1153 



tions tapped the surplus labor market abroad ttf meet theii^ demands. 



However, the key question is why the United States With its abun- 

 dance of wealth, power, and human material resources (5bnld not pro- 

 duce a sufficient number of medical doctors to meet its needs. Repeat- 

 edly, American students of brain drain attribute the cause to the Amer- 

 ican Medical Association, which they assert has maintained effective 

 control over the supply. Perhaps the most complete statement of this 

 process was made by Dr. Adams in hearings on the brain drain prob- 

 lem before the House Government Operations Subcommittee. 



He said : 



The cartel-like guild restrictions, such as those imposed by the American Med- 

 ical Association, which restrict entry into certain professions, set up an almost 

 irresistible magnet which, at prevailing income differentials, attracts talent from 

 advanced and underdeveloped countries alike. They constitute an impediment to 

 the proper functioning of the free market within the "pull" country, and thus 

 prevent the domestic production of the talent required to satisfy the effective 

 demand for it. By stimulating immigration to compensate for existing artificial 

 shortages, these restrictions lend force to the argument that "have-nots" are sub- 

 sidizing the "haves." ^ 



In contrast, the AMA appears to attribute the shortage to problems 

 in medical manpower maldistribution and excessive demands on health 

 services created by new programs. In its 1970 report on FMGs, the 

 AMA explained in the introduction : 



While the United States enjoys a physician-to-population ratio higher than that 

 of most nations, the geographical distribution of physicians and the mechanisms 

 which bring patients into contact with physicians are thought to create shortages 

 of physicians in some areas of the United States and overutilization of medical 

 services in others. New programs which have increased access to health services 

 have increased demands on the physician population without doing much to 

 alleviate this imbalance.** 



*« Hearings, House Government Operations Committee, Brain Drain, 1968, p. 60. For 

 other comments on the role of the AMA in restricting the supply of American doctors, see, 

 Johnson, op. clt., p. 73 and Myint, op. cit., p. 237. Herbert G. Grubel writes : "In the 

 United States highly skilled persons are attracted from abroad as a result of conditions 

 of excess demand. Thus, practices by the American Medical Association restricting the 

 suoply of doctors in conjunction with massive government medical care and health research 

 programmes have created an excess demand for medical personnel." "The Reduction of the 

 Brain Drain : Problems and Policies," Minerva 6 (Summer 1968), p. 550. 



»3AMA, FMG Study, 1971, p. 1. 



An editorial annearing in the Journal of the American Medical Association of Oct. 22, 

 1973 entitled, "Physician Migration: Brain Drain or Overflow?" commented approvingly 

 of an article by an Iranian medical educator, Bahman Joorabchl, who challenged the 

 brain drain theory adopted by American writers. Yet it raised many basic questions that 

 go to the heart of the brain drain Problem. 



According to the JAMA editorial. Dr. Joorabchl "demonstrates in very clear terms that 

 t'.ie shifting from Iran is an overflow and not a brain-drain." The editorial explained the 

 problem of mismatched training and failure of LDC economies to absorb surplus manpower. 

 The editorial cited the fact that American observers who espouse the brain drain theory 

 point to the very low physician-population ratios in these countries as evidence that they 

 need the doctors more than the U.S. "Yet, thev fail to observe," the editorial said, "that 

 90% to 95% of their physicians practice in urban centers where the physician-population 

 ratios are considerably higher than the U.S. cities. In these countries, therefore large 

 segments of the rural population have no medical care." Dr. Joorabchl noted that in 

 suburbs of Teheran there is one M.D. for every 200 persons. In the rural areas where 7b 

 percent of the people reside, there are few physicians. He explained that rather than 

 struggle through economic, professional, and social barriers, the doctors naturally move 

 to where t"~eir services are in demand. 



The JAMA editorial concluded with the observation that the data indicate that the 

 business of providing profe.^^sional services for its peoole is today a complex matter for 

 an agrarian nation." And it posed the following questions that suggest an awareness or 

 the complexity of the dilemma of medical brain draLn : "Should such a nation be training 

 a technician or orofessional other than the traditional physician (as Dr. Joorabchl sug- 

 gests) ? Should the United States deny physicians from these countries the privilege of 

 taking specialty training in its hospitals? If so, Is there any assurance that the problem 

 of nrovldlng medical services in the rural communities of these countries will be relieved? 

 Moreover, is it consistent with our basic tenets of individual freedom and the pursuit of 

 excellence to deny training to foreign-educated orofessional people." (Henry R. Mason, AMA 

 Division of Medical Education, "Physician Migration: Brain Drain or Overflow? JAMA, 

 226, (Oct. 22, 1973), p. 463.) 



