Icelandic healthcare is currently suffering from serious brain drain. A huge number of physicians and other medical professionals have left their positions at the only University Hospital in the country for positions elsewhere, mostly abroad. Many of the major specialties within the hospital are left in severe crisis. The same thing is happening within primary care. For a small country like Iceland such brain drain may have serious consequences for years to come and may take decades to repair.
The term “Brain drain” originated in the 1960s, when many British scientists and intellectuals emigrated to the United States for a better working climate. In recent years, however, the problem of brain drain has mainly been confined to poorer countries that lose workers to wealthier countries.
Brain drain is defined as a large-scale emigration of a group of individuals with technical skills or knowledge. Most commonly the term is used to describe the departure of educated people from one country, or field for another, usually for better pay or improved living conditions.
How to attract and hold on to skilled labour has been a major challenge among underdeveloped nations for decades. Countries in Sub-Saharan Africa have lost a tremendous amount of their educated and skilled populations as a result of emigration to more developed countries, which has harmed the ability of such nations to get out of poverty.
One of the first documented brain drains occurred during the Dark Ages, when emigrants from the Byzantine Empire played an important role in the transmission of classical knowledge to the Islamic world and Renaissance Italy. In the 19th and 20th centuries there were notable emigrations to North America from Europe. In modern times, brain drain occurs mostly from low-resource to high-resource nations and from rural to urban areas.
In the year 2000, The International Organization for Migration (IOM) estimated that some 300 000 professionals from the African continent live and work in Europe and North America. By some estimates, up to a third of research and development professionals from the developing world are believed to reside in the OECD area.
For its World Health Report 2006, the World Health Organization (WHO) noted that there is a global shortage of 4.3 million doctors, midwives, nurses, and support workers. Furthermore, “these shortfalls often coexist in a country with large numbers of unemployed health professionals. Poverty, imperfect private labor markets, lack of public funds, bureaucratic red tape and political interference produce this paradox of shortages in the midst of underutilized talent”. In addition, “Unplanned or excessive exits may cause significant losses of workers and compromise the system’s knowledge, memory and culture.”
The Icelandic Situation
Five years ago Iceland was hit by a severe economic crisis. The collapse of Iceland’s major banks in 2008 dragged the public finances down and caused the worst economic rupture seen in Europe since World War II. The Krona fell 50% against all major currencies, unemployment, hitherto unheard of, soared to 10% and money flew out of the country at an alarming rate.
In October 2008, the government took over control of all three of the country’s major banks in an effort to stabilize the financial system. Shortly thereafter, Iceland became the first western country to apply to the International Monetary Fund (IMF) for emergency financial aid since 1976. The economy shrank by 6.8% in 2009, although since the end of 2010 it has recovered steadily, with growth averaging 2.5% per annum and unemployment falling to just below 5%.
Since 2008, Iceland’s economic recovery has been hailed as a miracle, especially by foreign commentators. By first sight, the Icelandic economy looks to be doing surprisingly well. Inflation is 3%, unemployment is 5%, and the government budget is almost balanced. The currency stable and the economy grew 1.6% last year. The government is seen to have dealt firmly with foreign creditors and not bailed out its banks. Domestic creditors and the welfare system have supposedly been protected. However, according to Jon Danielsson at the London School of Economics “the positive economic statistics hide a multitude of sins”.
Following the economic crisis in 2008 governmental health funding was cut down dramatically. Renewal of medical equipment was largely put on hold, and recently it was decided not to go ahead with the building of a new University Hospital, which many consider to be of utmost importance for the future of Icelandic healthcare.
Most Icelandic doctors graduate from the Medical Faculty of the University of Iceland. They usually work as trainees or residents in hospitals or primary care for 2-3 years. Thereafter, the majority leave home for further training abroad. Most are trained in Scandinavia, mainly Denmark, Norway and Sweden, and in the US. Many are also trained in the UK and the Netherlands. After 5-10 years of training abroad, most Icelandic doctors return to their home country. This has created the foundation for Icelandic healthcare because of the wide perspective gained by the doctors, most of whom are trained at University Hospitals with high reputation abroad.
However, for the last few years the tides have been turning. Young Icelandic doctors are reluctant to return back home. They have watched the continuous cut down of funding to healthcare, the lack of renewal of medical equipment and the terrible ignorance by politicians of the importance of human resources.
Politically there seems to be a complete lack of future perspective. Rescuing Icelandic healthcare is not a priority among politicians. There are no plans on how to stop the bleeding. Doctors salaries are less than half of that in other Nordic countries. Of course the Icelandic nation is till suffering economically. However, the newly resuscitated Icelandic banks are now making huge amounts of money each year. The politicians have the power to decide who should be saved and who should be left for death in the cold blue sea. Healthcare is not among the lucky ones.
Today, while the Icelandic government is busy dealing with extreme economic issues, and how to tackle the serious national debt evolution, the main foundation of Icelandic society is being left in runs. For decades, Icelanders have been proud of their high standard of health care. Life expectancy is high and infant mortality has been among the lowest in the world. Death rate from heart disease has diminished tremendously and mortality from acute heart attack (acute myocardial infarction) is among the lowest in the world. However, tomorrow this may all be history. The reason is that for years Icelandic politicians have viewed healthcare as a costly parasite, instead of an important investment for the future. Expenditure is the only thing that is measured. Results are not counted.
Can Brain Drain Be Prevented?
The harsh reality is that only a handful of countries have been successful in luring their talented emigrés back home. However, governments can do quite a lot to address the causes of the brain drain. Science and technology policies are key in this regard. Developing better conditions for scientific research and framing the conditions for innovation and high tech entrepreneurship can make a Iceland attractive to highly skilled workers, both from within the country and from outside.
Currently, Icelandic politicians acknowledge that more funding is needed for healthcare. They are aware that renewal of medical equipment can’t be compromised any more. However, they do not seem to acknowledge the damaging effects of continuous brain drain from Icelandic healthcare. The problem is rarely mentioned among them. In their view healthcare seems to be mainly about high tech equipment and not about highly qualified and devoted professionals.
Maybe politicians are not ready to acknowledge brain drain because they don’t see a solution. Salaries can´t be raised because of a proposed domino effect throughout society, which will supposedly increase inflation. While Icelandic doctors can double or triple their salaries by working in Scandinavia, it may be hard to see how they can be prevented from leaving home. So, maybe the brain drain is inevitable. Maybe Icelandic healthcare is doomed, and bound to go down, just like the Titanic.
However, there are measures available to prevent brain drain from healthcare. Firstly, the importance of the problem has to be acknowledged and its priority has to be emphasized. We have to create an environment that has the potential to retain and attract well educated and talented professionals. In the beginning of the millenium the UK government made plans to increase the salaries of post-doctorates by 25% and increase funding for the hiring of university professors. In France, some 7 000 teaching-researcher posts were created between 1997 and 2002 to retain talent and encourage the return of post-doctorates working abroad. The European Commission has looked to improve the attractiveness of the European research area and has increased the amount of funding devoted to human resources.
Some governmental representatives believe that attracting foreign doctors may be the solution. However, there is strong competition in the world market when it comes to attracting highly qualified medical professionals. I don’t see how Iceland could be top of that league.
I worry for my country because I believe that good health care is the foundation of our society. If we continue to neglect the importance of human resources within our healthcare system we may cause damage beyond repair. This damage will affect all areas of our society for years to come.