1272 



EFFICIENCY IN MEDICAL MANPOWER MANAGEMENT 



Another kind of reform urjj;ed by students of U.S. medical care 

 delivery systems is the heightened rationalization in medical man- 

 power planning, particularly the more efficient use of paramedical 

 personnel to relieve doctors of routine tasks that could be done by 

 semiprofessionals specifically trained for that purpose. (An example 

 is the training of peacetime prototypes of the medical corpsmen used 

 so successfully in the military service during World War II, the 

 Korean War and the Vietnam War. Apparently the doctor's assistant 

 programs, operating in many medical facilities in the country, is 

 structured along these lines. )^'^° 



With a satisfied American medical manpower market, it is rea- 

 soned, the "pull" force attracting FMGs to the United States will 

 diminish. FMGs will then be constrained to work in their own coun- 

 tries and meet its needs, which are by all accounts overwhelming. 

 Given a freely operating manpower market, surplus professionals and 

 professional trainees will be impelled to restiiicture their career 

 plans, rethink their career expectations, and accordingly move into 

 areas where the demands and needs of their countries are the greatest 

 and for them the most professionally satisfying and profitable. 



Other remedies for medical brain drain have been suggested by 

 various sources including the Panel on FMGs of the National Ad- 

 visory Commission on Health Manpower. But these remedies appear 

 to overlook the more fundamental supply-demand problem that gov- 

 erns the American marketplace for medical manpower, the main 

 source generating the flow of immigrant FMGs; they focus rather 

 on the more superficial, administrative features of the problem, such 

 as, FMG qualifications and changes in visa policies requiring return 

 on completion of training.""^ Professor Deutsch put this problem of 

 remedies in proper balance when he wrote of the essential importance 

 of diminishing the "pull" factors of brain drain : 



The problem ... is not only one of preventing the "brain drain" by providing 

 incentives for foreign students and experts to return to their home countries, but 

 also of increasing human-resource development in the United States so as to 

 reduce this country's need to attract talent and skills from the other nations 

 of the world.'"^ 



In brief, the remedy for medical brain drain lies in human-resource 

 development in the United States. In the case of the inflow of scientists 



^^ Dr. Hunt observed In his testimony to the House Government Operations Committee: 

 "The long-range solution of the brain drain problem in medicine . . . will also require the 

 development, as Dr. Sprague suggested, of methods of greater utilization of paramedical 

 personnel to relieve the doctors of some of the things that they are now doing." (Hearings, 

 House, Government Operations Committee, Brain Drain, 1968. p. 68.) Dr. Hunt referre<l to 

 a recommendation by the National Advisory Commission on Health Manpower concerning 

 FMGs which, he said, would eventually result in a considerable diminution in the number 

 coming to the United States. But he added : "The reduction in the number of foreign 

 medical graduates recommended by the Commission cannot realistically be expected to take 

 place until the vacuum created by the shortage of physicians' services "in U.S. hospitals has 

 been alleviated by the production of more U.S. doctors, or by greater utilization of para- 

 medical personnel, or both." (pp. 68-69.) 



Stevens and Vermeulen discuss the use of physician associates or assistants as a means 

 for meeting the critical need of medical care. (Stevens and Vermeulen, op. cit., pp. 77-78.) 



During World War II, the writer was attached to U.S. Marine Corps Evacuation Hospital 

 No. 1 in the Pacific and participated In the Two Jima campaign and the occupation of Japan. 

 This highly mobile hospital unit was composed of some 23 officers, mostly physicians and 

 surgeons, and 220 men, mostly U.S. Navy medical corpsmen. This personal experience, 

 supported by the judgments of the physicians and surgeons, tends to confirm the views of 

 those who value the services of paramedical personnel. 



™i Stevens and Vermeulen, op. cit., pp. 68-69. 



■""Deutsch, op. clt., p. 30. 



