1194 



tion of Western values which are inappropriate to local problems. Physicians are 

 lost at the very time they can be most useful but after they have been expensively 

 educated. The short-term effects are measured-by preventable disease and death, 

 the long-term by retarded development of institutions and health services, both 

 highly undesirable."' 



In their study on FMGs, Margulies and Bloch summarize the posi- 

 tive aspects of the inflow, but render this critical judgment : 



While these and other events were occurring, no one was measuring the 

 results. There seems to have been a benevolent assumption that nobility of 

 purpose leads inevitably to a happy ending. What did happen has now become 

 evident, even with some of the information still lacking. The United States 

 has been siphoning off medical manpower from areas of the world which can 

 least afford such losses, returning to them physicians with inapplicable skills 

 and doubtful professional careers at home.*"* 



In their U.S. Government-sponsored study, Stevens and Vermeulen 

 concluded : 



. . . the majority of foreign medical graduates in internship and residency 

 positions in this country — whatever their initial intentions — elect to remain 

 in the United States. Thus, this country is the recipient of substantial "reverse 

 foreign aid." The United States is reaping the rewards of investments made by 

 other countries in the education of physicians, and those countries i^ve suffering 

 a long-term loss of physician services."" 



Awareness of the price paid by the LDCs for medical brain drain is 

 often expressed in terms of moral guilt. For Dr. G. Halsey Hunt, 

 who found this dependency a "depressing and liumbling experience" 

 and in the long run completely untenable, it "ill becomes us to depend 

 indefinitely on other countries for the production of medical man- 

 power to provide services to American patients." *'° For Dr. Irene 

 Butter of the University of Michigan's School of Public Health, "A 

 permanent loss of doctors from the poorest to the richest nations is 

 the most disturbing aspect of the medical brain drain." *''^ And Pro- 

 fessor H. ISIyint, who tended to minimize the effects of brain drain, 

 acknowledged that, 



From the welfare point of view, the migration of doctors from the underde- 

 veloped countries, where the ratio of doctors to the total population i.s so low, 

 to the advanced countries where the doctors are relatively more numerous, is the 

 most disconcerting aspect of the brain drain, whatever its effect or lack of 

 effect on the economic development of the underdeveloped countries.*" 



Thus, the imbalance in doctor-to-population ratios indicates that the 

 LDCs may have an oversupply of physicians to meet the demands of 

 urban dwellers — or at least of those with money to pay for physicians' 



"'.Margulies to Mrs. Edna Gass, Jan. 19, 1968, In Hearings, House Government Oper- 

 ations Committee, Brain Drain, 1968, p. 91. 



*^ Margulies and Block, op. clt., p. 86. The authors noted that the 40 Nlcaraguan physi- 

 cians in the United States approximate the total medical school output of Nicaragua for 

 2 years, and that the 328 physicians for the Dominican Republic represent their medical 

 school output for 4 years. "If the United States lost 60.000 of its own medical graduates 

 to other countries, the equivalent of Iran's or Thailand's loss to this country, for even brief 

 assignments," they wrote, "there would be widespread cries of shock and outrage. If wo 

 added to that migration the repatriation of all FMGs now in this countrv, the total number 

 of physicians remaining would be reduced from ,300,000 to 200.000. Even so, we would still 

 have 1 physician for every 1,000 people, an enviable goal for the less developed countries." 

 (pp. 80-81.) 



^'^ Stevens and Vermeulen, op. cit., p. xl. 



«™ Department of State, Proceedings of Workshop on the International Migration of 

 Talent and Skills, October 1966, pp. 126-127. 



*" Butter, op. cit., p. 23. 



<'2Myint, op. cit., p. 235. 



