We owe South Africa $44.7 billion

There was a great article in the New York Times this week that follows the story of Dr. Kunj Desai, a surgery resident originally from Zambia who is about to complete his training in New Jersey.  Through Dr. Desai’s story, the article highlights the agonizing personal and professional compromises that foreign doctors must make when faced with the decision to return home (where doctors are badly needed) or to stay on in the US.

What got me, however, was the article’s provocative title: “America is Stealing the World’s Doctors.”  While the article focused on the individual choice to leave or to stay, it did not so much address the fact that doctors migrate to the US due to an American health system that by design relies upon doctors from developing countries.

The US isn’t the only country that does this.  Australia, Canada and the UK ‘import’ between 23 and 28% of their doctors. And while there is plenty of doctor migration between these countries, there is also plenty of reliance upon the developing world as a source.  Our British friends provide the most stark example: nearly 75% of their foreign doctors come from low or low-middle income countries.

So, in light of the title of the article and the fact that I am now in South Africa (where there is a substantial physician shortage), I started to wonder just how much have these Western countries have ‘stolen’ from South Africa.  One article I found, gives an estimate of $1.4 billion.  This is based on the fact that South Africa spends $58,698 to put a kid through elementary school, high school, and medical school and the fact that 10,822 South African doctors have left their country for either the US, Canada, the UK, or Australia.

Sounds like a reasonable estimate, eh?  I think it’s too low.

McCord Hospital in South Africa brings in doctors from Poland, Romania, Cuba, and Zambia

Economists think that through the way we spend money we reveal our preferences on how much we value human life.  I.e. I am willing to spend $400 extra to put seat belts in my car, such an action will reduce my risk of dying by 10,000, so I value a statistical life at about $4 million. (These are made-up numbers, someone check my math)  And economists have calculated this repeatedly with various costly but life-saving measures (controlling pollution, buying safer cars, etc) and generally find in the US we value one statistical life between about $4 million and $10 million.

Yeah. I always thought economists were cold too.

Cold, but useful.  So let’s take the low number. $4 million per life saved.

Unfortunately, I couldn’t easily find data on how many average lives a physician saves (maybe my economist friends can help me out here. This data must exist in some form… I’m sorry I called you cold) But let’s say one. Lets say a doctor saves one life in her career.

Well by that incredibly conservative measure South Africa’s doctors have saved 10,822 lives in the West.  And at 4 million bucks a piece that is $43.3 billion of value that that the US, Canada, the UK and Australia have gained at South Africa’s expense.

So returning to Dr. Desai and the tough decision that he faces: the fact is that it isn’t my place (or anyone’s) to force a doctor to work (or not work) in a given setting.  Dr. Desai was pushed to his personal brink before he left Zambia.  In his shoes, I might have done the same but probably much earlier.  I do think, however, that we in the West owe Zambia some money for taking one of theirs.

We also owe South Africa and India and Nigeria and Pakistan and Ghana some money.

Maybe while we are writing the check, South Africa can think about how they’ll use $44.7 billion to train and keep their doctors at home.

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