South Africa is Hemorrhaging Doctors

According to a report in the news source The Times, South African doctors are quitting the health system 'in droves' due to inadequate pay and poor working conditions.  40% of positions for state-employed doctors remain unfilled. 

Loss of physician talent from the third world to the first world is not uncommon; Berhan reports in the Ethiopian Medical Journal that a full 73% of doctors working the public sector in Ethiopia left for higher paying positions overseas from 1987 to 2006. 

Many international medical graduates who emigrate do so because of immigration policies put in place in the 1960s to combat what was perceived as a physician shortage in Western nations.  Wright et al trace the origins of this brain drain of physicians from South Africa to Western nations directly to the present day ongoing HIV catastrophe. 

Switzerland, which had the second highest health care expenditure per person in 1996, after the United States, also has one of the highest physician densities in the world.  This has lead, according to the authors of the white paper On the Dynamics of Physician Density:Theory and Empirical Evidence for Switzerland, to what is called supplier-induced demand (SID).  The concept behind SID, namely that physicians are able to generate demand and charges for their services above and beyond what is required for the population's optimal health, runs counter to traditional market theory, in which a glut of physicians would be expected to create a competitive market for a limited supply of patients, and would thereby reduce costs per patient. 

The surprising finding of Shipp et al that locations in Alabama with higher physician densities were associated with higher incidence of colon cancer rates makes sense in the setting of supplier-induced demand, and also explains the lower incidence of colon cancer in underdeveloped countries; it may be question of detection; no doctors to detect, no cancer found. 

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