The sad plight of fledging doctors

This article was exclusively written for the Sting by Mr. Manish Kumar Gupta, a medical student at VA Healthcare medical center at Miami, FL. He is also affiliated to the International Federation of Medical Students Associations (IFMSA). However, the opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Migration of human beings has taken place at all times and in substantial diversity of circumstances. Causes have been climatic, political upheaval, economic or simply marketing of western concepts of living. The migration of medical students from developing to developed countries often remains a contentious topic with international policy makers. Arguments have long been made that migration stands as a stumbling block on the road map of global health. In “An essay on the principle of population,” Thomas Malthus wrote: “An emigration necessarily implies unhappiness of some kind or other in the country that is deserted.” The rationale behind emigration of human beings orbits around this Malthusian principle and it bodes well for fledgling doctors as well.

The linchpin behind emigration of medical students in general is debated around “Push/Pull” polarities. The strands that weave the thought inside medical students to leave their own native country are called “Push” factors, and the facets that inveigle them towards the high-income group countries are called “Pull factors”.

The Cardinal push factors that compel medical students to migrate towards the high-income group countries are already well documented in literature and these factors remain unchanged since many decades. These elements are lack of financial resources in the healthcare sector, limited career opportunities, poorly structured residency programs, intense and unfair (nepotism) competition for few residency positions, inability to practice theoretical concepts, dissatisfactory mentorship, weak institutional commitment towards teaching, lack of incentives for hard work and ever going culture of migration towards the west.

But in the year 2017, the pivotal role driving the exodus of medical students is played by deadly armed conflicts between the government and various factions that are prevalent in South East Asian and Middle Eastern countries. The conflict has arisen due to the malfunction of geopolitical structures built over the past one century, escalating the risk of ferocity and withering the world’s joint ability for conflict management. Geopolitical shifts, intensifying rivalries between major powers and rising regional tensions have fueled conflicts and made emigration towards the high-economic group countries an only available option for common citizenry including medical students.

Key pull factors that fascinate medical students towards high-income group countries incorporate higher remuneration, availabilities of larger number of residency positions, competition based on intelligence and productivity, higher commitment and collegial relation of attendings towards the trainees, well-structured research environment and above all the covenant of safety and security of the family.

The sincere challenge is what can be done now to revitalize the economic and political framework of countries, which are already facing a health crisis, topped with skilled workforce wanting to migrate. The area would benefit by a security centric approach coupled with developmental initiatives and arbitration and mediation by international peacekeeping institutions such as the United Nations. Additionally, efforts should be made in formulating policies that focus mainly on diminution of push factors and building up of elements that may persuade medical students to stay back in their aboriginal countries.

About the author

Manish Kumar Gupta is a research associate at VA Healthcare medical center at Miami, FL. Born and brought up in heart of India, Manish’s interests include a commitment to medically underserved population, preventive medicine and a love for teaching. By incorporating these in to a full service practice, he can truly meet the needs of his community as well as his own personal goals. Other interests include also reading geopolitical and other non-fiction literature and debating with people on geopolitical equations.