JAMAICA is haemorrhaging doctors.

More than four out of ten of the country’s physicians have left home to work abroad in the United States, Canada and in the United Kingdom, according to a new report.

The report, published in the October 27 edition of The New England Journal of Medicine, shows that of an estimated 4,000 Jamaican doctors, roughly 1,600, or 40 per cent, have left the country to work overseas.

The majority, 938, are in the United States, another 472 are working in the United Kingdom, and 179 in Canada.

The study suggests that the exodus is largely for financial gain, but individual migrant doctors say too that they leave to escape the old boys’ network, which they claim, starves young physicians of professional opportunity.

But, Dr Alverston Bailey, president of the Medical Association of Jamaica (MAJ), who says he found the physician brain drain study interesting, questioned whether things are quite as bad for Jamaica as it suggests.

“We find the data a little unusual, because here on the ground in Jamaica, we do not get the sense that we have such a large movement of doctors from Jamaica to the United Kingdom, Canada or the United States,” said the MAJ president.

“We are not feeling a devastating brain drain, at all.”

For the 40 per cent who have left, Dr Fitzhugh Mullan, author of the brain drain study, says the US and other wealthy nations that drain developing countries like Jamaica of their physicians are at fault.

But so too, he adds, are the Jamaican doctors themselves who, after receiving a subsidised medical education, choose to cut and run to the US to cash in on their training.

“I don’t want to be a moralist, but there is a moral question,” says Mullan, a professor at George Washington University School of Public Health and Health Services in Washington DC.

“Leaving does raise questions of ethics and social policy and whether someone trained with taxpayer’s, government money, should simply take that skill elsewhere.”

But the individual stories suggest that there are complexities to the issue. For Dr Kathleen Watson, who attended medical school at UWI Mona and did part of her post graduate training in Jamaica, it was nothing to do with dollars and cents.

“I came abroad, as so many do, to seek medical training that I couldn’t get in Jamaica, and one thing led to another and before you know it you have not gone home, gone back, as you had promised yourself you would,” says Watson, who lives in New York.

Unlike many others, Watson did keep her promise to herself to return to Jamaica.

But, frustrated at being closed out by an old boy’s network that, she said, parcelled out patient referrals among themselves, and because she was in a bad car accident, she left again for the US.

“I don’t have any anguish about not being in Jamaica, no; and yes I do believe really that, in the end, a person’s medical education basically belongs to the individual, not to the country.”

A paediatrician, who also requested anonymity, said doctors are given mixed messages.

“I only left because I was told there were no jobs for us there,” the pediatrician says. “In some ways they want you to stay, to work in the system, but they can’t offer you anything…. There’s no personal development, there’s no academic development for me.”

A new World Bank study on migration from poor to rich countries, estimates that Jamaica loses some 85 per cent of its college-educated professionals to OECD countries.

For expatriate Jamaican physicians who choose to leave their home to earn their living in the US, the physician brain drain is a favourite topic, but not one they like to discuss publicly.

Many admit to feeling shame at their decision to leave. Others say they fear discussing the subject publicly will lead to retribution against them should they return home some day.

One expatriate physician, who wouldn’t use his real name and agreed to talk only if he could use the pseudonym ‘John Jones’, said a group of older men who have a stranglehold on the upper tier of the medical world in Jamaica are responsible for driving bright young graduates out of the country.

“Yes you leave because of crime, but really you leave because the group of old men that run things are afraid of the young ones like me…,” says Jones, who has only been in the US for three months.

“I would have to wait a generation for them to die to get a chance to practice what I’ve learned.”

Leaving was a wrenching decision, said Jones, and one he put off making even as other family members migrated year after year.

“I never wanted to come here. I don’t think the United States needed another doctor. I was happy in my country and serving my own people,” said the young doctor.

“I only hope Jamaica can learn from this, because it has lost so many good people.”

Among Caribbean countries, Jamaica provides the largest number of physicians to the US, Canada, and the UK.

Haiti is next with 35 per cent. By contrast, the Dominican Republic has lost only 17 per cent of its physicians to wealthy countries; Cuba three per cent, and Trinidad and Tobago two per cent.

To stop the exodus, Mullan says two things need to be done:

. the US, the UK, and Canada must train more of their own people to become physicians so they have far less need to poach; and

. that more developing countries introduce ‘national service’ for doctors. In other words, physicians who benefit from subsidised medical training should be required to give something back by working for a couple of years in government service.

“You can’t tell them they can’t leave,” says Mullan of Jamaican doctors, “but you can require a kind of national service before a medical licence is certified and granted – a kind of community service for a year or two.”

The system has long been in place in Mexico, and South Africa recently introduced a similar programme.

But, the MAJ president sees no need for such a system here.

Bailey says, however, that if there were adequate postgraduate training available in Jamaica, only a handful of the country’s medical school graduates would even consider going abroad.

“How many would leave and never return in a typical class? – I would say maybe as high as 20 per cent and as low as 15 per cent. Things are improving significantly,” he said.

“Since the 1970s, there has been a tremendous return of doctors to Jamaica.”

One Jamaican doctor who is not coming home, though, is Kathleen Watson.

“I’m not feeling guilty anymore,” she says. “I tried but I, as so many do, faced resistance when I returned, plenty of resistance, and so although Jamaica will always be my home, where I am now, the United States, is where I am going to stay – probably.”

editorial@jamaicaobserver.com