thank you. I am not sure I have an answer. The immigration is complex issue. The Brain drain could be seen from individual and government perspective.

At individual level one should ask themselves what are your dreams and aspirations, what is the most important thing in your life, are you happy with what you are doing, are you sure what you doing is right. It is very personal and if you think taking all this hassle (USMLE) is worth it so be it. This is depicted well in the bollywood movie Namesake.

Why should US government pay for IMG doctors training? I heard it from all developed world they have this ideology of training doctors in order to help their countries in providing the best care possible and this is what they diplomatically say to the Indian government in justifying the import. How many doctors really believe that and you could do a survey on this forum asking doctors why are they coming to USA? My guess is that majority says they want to get the best training but not to go back. And if they do I wouldn’t believe they do to improve the health of our nation. Even if the reasons are like that shown in Bollywood movie Swadesh I would still be happy. I think it is time that all developed nations should come clean why they are so much dependent on the foreign professionals.

I don’t believe in these controversies as long as there is simple explanation. Why do you think US and other developed countries are outsourcing software jobs and other businesses to India and china. Why are they importing all the ready-made household items from china? It is simple economics! I believe when there is need to bring the trained doctors or professional from other countries and is economical, they allow migration of skilled people, period, end of story.

However I heard more problems from engineering field in USA and UK where university lobbyists are filling university seats with foreign students especially from India and china and locals were very worried about jobs as the students are staying in the country too long and competing after graduation.


At Government level, as I said if they are worried about doctors leaving then they should do something about it. I haven’t seen Indian Government taking robust initiative at all. Next we will discuss about US, and other developed countries, here the institutions, state Boards, and immigration department should liaise to check how many posts are unfilled by locals each year and allow equal number of doctors to train in US. I thought US is well regulated compared to UK as I can see from match there is great disparity between AMG’s and IMG’s getting into placements. And if the local doctors are not getting the job they should take it to the representative of the house. In UK the institutions by law couldn’t prefer locals over IMG’s hence it was a big issue for locals however recently they changed the law.

Do not worry, I heard the immigration department are already looking into how many work permit visa they could issue. In Britain they are looking into changing visa for foreign students so that they are made to leave as soon as they finish their training. Here I heard that they are looking closely the need for exemption of H1B cap for teaching hospitals and university affiliated hospitals and I also heard they are going to issue only J1 visa only for IMG’s very soon. (please don't spread bull as I can't confirm for sure)

In Australia they introduced point-based system immigration of professionals hence it is also better regulated.

At the end of the day we are economically productive young people who work hard and contribute to the economy even while training. I guess the institution would have the advantage of subsidies and funding from central reserve if they get status as training institutes. So I wouldn’t worry about the cost they spend on us because most of the IMG who get training settle here so it is a loss to the home country more than the burden to USA. I think the burden for these developed countries is from “illegal immigrants” and those who depend on the benefits and resources. Don’t get me wrong; I have enormous sympathy towards “illegal immigrants” as they are not as fortunate like us with money, education, family and political stability for being “legal”.

At the end of the day I follow this simple principle, everyone has liberty and right to move around and explore and so enjoy while you can, learn when you could and help others on the way.

If all these didn’t help I will hum John Lennon song before going to bed.

Imagine there ‘s no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace

You may say that I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one


I must be honest and tell you that you got it wrong. I personally don't panic about the specific reasons of so many doctors wishing to immigrate into the U.S. or any other industrialized country. This is a matter of speculation as I cannot get inside people's brains, and you rightfully point out that it's a very personal issue. I apprecite you citing examples from the entertainment industry of the human and individual tragedy of being an immigrant doctor, and I can also complement it here in the forum in a more real & vivid form. I also appreciate sharing the names of the movies as I do enjoy watching and Bollywood ones have catchy music and good looking actreses. But the very personal reasons of why people in their individual selves decide to become doctors in the U.S. was hardly the purpose of my bringing up the topic of brain drain. As you can see in the scientifically prepared study of Mullan in the NEJM, the 'fatal flows' or brain drain represent a truetelling sign of imbalance (at many levels, even if you decide to cavalierly ignore them). The accompanying editorial is more blunt as characterizing it as a 'poaching attitude' by industrialized nations. But let me go over a few facts that seemed astonishing to me. For example countries like Haiti and Jamaica contribute few doctors to the large IMG pool in the U.S.; but their emigration factor is much higher than India, for example. In other words, 35-41 % of Haitian & Jamaican doctors end up in the U.S. That's a big draw from these two poor countries (Haiti is considered the poorest country of the Western hemiphere). This is a fact that's hard to refute but like any scientific study is open for debate. Similar figures about the draw from Subsaharan Africa are appalling.

The factual article from Mullan should prompt deeper questions like the ones hinted in the Discussion. What are the health systems in those countries? Why can't their labor market capture their own domestically labor force? For example I know almost nothing about India. I don't know if India has a single payer system of healthcare (like NHS) and if not, what are the road blocks to achieve that. Probably you can tell us about it, that would be something I'd sincerely appreciate. I'm pretty sure that if countries allocate more resources for their own populations the doctor brain drain will be less, and would be even fair-er to their home populations, and possibly more fulfilling to many doctors. So there are tons of reasons whereby doctors migrate. I don't attempt to judge how individual doctors base their personal decisions but I do care of the mechanisms that might be pushing massive numbers of human beings outside their home countries. I do care more if those countries supported them with the intention to retain them (although ultimately incapable to successfully compete in the labor market). You for example don't seem much squeamish about India losing manpower even if you accept this is a loss for the country. Political mechanisms are the least discussed and sometimes overly twisted (like in the opinion editorial article of Chen & Boufford that even goes into suggesting that the U.S. should police these imbalances). It's the perfect example of appointing the fox to guard the hen house.

Bottomline, the imbalances of these 'resources' is what prompted
my citation of the brain drain. Analyzed in the context of other imbalances (say, global warming) represent a dire picture for humanity and the Planet.
So please don't say that I'm spreading bull since I would hardly cite an anonymous source like yours. I don't support your other premises like the 'working hard for the contribution to the economy' but it'll let it pass since I already alluded to the 'sustained economic growth' as a significant threat to life in this Planet. It would be too much of a burden to go after each sentence you said. You might wonder why do I care about economical or political factors mentioned above? Well, that's something you'll understand when you become politically conscious, as you will if you continue with the truthseeking attitude that I celebrated before.

I do celebrate of anybody taking a stand on these issues, volunteering their opinions and even correcting them as new information come to their awareness. I also celebrate the quotes from Gandhi and even the lyrics from John Lennon's song.

Now it's time for me to suggest you a movie; it's called "The U.S. vs. John Lennon". I hope by the end of the documentary you get an inkling behind Lennon's assasination. So in fact liberty is at stake, even if casually cited.


OK, I found the policy document that I alluded to in commentary #39. It's from the our dear friend the ECFMG, and is not from the 1970's as I initially thought. It's just from 1986, merely 4-5 years before the official dissolution of the Soviet Union. I scanned it and here it is for your perusal.

Although is a small document, reading it could be boring if you don't see the connections right away, so I extracted those parts that in my view were most interesting. The rest of the document is pretty logical and consistent with the goals set in the rationale.

By itself the document might not tell you much, but if you put it into the context of recent efforts to establish Free Trade with many nations (say NAFTA, which in reality is not free trade, as if it were really free you wouldn't need a Treaty for free trading), then the document makes a lot of sense.

Edited by xenopus on Jun 03, 2011 - 11:53 AM


This show from DemocracyNow! fits very well with the Stephen Bezruchka's lecture ( )

Hopefully further research will prove or disprove these hypothesis and please pay attention to the large amount of social work we have in our hands, if these are correct.

@hallucination, where did you match? Good luck in your pursuits.


This is a good read, just for reference as this thread is dead now.

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