Dear Michael,

thanks for the reply and you get my point, actually the study you provide have very interesting way to assess question. I'm interest also in migration inside first world countries like Canada, US, and Europe where the cost of training is known to be higher.  Economic crisis push doctors to move inside Europe countries (for european like mediterranean area to north europe regions). For different reason the migration between Canada and USA occurs and  I believe is mostly related to better salary most of the times, but not exclusively.

My intention is not only to understand the economic impact of losing a trained health care professional but I believe would be also interesting relate this to the quality care service provided in areas that looses doctors and the ones which acquired them.

Interesting example of this is Philippine nurse migration to UK. They are very well train nurses with years of experience. The UK health care system, known to be always looking for nursing professionals due to shortage,take them because they are fully trained and experienced professionals by simply offering better working/economic conditions.

I believe that politics, health and educational planner should investigate on this because I think that when they realize the lost the are generating loosing trained persons (economically and socially); then they will be forced to re-think and re-shape working and economic condition to reduce this lost. 

For example is probably better keep the trained doctor in the country improving the working and economic condition rather than keeping investing in training a larger number of doctors that will leave after they finish the training.

10 migrating doctors from South Africa count for a lost of 600.000 without counting that they will leave and empty spot that will cause probably a shortage of services provided.

What do you think? I personally believe that healthcare planning, educational program and politics should have this sort it out, in combination with health care professional needs before planning future strategies and plans.

Hi Michael, this is a great development discussion. Interestingly let say that study loans (UK-Canada-US) are payed by the doctors with their activity and this is ok for me. I have no doubt that if you do a debt you have to repay for it. What about countries like Italy, Spain, Germany and France where education is public and the fee that student pay is around couple of thousands euros that is not even close to cover probably 5-10% of real cost that education system is playing. The the trained person that leave the country will create a real lost does not have to be charged to him if obviously the country is not offering him the possibility of working.

Because too many personal /enviromental reason play the game of the choice of leaving a country or return to it, i would exclude that consideration because obviously will be based on each individual. What about if you train 5 cardiovascular surgeon a year in canada and the available jobs are 1 a year. Then the other 4, if they want to practice have to leave, then who should be accounted for that lost, the individual or the country? 

I'm originally form italy and interestingly some regions, with independent economic balance, which required doctors offer to pay full residency cost but you have to return to work in the region (they provide you also the job) for at least 5 years. In this way you repay the money they invested into your training. I believe this is a good option to adopt then trainees will be able to choose to be helped and repay with work for the expenses, or pay by them self and be free to work every-where.

I agree to count into the study should be the interaction between innovation and new technology with younger generation doctors. 

I the more I study this topic the more interested it becomes for me because show the complexity of society, countries educational and health policies and at the same time personal freedom. 

Being provocative should a trainee not be allow to leave for x amount of time (lost of freedom) if their study are payed by their country?. Should then the society offer him always a job if they pay for the training expenses? and at this point what if the trainee will result not good enough? should still the country pay for it?

I think that part of these questions should be answered in a rigorous way because with economics shortage, constantly increased cost of health care, aging of the population (that requires more healthcare) understanding how to make cost-effective education in relation to the application of the knowledge and usage of the trainee is key factor to improve the quality and service of health provided.

Hi Michael, thank you very much for the references. 

I worked at the Birmingham Children Hospital for almost 2 years and I know The Brompton in London. 

Although late I hope you enjoy your easter dinner too.