Most countries, like our own, have a severe shortage of skilled health workers. According to a report published by the Canadian Nurses Association, by 2016, the estimated shortage of Registered Nurses (RN) in Canada will be as much as 113,000. For me, a young, healthy, soon-to-be RN, this is great news. I can walk into a hospital in just about any country in the world and say, “Here I am! Employ me,” and they will welcome me with open arms.
But do we, as healthcare professionals, have ethical responsibilities when deciding where to work? Where should my medical loyalties lie?
I receive a student loan and grants from the Newfoundland government. They invest in my education, so should I provide a return on that investment by bringing my skills home when I graduate? On the other hand, the Quebec government partially subsidizes McGill, so maybe I should stay in the province to work. And wouldn’t I be wasting the subsidies and grants provided by the Canadian government if, after graduation, I decide to chase kangaroos around a country health clinic in Australia?
Whether to move abroad or stay home to work is a personal decision, but that doesn’t mean it’s isolated from global ethical concerns. If I decide to work outside of Canada, will I be indirectly contributing to poor health levels in the rural villages of South Africa? Might a young pregnant woman and her child die because I’m treating hangovers and hemorrhoids on a cushy cruise ship bound for Alaska?
Many developed countries, such as Canada, Australia, New Zealand, the U.K., and the U.S. rely on external recruitment to fill the gaps in their healthcare systems. These countries are able to attract a substantial number of skilled healthcare workers from (mostly) developing countries with the guarantee of higher wages, more structured work environments, and better opportunities for training and education.
The problem is that many developing countries have desperate healthcare-worker shortages of their own. So by leaving Canada to work on an American cruise liner, I may be encouraging Canada to poach much-needed doctors and nurses from the developing world.
The migration of health care providers is such a relevant issue that it has been chosen as the topic for the upcoming World Health Organization simulation here in Montreal.
Some propose that source countries can benefit from the remittances that healthcare providers working abroad send home, as well as the potential training and experience that the worker could eventually bring back to the home country. Several policy changes have been suggested, including providing short-term training visas in destination countries and provide monetary compensation to source countries for each healthcare worker lost.
Still, at this point external recruitment and the flow of healthcare workers from developing countries to developed ones is under-regulated. As a result, regions such as sub-Saharan Africa, the Caribbean, South Asia, and Southeast Asia, are experiencing a significant “brain drain,” which further weakens their struggling healthcare systems.
Healthcare systems in developed countries grab what doctors they can, but often give little back to the countries whose doctors they have appropriated. As a result, there is a chance that our decision to work outside of Canada may lead the government to poach doctors and nurses from South Africa. None of this is to say that we shouldn’t recognize the healthcare credentials of foreign workers, or prevent migrants from entering Canada. But looking at the ethics of leaving Canada to work abroad has led to me to forcefully say: yes, as healthcare professionals, we do have moral responsibilities when deciding where to work.