Original communication| Volume 72, ISSUE 5, P668-680, November 1972

The surgical manpower drain

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      The subject of physicians in general and surgeons in particular migrating and becoming a fundamental addition to the United States medical profession is reviewed. Before the 1960's, most of the newly licensed foreign medical graduates (FMG's) came from developed nations; now most come from the developing countries. FMG's, representing a major contribution to U.S. medical school faculties and research power, provide the manpower that 12 new medical schools in the U.S. would produce. Immigrating FMG's include 300 doctors annually from Latin America, a number equal to the output of 3 medical schools, the cost of which would surpass U.S. aid to Latin America in the health field. The U.S. has thereby become a recipient of foreign medical assistance, depending on FMG's who have increasing influence on U.S. health care, to maintain its hospital system. Surgeons excepted, FMG's perform at a lower level as the result of poorer training and other important factors and are generally dissatisfied, in comparison to their U.S. counterparts, with their training. Foreign residents are generally rated lower in competence than U.S. residents, except in surgery, in which there is little dissatisfaction with earlier training. Accepted largely for service purposes, over 80 percent work in hospitals but mainly non-affiliated ones where the educational experience is diminished. The term “brain drain,” often a negative and emotionally charged expression, defines what is the basic human right of international mobility and an effective mechanism of cultural and scientific communication; it has occurred since antiquity. It is a symptom, not just a cause of underdevelopment, for less developed nations cannot utilize their total output of professionals at their highest level of skills, resulting in unemployment, underemployment, and internal and external migration. The highly trained professional who emigrates is not a total loss, for he serves as an example and a very effective cultural bridge to the more advanced scientific world.
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