Here are some resources for understanding the use of foreign physicians in Britain, and elsewhere in the Western world. See especially “The current status of migration into the UK’s National Health Service.” “Factors affecting the global migration of health professionals,” is also helpful.

These articles make it clear that there are many factors at work in the importation of foreign physicians. Historically, overseas physicians have played a large role in Britain’s National Health Service. From the early days, many British-trained doctors resisted the new system (because of low pay and lack of freedom, one presumes) and moved overseas. Consequent shortages were dealt with by importing physicians from less affluent countries. Many foreign doctors who entered the NHS in the 1960′s and early 1970′s became the mainstay of primary care in inner-city areas. But this generation of immigrant doctors is now nearing retirement.

In the meantime, British officials noticed that they were facing a serious doctor shortage in future years, and therefore greatly expanded the cohort of entering medical students. The reasons for the coming increase in demand for medical services are several. As medicine grows more technological, more specialists are needed. And in Britain, and throughout the West, an ageing population is going to put huge new demands on medical services. Therefore, Britain has increased the number of entering medical students by as much as 40 percent. Presumably, this was relatively easy to do, because whatever the underlying demographics, lots of people want to become doctors. On the other hand, it looks as though Britain may have cut some corners in its usual training program in order to get this increase (although the changes described could be wise innovations. It’s tough to tell from the brief account).

Despite the substantial rise in the number of British medical students, there are still supply problems. In part this is because it takes 12 years between entry into medical school and the output of a fully trained specialist. With the big expansion of British medical schools beginning in 1998, that means there is still a shortage of advanced professionals. At the same time, foreign doctors are now being squeezed out at the junior level. Another supply problem has to do with the greatly increased number of women doctors. Only 52 percent of female physicians with children under 5 are in the workforce, compared with 91 percent of male physicians of the same age. This means that even the significant increases in British medical students may still leave a shortfall.

Most of the material I’ve scanned on this issue focuses on the impact of the physician brain drain on source countries. There is less discussion of problems for the host country, although there does indeed seem to be a concern about the quality of training received by foreign physicians. The key demographic variable mentioned is the aging of the West and the greatly increased demand for medical services this will create.