PUBLIC HEALTH ETHICS • 2008 • 1–13 1 Physician Brain Drain: Can Nothing Be Done?

Access to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternalmortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses tomedical braindrain. It reviews existingproposals and their limitations. Itmakes a case that, in resource-poor countries, ‘locally relevantmedical training’—teachingprimarily locally endemic diseases andprac-tice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical brain drain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates ’ expectations with actual practice, di-minishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit appli-cants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reformmay raise worries about poor-quality care, breach of the freedomof education and occupation, breach of the freedomofmovement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. Background I have been working in a hospital in southwes