Doctors,opportunities and mobility of labour

In september 2002,I resigned my position as Medical Registrar at the University College Hospital,Ibadan Nigeria.Two weeks later,I was on a plane to Dublin unsure of what fate had in stock for me.All I knew was that several other young doctors like me were embarking on the same voyage.The script was simple:write the TRAS exam,attempt the MRCPI part 1 and start applying for jobs.
As often with many other things in life,the reality couldn't be further deviant from the script.Several young doctors mostly from the developing world(India,Pakistan,Sudan and Nigeria) suddenly found themselves out of job,out of cash and out of hope.Many were forced to take up the less prestigious means of livelihood from flipping burgers at Mcdonald to kitting up as security guards and perhaps the luckiest ones were the select few that got posts as care attendants in the bigger hospitals.

I take the pain to paint the picture above so that readers might be able to understand better some of the issues i plan to raise in subsequent paragraphs.It wasn't much rosier for the 'lucky' ones that ended up in the overcrowded East Ham flats in London hoping to scale through the PLAB exams as a gateway to the NHS....needless to say this has somewhat mellowed down now owing to the MMC restructuring currently being forced through in that country.
I also need to mention the Yankee hopefuls some of whom had to endure inhuman treatment at the hands of factory bosses content to exploit loopholes in the immigration policy in the US to employ these hapless aspiring docs in grossly underpaid "long-hours" factory jobs.Many of these doctors never got enough time to study for the USMLEs,subsequently failing several times.I know at least one such frustrated doc who is now a physician assistant...he was a plastic surgery resident in Nigeria!.

Those who managed to find caring relatives or friends willing to extend a hand of charity quickly discovered that human kindness had limits.Stories abound of some docs arriving at their relatives/friends homes where they had hitherto been squatting to meet bolted doors with their belongings left out in a 'Ghana-must-go' bag in the snow.
Now it was customary in this emerging subculture for young doctors to both envy and celebrate each new person that broke the code and secured a job...usually in far removed remote areas naturally underserved by indigenous phycisians.These 'lucky' ones almost invariably quickly recognized that 'all animals are equal but some are more equal than others'.In the very occasional instance that the exceptional foreign doctor got into a big center,training opportunities were at a premium and invariably exclusive to local grads.I know at least two compelling examples:the elder brother to a friend of mine has held cardiology registrar positions in Ireland since the mid '90s....he's still looking for an sPR post today.There is also a middle aged surgeon based in Co Kildare.Nurses and medical colleagues alike would testify to his superior surgical skills....but today,his consultant supervisor is a kid who was his intern 12 years ago!

But the picture is not all grim.Recently I learnt that a brilliant young Nigerian surgeon was confirmed as permanent consultant surgeon in Tallaght Hospital,Dublin.It is however pertinent to mention that he broke the all-time record in the FRCSI exams and has been widely acknowledged as an exceptional scholar.There are several other foreign (asian and african) doctors currently filling the 'locum consultant' posts springing up all over UK and Ireland especially in Psychiatry.Now this 'locum' epidemic can only last so long,so it's instructive that those fortunate to get in early are trying to put enough money away before the door closes.In 5 years or so,it's only natural that these locum doctors will find themselves surplus to requirements without specialized training and some real questions to answer to themselves.That is why several foreign grads are queueing up at interview centers for Family Practice training schemes in the UK.This is the closest path to what obtains in the US where residency graduates ,increasingly finding themselves short on fellowship training options, at least have a safety net in building their own individual practices as general internists.

Finally,let me put this whole thing in context for you.Few weeks ago,the world was shocked to realize that many of the airport bombing suspects in Scotland were doctors.Insiders and close industry watchers would not have been in the least surprised....this was always coming.The human mind,like the heart also obeys Starling's law...up to a point,then it switches to Laplace's law.It can only take so much frustration before reaching breakpoint.

I suspect that policy makers in the more affluent societies are by now reviewing their startegies towards medical recuitment.The current situation where close to 50,000 young doctors roam the streets of London,Dublin and Sydney jobless and out of visa status cannot be said to be serving anyone's interests...not in the least that of their home countries where ordinary people continue to die daily from a combination of incompetent governance,non-existent medical infrastructure and an unabating trend to brain drain.

OMC