Canada must decide to what degree we will be accessories to theft. We’re receivers of stolen goods when we encourage the poaching of foreign-trained health-care professionals
Canada must decide to what degree we will be accessories to theft. We’re receivers of stolen goods when we encourage the poaching of foreign-trained health-care professionals
Arguably the biggest HR challenge facing Canada’s health system is a shortage of doctors, nurses and other health professionals. Solving the problem preoccupies governments across Canada.
For employers, desperate for skilled health professionals, increasing the supply of foreign-trained health professionals coming to Canada can be a very seductive option.
Luring health professionals from other nations — commonly called “poaching” — is nothing new. It is global in scope, since the health human resource crunch faces almost every country.
But recruiting physicians and caregivers from other countries is an ethical quagmire, particularly if recruitment is targeted at countries in the developing world that can not afford the loss of trained doctors and nurses.
Poaching from developing countries first emerged as an issue when it was being done by the United Kingdom. The country’s National Health Service (NHS) was recruiting aggressively in Caribbean, Asian and African nations, luring doctors and nurses to Britain.
An outcry from developing nations led the NHS to develop guidelines discouraging recruitment from 120 nations whose supply of trained health services workers is precarious. But much damage was done, by the U.K. and other countries including the United States, Australia — and Canada.
The results of poaching in some countries became devastating. Zambia saw its physician supply decline from about 1,600 doctors to fewer than 600, largely because of poaching. South Africa, too, saw its supply of health workers dwindle. Recruiters found a ready market among South African doctors and nurses worried about instability in their homeland. Recent estimates suggest South Africa has spent more than $100 million training doctors who then left the country.
Saskatchewan is a good example of a beneficiary of this global brain drain. More than half of Saskatchewan’s doctors were trained elsewhere, and about 20 per cent of those doctors are from South Africa.
The response from the industrialized world toward Third World concerns about poaching has been to establish guidelines — usually without the force of law behind them — to curb the practice.
Guidelines have tried to deal both with the ethics of poaching, and the ethics of denying the right of health professionals in developing nations to seek a better life elsewhere.
Generally, the guidelines have attempted to curb aggressive recruiting, while acknowledging the right of health workers to seek employment beyond their own borders. This trade-off between two ethical issues is at the heart of a “Code of Practice for the International Recruitment of Health Workers,” adopted by Commonwealth health ministers (including Canada’s health minister) in May 2003.
This code attempts to discourage aggressive recruiting by industrialized nations, while respecting “the right of health workers to migrate to countries that wish to admit and employ them.”
The code also makes a watered-down plea to countries recruiting health workers to provide restitution to countries from which they have poached health professionals. The code’s draft text said countries “should” provide restitution, but the weaker phrase “may wish to” make restitution was the one that ended up in the final version.
Recently South African medical officials, recognizing the inevitability of at least part of the brain drain, proposed that poaching countries should provide cash payments to South Africa-poached doctors, as well as payments to cover the cost to South Africa of training replacements.
Some argue that morality has nothing to do with physician recruitment — that in an unfettered free market, buyers and sellers should be allowed to operate freely and governments should have no role in regulating the trade.
What makes a mockery of this argument, though, is the fact that most nations see their health system as more than a marketplace. Health systems are intrinsic to the well-being of citizens, and governments invest heavily — even when they can ill afford it — to train health professionals.
One could even make the market-oriented argument that if a country trains one of its citizens in a health profession, the country “owns” the expertise it has paid for — and that to leave the country without repaying the nation for the cost of gaining that expertise is, in effect, theft.
We in Canada need to decide to what degree we will be accessories to theft — the receivers, if you will, of stolen goods — and the extent to which we will encourage poaching through active foreign recruitment to solve the ills of our own health system.
John Butler, president of the Agora Group, a Markham, Ont.-based HR and health-care management consulting firm, is a regular contributor to Canadian HR Reporter’s Insight section. He can be reached at (905) 294-9762 or [email protected].
Arguably the biggest HR challenge facing Canada’s health system is a shortage of doctors, nurses and other health professionals. Solving the problem preoccupies governments across Canada.
For employers, desperate for skilled health professionals, increasing the supply of foreign-trained health professionals coming to Canada can be a very seductive option.
Luring health professionals from other nations — commonly called “poaching” — is nothing new. It is global in scope, since the health human resource crunch faces almost every country.
But recruiting physicians and caregivers from other countries is an ethical quagmire, particularly if recruitment is targeted at countries in the developing world that can not afford the loss of trained doctors and nurses.
Poaching from developing countries first emerged as an issue when it was being done by the United Kingdom. The country’s National Health Service (NHS) was recruiting aggressively in Caribbean, Asian and African nations, luring doctors and nurses to Britain.
An outcry from developing nations led the NHS to develop guidelines discouraging recruitment from 120 nations whose supply of trained health services workers is precarious. But much damage was done, by the U.K. and other countries including the United States, Australia — and Canada.
The results of poaching in some countries became devastating. Zambia saw its physician supply decline from about 1,600 doctors to fewer than 600, largely because of poaching. South Africa, too, saw its supply of health workers dwindle. Recruiters found a ready market among South African doctors and nurses worried about instability in their homeland. Recent estimates suggest South Africa has spent more than $100 million training doctors who then left the country.
Saskatchewan is a good example of a beneficiary of this global brain drain. More than half of Saskatchewan’s doctors were trained elsewhere, and about 20 per cent of those doctors are from South Africa.
The response from the industrialized world toward Third World concerns about poaching has been to establish guidelines — usually without the force of law behind them — to curb the practice.
Guidelines have tried to deal both with the ethics of poaching, and the ethics of denying the right of health professionals in developing nations to seek a better life elsewhere.
Generally, the guidelines have attempted to curb aggressive recruiting, while acknowledging the right of health workers to seek employment beyond their own borders. This trade-off between two ethical issues is at the heart of a “Code of Practice for the International Recruitment of Health Workers,” adopted by Commonwealth health ministers (including Canada’s health minister) in May 2003.
This code attempts to discourage aggressive recruiting by industrialized nations, while respecting “the right of health workers to migrate to countries that wish to admit and employ them.”
The code also makes a watered-down plea to countries recruiting health workers to provide restitution to countries from which they have poached health professionals. The code’s draft text said countries “should” provide restitution, but the weaker phrase “may wish to” make restitution was the one that ended up in the final version.
Recently South African medical officials, recognizing the inevitability of at least part of the brain drain, proposed that poaching countries should provide cash payments to South Africa-poached doctors, as well as payments to cover the cost to South Africa of training replacements.
Some argue that morality has nothing to do with physician recruitment — that in an unfettered free market, buyers and sellers should be allowed to operate freely and governments should have no role in regulating the trade.
What makes a mockery of this argument, though, is the fact that most nations see their health system as more than a marketplace. Health systems are intrinsic to the well-being of citizens, and governments invest heavily — even when they can ill afford it — to train health professionals.
One could even make the market-oriented argument that if a country trains one of its citizens in a health profession, the country “owns” the expertise it has paid for — and that to leave the country without repaying the nation for the cost of gaining that expertise is, in effect, theft.
We in Canada need to decide to what degree we will be accessories to theft — the receivers, if you will, of stolen goods — and the extent to which we will encourage poaching through active foreign recruitment to solve the ills of our own health system.
John Butler, president of the Agora Group, a Markham, Ont.-based HR and health-care management consulting firm, is a regular contributor to Canadian HR Reporter’s Insight section. He can be reached at (905) 294-9762 or [email protected].
