Out of Africa

Brain drain or brain gain?

Last year, as Congress was wrangling over immigration policy, Sen. Sam Brownback (R-Kan.) proposed a simple solution to the U.S. nursing shortage: lift the cap on nursing visas. The proposal fizzled, but not before critics charged that such a policy would be cruel and irresponsible. A news story in The New York Times asserted that "the exodus of nurses from poor to rich countries has strained health systems in the developing world," where countries "are already facing severe shortages of their own."

A new study has turned this assumption on its head. To test whether health worker emigration is hurting developing countries, Michael Clemens, an economist at the Center for Global Development and an expert on international migration, created and analyzed a database of health worker emigrants from Africa. To his surprise, Clemens failed to detect "any negative impact of even massive movements of health professionals out of Africa upon health worker stocks, basic primary health care availability, and public health outcomes." The African countries that send the most workers abroad, it turns out, are educating many more doctors and nurses than they are employing. It's a mistake to assume that an Ethiopian physician who takes a job in New York would otherwise be seeing patients in Addis Ababa. The shortages of working medical professionals to which the Times referred are a reality, but they reflect systemic problems, not a lack of health care workers.

For some would-be physicians, the opportunity to emigrate may be the driving force behind the decision to seek training. Denying visas to nurses in Mozambique may just result in fewer nurses overall. "Punishing emigration, restricting quotas, and banning recruitment," Clemens concludes, "may at best make no one better off and at worst make everyone worse off."