Physician careers in global health: An ethics review and synthesis

An examination of ethics surrounding global health physician careers is critical, given the associated long-term outcomes, growing professional interest, and government support of physicians in foreign aid and development. However, existing global health ethics literature mostly considers physician trainees completing short-term work abroad. Our review aims to consider the wider ethical implications involved in long-term career work for practitioners and the communities they serve. An initial review drew on literature from relevant global health organizations and academia. A supplementary PubMed search was conducted using the term “global health ethics.” Subject specific abstracts were obtained by appending the terms “practice” and “physician.” The final combination of search terms provided 1335 results. Abstracts were reviewed for relevance with 20 articles identified for use. The references for these papers were hand-searched for additional literature. Ethical issues identified in short-term medical missions can be hypothetically applied to long-term careers, though their significance may differ. Our review categorizes these into practitioner- and community-relevant issues. The former considers cultural/linguistic differences, inherent power imbalances, and competence. The latter include resource limitations, disparities in standards of care, and community autonomy. Using extant literature, our review examines existing global health ethics literature and its applicability to long-term global health careers. The complex interplay of career-related ethical issues is described in terms of its impact on practitioners and the communities they serve both domestically and abroad. Through proposing further areas of ethics research, we hope to ensure that global health physician careers remain sustainable, effective, and beneficial for all involved.