By Lawrence Loh, MD MPH
Finishing a recent residency rotation in New York City, I had the opportunity to speak with some of the residents there about their plans for the future. All of us final year residents had plans to head back to some combination of clinical work and public health, but those of us with global health aspirations seemed a little bit more cynical about the possibility of pursuing our chosen field. In describing her plans for the future, one of the residents mentioned she would be signing up with Doctors Without Borders (MSF), despite significant debt load and familial obligations. We also talked about the likelihood she would be engaging in work that was not commensurate to her training – starting out from the “very bottom” of the totem pole, as it were.
Her response was one almost of resignation: “Well, that’s just the way it has to be, right? If they want me to pour tea for them, then I’ll do that. Whatever it takes to get your foot in the door.”
Therein lies the great irony for most young professionals pursuing work in global health and development – unless your family is independently wealthy and with the right connections, you’ll spend an immense amount of your personal time and finances to gain mixed experiences that will potentially land you that (often poorly) paying first job in some sort of long-term arrangement for the sake of “getting yourself in the door.” And for many, that’s a dream too far – and many global health aspirants end up throwing in the towel and embracing “reality”, giving up their pursuits abroad for the sake of staying home and paying back their seemingly insurmountable educational debt, and maintaining their certifications and ties that are so critical for ensuring they can do so effectively.
Yet every global health career day you go to, every fair that you visit, the same stories come out. The same unfollowable tales from those who have “made it” (almost a la Hollywood or entrepreneurship) – these folks either had a lucky break, a person who paid them a living wage in pursuing the dreams abroad, or a family that let them do unpaid internship after unpaid internship until they landed that first position. They sold all their worldly possessions and moved to Africa for 10 years, gaining that experience, sacrificing family, earning potential, and time, to succeed in finding a job that filled their passions and skills.
It really shouldn’t be like that.
The current global health workforce set-up and “road map” to success strings along young professionals who may have the skills and passion to succeed, but lack the resources or support to do so. It results in the privileged gaining those posts and those positions, regardless of their abilities or skill set – but simply because they’re the only ones who can pour enough money and time into building those networks and those collaborations. And perhaps this is like “anything else” in life, but moreso in global health does it seem truly like whoever has the money and whoever knows the right people has play.
So where has this paradigm led organizations today?
In a news article published in the Canadian Medical Association Journal (CMAJ) just a year and a half ago, MSF in Canada described their recruitment shortages and the pending crisis in recruiting Canadian physicians.
The comments from the MSF recruiter are incredibly interesting. On one hand, the recruiter recognizes that high debt loads, the demands of residency and life in Canada affect the ability of young Canadian physicians to go abroad for more than 1-2 weeks at a time. At the same time, the recruiter goes on to denigrate the work of interested young physicians who can contribute that amount of time, calling them “tourists” and “people who are [only] interested in cross-cultural experiences, in doing a couple missions for their resume […] their primary motivations are not the humanitarian objectives of our organization.”
But in other articles, we know that humanitarian reasons and improvement of work abroad is a reason why many people pursue medical volunteer trips – regardless of how long they are. A survey of Wisconsin residents and medical students found that 82% of students wanted to continue incorporating global health in their future career, with 63% wanting to work with underserved populations abroad:
If that doesn’t sound like a disconnect, I don’t know what else there is.
MSF and the rest of the global health community needs to think long and hard about how things are. Taking six to nine months off for young physicians is not something those from less-financially advantaged backgrounds can do, in the face of crushing debt loads, familial obligations, timing, and training requirements. Short-term medical trips represent the only opportunity for these young professionals, ironically so, since despite the enormous financial and personal investments that go into it, such short-term work often represents the “placebo” of global health: both the receiving community and the visitors feeling “good about themselves” without anything ever really changing.
There needs to be a paradigm shift, a challenge, a purpose and improvement of such opportunities. The future of the global health workforce might be how well we as a society adapt to remote technologies, allowing people to be involved for weeks at a time abroad and remotely from home – by leveraging the internet, collaborative models, and shared resources and vision.To stick to the romanticized version of the solo doctor in Africa represents the potential waste of a huge groundswell of passion and talent from young physicians. At the same time, we know short-term work as it stands is also untenable.
It’s time to make these opportunities both accessible and valuable. We see the interest. Let’s figure out how best to harness it, instead of turning people away – instead of having them just serve tea – and instead of leaving them to languish in “medical tourism” venture after venture. Young professionals have so much more to offer – in fresh eyes, passion, skills, and ability.
As we implement our coordinated model of short-term care, we hope to move the conversation forward in providing at least one innovative way to open those opportunities to those young professionals who want it and are good at it, not merely those who can afford it, while also ultimately benefiting those populations abroad that these short term trips aim to serve.
Dr. Lawrence Loh is Chief Medical Officer of The 53rd Week, and a physician in Toronto, Ontario, Canada.