Hi Forgive me if I have brought this subject up earlier, but I am seeking input from nursing and medical professionals on this. If you could read my ideas below and give feed back, it would be welcome. However, as the subject also seemed relevant to recent discussions here, I wanted to see if people were interested in discussing the topic for its own merits.
Please remember, the ideas being offered are focused at a population or group level of analysis, this is not meant as an attack on individual practitioners. It structured as a way to work out ideas.
I am in the process of writing a paper to be presented at the African Studies Association as part of the roundtable called "Medicine on the Move: Interrogating the Direction and Meaning of Mobility in Global Health Discourse on Africa". My paper is, admittedly, part of an effort to further the conversation about what we value in care.
There are many regulations that limit international migration of nurses, pharmacist and physicians from Africa to OECD countries, particularly the US. The reason for limiting foreign educated health professionals’ practice in the US is typically centered on concerns about adequate education, knowledge of the US health system and other qualifications. Is this reasonable given our discussion medical and nursing missions; from those and other related conversations and indeed my own experiences, it is clear that there are no firm regulations for those who practice in these missions. Nursing and medical schools are implementing guidelines, but outside of those groups and a few large NGOs, screening and preparation of European health professionals and US for missions is uneven at best.
What does this mean to people who are served by the missions? The implication is that because we have a superior system, there is less need for a country to verify our qualifications to practice. Is that always the case? The Institute of Medicine recently released a comprehensive report that illustrated the weakness of that assumption: though the United States spends more on health care than any other country on the planet, almost double that of the second highest spender, we have the worst health outcomes of the 17th wealthiest countries in the world. Our outcomes remain poor regardless of access to and use of insurance, ethnic background, income, and engagement in healthy behaviors, or education. The countries we visit are had great improvements in health indicators, because of external funding and training initiatives but also due to incredible efforts from direct care workers, government and members of civil society to improve care and the right to health. At some point in the near future some "developing" countries will surpass us in terms of population health.
Given our poor health outcomes, a number of questions come up when considering cross-country practice of health professionals:
Should health professionals from countries with poor outcomes have more regulations when they practice outside their setting (home country)? And for those who do not provide direct care on missions but teach - do you think that given our health system, that we may be teaching practices, which may lead to more rather than fewer problems within a health system?
Should the US loosen up regulations on access to practice for foreign educated health professionals?