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09-24-2009

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Subject: Oh Where, Oh Where, Did All The Doctors Go?

Here is a very interesting article: South Africa: Doctor brain drain continues.

The article states:
    "The country is losing 17% of its qualifying doctors every year and, in the four years since 2005, nearly 1,000 new doctors did not register to work, according to government figures."

The author then quotes Mike Waters, the shadow minister of health for the official opposition Democratic Alliance as stating:
    "It mirrors the depth of dissatisfaction among doctors over South Africa's public health system."

What is interesting about this is that South Africa seems to have the type of medical system being proposed for the United States. Medical schools are state-run and student tuition is subsidized by the government. In addition to a year of internship, graduates are also required to contribute twelve months of their life to community service at a state-run health institution before being allowed to obtain a license to practice medicine. The majority of the health care system is run by the government, and is available without charge to roughly 80% of the population. And yet, despite this idyllic set-up, there appears to be problems in paradise.

As the article explains:
    "Community service doctors and interns are crucial to the public health system, which suffers a 40% vacancy problem. Newly graduated doctors are expected to 'give back' to the community, and they are often deployed to very remote and under-equipped hospitals where their skills are most needed. Working conditions are often extremely difficult."

    "South Africa employs 18,000 doctors in state-run hospitals — or one doctor for every 3,800 people without medical aid"

Ravick van der Merwe, an industrial relations adviser for the South African Medical Association states:
    "Considering the money they will earn after five years, new doctors might run away even before they enroll for community service. The remuneration that they get is not enough for some to pay back loans that they would have borrowed."

What ideas are being considered to solve this problem? The article states:
    "One way of trying to ease the medical brain drain is to select students who display social responsibility and a commitment to the country and to communities, especially in rural areas."

Well, if I was really ill or injured and required extensive or complicated medical assistance, I know that I would much rather have a doctor who pursued that career out of self-interest, following their thirst for knowledge and love of that type of work. Those are qualities that I can rely upon in a critical situation. I would not be comforted to know that the criteria used to select my doctor was "commitment to the country and to communities." He might be a warm body filling a space in a hospital, but a person's "social conscience" tells me nothing about their commitment to themselves and their work! When my life hangs in the balance, I want the self-motivated, competent doctor making the judgment or holding the knife, not the "nice guy".

The article concludes with the following observation:
    "South Africa has been experiencing a brain drain for decades, undermining the regional economy. Previous studies have shown that 25% of medical graduates have been lost to the US alone. And it is not only doctors who move to greener pastures. Official statistics estimate that between one and 1.6 million people skilled in professions and managerial occupations have left the country since 1994, the year South Africa became a democracy."

As those of you who have read Atlas Shrugged know, this "Brain Drain" phenomenon — or the John Galt effect — was described by Ayn Rand as a completely predictable consequence of the ever tightening government regulation of any profession or industry. If we continue to move in the direction that the Obama administration is leading us, this is one aspect of the future awaiting us.
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