Offshore Medical Schools Are Buying Clinical Clerkships in U.S. Hospitals: The Problem and Potential Solutions.

U.S. medical education faces a threat from for-profit Caribbean medical schools which purchase clinical rotation slots for their students at U.S. hospitals. These offshore schools are monetizing a system that was previously characterized as a duty-the duty of the current generation of physicians to educate their successors. Offshore schools purchase clinical rotation slots using funds largely derived from federally subsidized student loans. This leads to pressure on U.S. schools to pay for clinical clerkships and is forcing some of them to find new clinical training sites.For-profit Caribbean schools largely escape the type of scrutiny that U.S. schools face from U.S. national accreditation organizations. They also enroll large classes of students with lower undergraduate GPAs and Medical College Admission Test scores than those of students at U.S. medical schools; their students take and pass Step 1 of the United States Medical Licensing Examination at a substantially lower rate than that of U.S. medical students; and their students match for residencies at a fraction of the rate of U.S. medical school graduates.Among the potential solutions proposed by the authors are passing laws to hold for-profit Caribbean schools to standards for board passage rates, placing restrictions on federal student loans, monitoring attrition rates, and denying offshore schools access to U.S. clinical training sites unless they meet accreditation standards equivalent to those of U.S. medical schools.

Primum Nocere: Medical Brain Drain and the Duty to Stay.

In this essay, we focus on the moral justification of a highly controversial measure to redress medical brain drain: the duty to stay. We argue that the moral justification for this duty lies primarily in the fact that medical students impose high risks on their fellow citizens while receiving their medical training, which in turn gives them a reciprocity-based reason to temporarily prioritize the medical needs of their fellow citizens.

The ethics of engaged presence: a framework for health professionals in humanitarian assistance and development work.

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors. The elements also help minimize or avoid certain miscalculations and harms. Emphasis is placed on the shared humanity of those who provide and those who receive assistance, acknowledgement of limits and risks related to the contributions of expatriate health care professionals, and the importance of providing skillful and relevant assistance. These elements articulate a moral posture for expatriate health care professionals that contributes to orienting the practice of clinicians in ways that reflect respect, humility, and solidarity. Health care professionals whose understanding and actions are consistent with the ethics of engaged presence will be oriented toward introspection and reflective practice and toward developing, sustaining and promoting collaborative partnerships.

Balancing the act: The international migration of medical graduates.

In this article I examine the phenomenon of international migration of medical graduates. The debate involving the ethical aspects of medical migration as well as the obstacles faced by doctors to practice unreservedly in their host countries are addressed. The situation of Australia in this context is also scrutinised. Finally, I propose a series of strategies aimed at minimising the unfavourable consequences of the international migration of doctors. This commentary favours a reform in the way institutions and society respond to the process of medical migration and to the needs of migrant doctors. Continued research on this health care topic is required in order to identify the major factors that play a role in this process.

International medical graduates in child and adolescent psychiatry: adaptation, training, and contributions.

This article reviews, consolidates, and enhances current knowledge about the issues and problems child and adolescent psychiatry international medical graduates face. Their training, work force issues, and establishment and advancement of professional identity are presented. Acculturation and immigration dynamics include facing prejudice and discrimination, social mirroring, and difficulties with language. Treatment issues are discussed with a special focus on therapeutic alliance, resistance, transference, countertransference, and child rearing practices. Recommendations for training and future goals are considered.

Adding insult to injury: the healthcare brain drain.

Recent reports published by the United Nations and the World Health Organization suggest that the brain drain of healthcare professionals from the developing to the developed world is decimating the provision of healthcare in poor countries. The migration of these key workers is driven by a combination of economic inequalities and the recruitment policies of governments in the rich world. This article assesses the impact of the healthcare brain drain and argues that wealthy countries have a moral obligation to reduce the flow of healthcare workers from the developing to the developed world.

International migration of doctors from developing countries: need to follow the Commonwealth Code.

There is an ongoing debate on the migration of doctors, especially psychiatrists, from developing countries. It is argued that these countries, which are already running short of psychiatrists, will further be jeopardized and their health systems will collapse if this migration and subsequent recruitment continue. In this paper the author presents a personal view of the ethics and human rights of this matter. He emphasises the importance of migration of doctors in view of the current situation in developing countries and advises that the Commonwealth Code be followed to address the problem of the shortage of psychiatrists in developing countries and psychiatrists' basic right to avail themselves of the opportunities in the developed world.

Use of deceptive tactics in physician practices: are there differences between international and US medical graduates?

Concerns have been raised about the medical practices of international medical graduates (IMGs) in the United States. This study examined the differences between IMGs and US-trained medical graduates (USMGs) in their attitude toward and utilization of deception in medical practices. A random sample of physicians practicing in the US was surveyed by mail in 1998. The dependent variables of interest included 11 attitudinal and behavioral indicators of deceptive tactics in medical practice. IMGs and USMGs displayed limited difference in their attitudes but some differences in their self-reported use of deceptive tactics in medical practice. IMGs were less likely than USMGs to change the patient's official diagnosis (OR, 0.557; 95% CI, 0.344-0.902) or to withhold a useful service because of utilization rules (OR, 0.612; 95% CI, 0.382-0.979). The hypothesis that IMGs have less appropriate professional standards than USMGs is not supported by this study. Alternative hypotheses, such as IMG familiarity with US health care and legal systems, warrant investigation.