Medical Education and Medical Migrations: Burning the Candle at Both Ends

The continuing shortage of health care personnel remains one of the most challenging, and vexing, public health dilemmas facing developed countries. One way of addressing it -- the ongoing migration of health personnel from the Global South to the Global North -- brings with it a number of serious moral worries about the relationships of responsibility between the donor developing nations and the beneficiary developed ones. Given the resulting personnel shortages in the developing world, an especially important question is one of moral obligations to distant others: what is owed, by whom, and to whom, or more precisely, how might we, the Western beneficiaries of these migrations, address the difficult balance between the social obligations we have to our own citizens, as well as to those who come to care for us, and those they leave behind. Although a number of solutions have been offered, in this paper, I argue that we have to begin by examining our own medical education system as a possible source of, and a solution to, these domestic shortages and resulting international inequities. I suggest that, at least within the United States, the relationship between the shortage of domestic health care personnel and the resulting medical migrations is partially grounded in the ongoing crisis in medical education. I argue that some of the moral dilemmas about our duties to proximate and distant stakeholder communities might begin to be addressed by an examination of our own medical education practices, assumptions, and priorities.