Brain Drain

Rick Johnson, for HealthLeaders Media , September 30, 2008

The AMA estimates that up to a quarter of practicing physicians in the United States received medical training abroad. Many of these are foreign doctors who sought visas in order to earn a more comfortable living in a developed nation. For emerging countries, physician brain drain continues to be a serious public health concern. But more recently, critics have emerged complaining about the threat of brain drain from private health systems within developing countries.

The thinking by some goes that physicians in Thailand, India, or Singapore are enticed to take on more patients in budding private hospital settings where they can get paid at a higher rate than in public hospitals and clinics.

But I've often wondered what the alternative would be if these physicians didn't have the option to practice in a private health setting. I've heard anecdotally that physicians in India, for example, are more inclined to practice in their homeland nowadays because they not only receive better reimbursement from the growing private health sector there, but also because they are excited to be part of the region's healthcare story.

"I have 200 physicians who wouldn't even be here if Bumrungrad didn't exist," says Bumrungrad International Group Chief Executive Officer Curtis J. Schroeder. "They wouldn't be in Thailand; they wouldn't be servicing Thais at all."

I had a wide-ranging phone conversation with Schroeder last week. He says that many of the physicians he has on staff also work and teach in government hospitals and take care of the poorest members of the Thai society.

As the largest private hospital in Southeast Asia, with 554 beds and more than 30 specialty centers, Bumrungrad clearly has a lot to gain by partnering with the best physicians in Thailand. It is, after all, the physician-patient relationship that is at the center of the system's care model that has earned Bumrungrad's international reputation for service excellence.

The Bangkok hospital reports that it cares for about 400,000 international patients annually—nearly half its patient population—but Schroeder holds firm that Bumrungrad isn't profiting at the expense of the Thai people. He points out that across Thailand only 0.3% of the healthcare delivered goes to non-Thais. Without the private sector to support Thailand's physician work force, it's likely that many would seek greener pastures in the West.

"A fully tenured professor of surgery at a major university in Thailand makes about $600 a month," says Schroeder. "Now if we think they are able to buy their cars and take care of their kids for that, we're of course fooling ourselves. Virtually all of them have sources of income through the private health sector. It's a well-known public-private subsidization."

Entrepreneurs continue to develop private health systems in emerging markets, serving international patients as well as the rising middle-class that suddenly can pay for better healthcare options. No doubt the goal of profitability is not lost on the CEOs of these hospitals, but through physician recruitment and retention efforts, perhaps these regions will be all the better because of these private networks.

Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at
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