MELISSA BLOCK, host:
Dr. Fitzhugh Mullan has been studying the questions of health equity in India and India's export of doctors to other countries. He's a professor of health policy and pediatrics at George Washington University here in Washington D.C.
Mullan sees what he calls a trend (unintelligible) of doctors leaving the U.S. and going back to India. But he says, they tend to practice in elite institutions that don't serve the needs of the vast majority of Indians.
Dr. FITZHUGH MULLAN (Professor of Health Policy and Pediatrics, George Washington University): You're looking at a country which has infant mortality that hangs in the 60 per thousand were in the West, even in developing countries such as Brazil, it's half that. And, of course, here it's six or seven per thousand. You're looking at 500 women dying in childbirth out of 100,000 compared to half that in many developing countries and less than 20 in this country.
So vast gaps in basic human services that are medically dependent, those are not the positions who are either - are being trained and certainly not the ones who've gone to the West and returned.
BLOCK: You've written about one other phenomenon here, which is that as Indian doctors leave, they're not just taking brain power away. It's not just the brain drain in terms of medical care, but it's also taking away any momentum for political reform of the health care system.
Dr. MULLAN: Well, this is true in India and elsewhere in the developing world, where you have people who are arguably very bright. They have benefited from the best education the country has to offer, usually at state expense, at public expense. And they have reasons to be dissatisfied. Their system is inadequate. It's unfair in many ways. It's not well-developed. If they stayed at home and fought to change that system, systems would change, fight maybe is too strong a word. But if they worked to change those systems, systems would change more quickly. There is this enormous escape valve called the West, and that diminishes, to some extent, the impetus for change and for reform.
BLOCK: So what would you have India do to turn this brain drain around?
Dr. MULLAN: Well, there are many things, and I - it should not be my role as a non-Indian to dictate or even speak ex cathedra on this. But the training systems need to change, but the values need to go with that. And this needs to be a system that values more of the primary care, public health, preventive kinds of services which the vast majority of Indians would benefit from. But the other very important thing to understand is that to the West - United States in particular, but it's true in Canada, it's true in Great Britain, and it's true to some degree in Europe - under train doctors and nurses.
We do not train the number we need. And we create a vacuum which is irresistibly appealing vacuum to ambitious, well-trained people in the developing world.
BLOCK: You're saying the U.S. doesn't have enough doctors from the United States itself. Is that a fault of not having enough medical schools, though, or is there just simply not, a big enough pool of people who say, I want to go into medicine, I want to be a doctor?
Dr. MULLAN: Annually, we turn away at least 50 percent of the applicants to medical school in the United States, many of whom have excellent GPA's and would be excellent physicians. We simply have had not offered enough medical school positions. Every year, we graduate about 18,000 medical students, and we offer almost 24,000 internship or first year training positions. And that difference between the 18,000 we graduate and the 24,000 that we staff our hospitals with is where the foreign graduates enter. Now, we are in the process of beginning to increase the number of medical school graduates. Something that's been long overdue.
But self-sufficiency in medical education and nursing education and pharmacy education is something that we need to take seriously as a national priority, both for domestic reasons - to provide opportunities and provide jobs in a sector that is much sought-after and very important - and as a foreign policy proposition as well. It is not lost in the rest of the world that we are eager consumers of graduates of institutions that are publicly supported, tax-dollar supported in these countries. And it would do great things to our global citizenship position if we were less involved in draining the world of its brains in medicine.
BLOCK: Doctor Mullan, thanks very much for coming in.
Dr. MULLAN: Thank you. Glad to be here.
BLOCK: Dr. Fitzhugh Mullan is a professor of health policy and pediatrics at George Washington University here on Washington.