Steve Thompson, MBA, the CEO of Johns Hopkins International (the arm of Johns Hopkins Medicine that provides a focus for all its international activities) has written a blog in response to the excerpt from Insourced that appeared in Salon.com.
Thompson’s response focuses on what Hopkins and other international organizations can do to improve the health systems in developing countries to make them a more attractive place to work so that health workers will not want to migrate to the US. I applaud this sentiment. In fact this is much of what IntraHealth, the global health NGO I work for, does in thirty-four countries throughout the developing world. Making sure that health workers have the skills, equipment, and motivation to save lives is crucial to their retention. We desperately need more investment in this area.
Thompson’s blog then focuses on building world class hospitals. There can be some trickle down retention effect, but we must be cautious about investing in hospitals. In most developing countries, the vast majority of people who die needlessly die at home having never been to a hospital. We see this in countries like Lesotho where the tertiary Queen Elizabeth Hospital takes up the vast majority of the country’s health budget while children die at home from diarrhea, pneumonia, and vaccine preventable diseases. These hospitals divert funding from the more critically needed community health and public health investments.
Yet making investments in the health systems of developing countries, no matter how large these investments are, will not solve the problems outlined in Insourced. Insourced addresses problems beyond the retention of healthcare workers in developing countries. The US is not training enough of our young people to meet our own healthcare needs. This is especially true in American communities with the greatest health disparities and fewest health workers per capita: rural, poor, and minority communities. Also, the costs of training health workers is spiraling up faster than inflation and faster than the costs of general tertiary education in the US and we must find a way to educate our young people more cost-effectively.
In addition, a large motivator for health workers to leave their countries is beyond the power of their countries to change. In general, health workers in the US have higher wages than in any other country in the world. Most developing countries will never be able to compete with the wages offered to health workers in the US, even if they improve their health systems. Consider the consequences if we open up all other American sectors to global recruitment the way we have opened up our health sector: with special earmarked visas, licensing exams, and clear entry pathways. You would see foreign workers flocking to US jobs, willing to work for less than US citizens.
(For full disclosure, I should let you know that I am an alumna of the Johns Hopkins School of Medicine and the Johns Hopkins School of Public health and serve as adjunct faculty at the Johns Hopkins School of Public Health. IntraHealth has bid on grants with the Johns Hopkins School of Nursing as a partner. )