PLOS Science Wednesday: We’re Sten Vermund and Akhenaten Tankwanchi, we just published a paper about the impacts of “brain drain” or the migration of the health workforce from Sub-Saharan Africa to the United States — Ask Us Anything! : science

Akhenaten: Thanks for the valid question! Of course skilled migration is not a zero-sum game. There are certainly some benefits including remittances, knowledge exchange, and technology transfer....

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/cto2an0/

Is the impact good? because all those smart people from your area going to the USA and then having opportunity probably returns to the region right? How many of these folks come back and set up...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctky7jk/

Akhenaten: Our research has focused on the USA for a few reasons: a) We are based in the USA and have easier access to US health workforce data; b) the scientific literature suggests that the US ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctktctq/

I notice your AMA is specifically for Brain Drain from Africa to the US. Why not Europe? Is this another negative effect of the market based healthcare system in the US as opposed to the more soc...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkp90m/

Akhenaten: Hayes, thanks for your questions! In my discussion with some SSA migrant physicians, they explained that admission to medical school was quite competitive and they liked the competitio...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctknfbc/

I share your skepticism to some extent (but I am not a physician). As I said earlier, it is difficult to talk of physician shortage in a country that has an average physician density of 200 physi...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkizh9/

Sten: There has been very little evaluation of these investments in African medical and nursing education to date. The jury is still out as to the true impacts that they have made.

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkidti/

We also find this recent PLOS Med publication very informative: Maximizing the Impact of Training Initiatives for Health Professionals in Low-Income Countries: Frameworks, Challenges, and Best ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkich0/

Sten is correct. I will add that the adoption in 2010 of the WHO Global Code of Practice on the International Recruitment of Health Personnel, is the most symbolic global effort to date to incent...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctki68l/

Sten: Yes, these are terrific examples, thanks!

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkhzfy/

Sara - I got the excerpt below from Cancedda, Farmer et al. "A number of innovative programs exist to address health workforce shortages globally, including the Cuban medical training model to ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkhsmk/

Sten: Even within the US, states have the authority for medical licensing. The European Community has done some liberalization and standardization for medical licensure across some borders, but t...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkharu/

Akhenaten: Kaiservonmaanen, you are talking about “brain waste” (i.e., highly skilled migrants working in jobs incommensurate with their advanced degrees in the host country). While I have ye...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkh6oi/

Thank you for taking the time to do an AMA on Reddit, Sten and Akhenaten. I have one question with a follow-up if you have the time: Have investigators measured the effects on these young (<35)...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkh4ut/

Sten: No, we have not gone back very far in time. The data are not as good from older eras.

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkh312/

There are vast differences in physician coverage both across and within nations that can exceed 10 to 1 and even 100 to 1 in terms of doctors per 100,000 persons.

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkh220/

Sten: Yes, precisely. Public universities in the US have had some success with this approach, preferentially selecting students from rural or disadvantaged backgrounds, then nurturing their caree...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkh059/

Sten: Persons who are not using hard fought skills and educations are typically frustrated, as one can imagine, but we have no data on this. The nations that have done better to keep their profes...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkgvtm/

Use criteria for medical school admission that select for persons less likely to migrate (see Silvestri D et al Medical and nursing students' intentions to work abroad or in rural areas: a cross...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkgq8s/

Yes, there are a number of initiatives: MEPI, CONSAMS, SACORE are three that can be googled. There are also excellent partnerships, such as the 14 universities partnering with Rwanda, various san...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkgkn2/

Yes, many teachers, engineers, business experts, nurses, and others who fill positions in Europe and North America. Yes, huge disparities within countries with internal migration from rural to ur...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkgh21/

The US does not train enough physicians to meet its needs and has always relied on migration from abroad to fill this gap.

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkger8/

Does that suggest that changing the selection criteria for incoming medical students might produce that result- that is, pick students who have stronger connections to their home countries, and a...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkft5a/

Akhenaten: Lucaxx85 - I agree with you that even if the Code was a binding policy, it would have done little to stem the brain drain of skilled health workers from SSA. It is not at random that s...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkfls1/

A tweeted follow up question...E. O. Walong @EOWalong @PLOS it's a massive difference, about x10, correct?

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkfg3g/

Akhenaten: Thanks for the question: In the paper, I have hinted that any policy to promote SSA physician retention in-country should target primarily physicians 35 years old and younger. I came u...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkf9y9/

Many other experts in SSA migrate to high income nations, not just doctors. Within nations, there is migration from areas with fewer job and educational and cultural opportunities into higher acc...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkewuu/

What are some ways the global political community and national governments in sub-Saharan African countries are working to incentivize physicians to stay and practice medicine in their countries ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkevm7/

Thank you Sten and Benjamin for taking the time to participate in today's AMA. We spoke extensively about how the "brain drain" of the health workforce in sub-Saharan Africa has negated efforts t...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkes4j/

Akhenaten: Good question Progo7! To my knowledge, US companies/hospitals do not engage in active recruitment of physicians in SSA. I distinguish between active recruitment and what I call in our ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkepty/

Akhenaten: Thanks for the question! Adequate compensation is a very important factor in the retention of skilled health workers. But, from my conversation with both migrant and non-migrant physic...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctken7x/

Is this also a trend across other professions in SSA. And is brain drain something that occurs in impoverished areas in developed nations, i.e. ghettos.

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkdkk9/

Hi, this is Sten Vermund at Vanderbilt. Looking forward to the discussion upcoming. I see several comments already, so here goes. 1. It is a substantial frustration for technically educated perso...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkcn8p/

That there's significant migration seems a little surprising. Are there really lots of open positions in the US, or is this just an attempt by corporations to drive wages down?

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctkbc87/

What can be done by governments on both sides to encourage SSA physicians to practice in their home countries? What incentives to remain in-country (or disincentives to migration) are currently i...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk8ks3/

Did you try to compare our era to what happened in the past when one civilization was attracting to lettered and scientist from others and how it impacted them ?

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk8cnz/

I've scrolled a bit the WHO code and I don't see how it possible could have helped. What's going to stop somebody with a very sought for qualification to get an higher pay abroad? I'm from Ital...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk8c6n/

When you say that these migrant physicians were recruited, do you mean that US companies/hospitals are actively depriving SSA of medical care?

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk6ome/

Your conclusion suggested incentivizing physicians to remain in SSA- what's currently the average salary/compensation difference between a physician practicing in an SSA country and one who has e...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk6c5r/

I know several people with engineering degrees back home that end up as taxi drivers in the west. Is that really better than what they can expect at home? Is something being done in developing co...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk64dh/

Science AMAs are posted early to give readers a chance to ask questions and vote on the questions of others before the AMA starts. Guests of /r/science have volunteered to answer questions; pl...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/ctk5nlc/

Hi Reddit, we’re Sten Vermund and Akhenaten Tankwanchi, we just published a paper about the impacts of “brain drain” or the migration of the health workforce from Sub-Saharan Africa to the ...

https://www.reddit.com/r/science/comments/3f0ot9/plos_science_wednesday_were_sten_vermund_and/