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The Hinged World: Doctors and Diseases on the Move. Fitzhugh Mullan, MD The Murdock Head Professor of Medicine and health Policy George Washington University St. George’s University 30 th Anniversary Symposium November 10, 2007. A Linked World and Medical Migration. Disease Mobility

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the hinged world doctors and diseases on the move

The Hinged World:Doctors and Diseases on the Move

Fitzhugh Mullan, MD

The Murdock Head

Professor of Medicine and health Policy

George Washington University

St. George’s University

30th Anniversary Symposium

November 10, 2007

a linked world and medical migration
A Linked World and Medical Migration
  • Disease Mobility
  • Economic Disparities
  • War/HIV/Corruption
  • Human Ambitions
  • Aging of the Population in the West/North
  • Health Educational Policies in the West/North
pulls to the north and west
Pulls to the North and West
  • Training Opportunities
  • Practice Opportunities
  • Better Remuneration
  • Better Technology
  • Family Opportunities
push factors from the south
Push Factors from the South
  • Lack of Post Graduate training Opportunities
  • Insufficient Practice Opportunities
  • Poor Remuneration
  • Security Concerns
supply of active physicians md do and ratio to population actual 1950 1990 and projected 2000 2020
Supply of Active Physicians (MD & DO) and Ratio to Population Actual 1950-1990 and Projected 2000-2020

Physicians Per 100,000 Population

Population is U.S. civilian population including possessions

Number of Residents in U.S. Allopathic Training Programs According to the Type of Medical School Attended from 1993-2007

Source: AMA










You are Here

Source: RA Cooper

background climate

Era of medical school expansion

New schools – allopathic and osteopathic

Increased class sizes

Branch campuses

AAMC predicts  17% increase in enrollment by 2012

AACOM AAMC predicts  25% increase in enrollment by 20011


Current allopathic schools

Planned allopathic schools


Current osteopathic schools

Planned osteopathic schools

health workforce stability
Health Workforce Stability
  • Bedrock of health system development
  • Requirement for HIV treatment and prevention
  • Prerequisite for public sector health reform
  • Essential for global health security
health worker migration as a business proposition
Health Worker Migration as a Business Proposition
  • The MD/RN degrees as passports
  • The privatization of education
  • The global health professional education “industry”
the success quandary of developing nations
The Success Quandary of Developing Nations
  • Established Example – The Indian Subcontinent
  • Emerging Examples -- Nigeria, South Africa, Ghana
previously proposed responses
Previously Proposed Responses
  • Ethical Recruitment Codes
  • Emigration/Immigration Regulation
  • Bonding/Community Service
  • “Reparations”
emerging stability strategies
Emerging Stability Strategies
  • Domestic Post Graduate Training
  • Salary Support
  • Ancillary Support
    • Car Loans
    • Housing
    • Schooling
  • Creative Use of Mid-levels
  • WHO/PEPFAR Task Shifting Project
what to do at home
What To Do At Home
  • Move rapidly toward self sufficiency in physician training in the North…5,000 more first year medical school positions in the US
  • Keep cap on government support for GME positions
what to do abroad
What To Do Abroad
  • Support capacity building and twinning in developing countries
  • Track immigration and set benchmarks of good practice
  • Promote “reverse flows”
  • Create and support a US Global Health Service
african proverb
African Proverb
  • The best thing to do is to have planted a tree twenty years ago
  • The next best thing to do is to plant a tree today