Health services delivery: reframing policies for global migration of nurses and physicians--a U.S. perspective.

One half of all of the nurses and physicians in English-speaking countries practice in the United States, yet future shortages of both professions are projected. Because the United States has failed to create sufficient educational capacity for its own needs, it is dependent on foreign health professionals. The magnitude of this dependency has a significant impact on the health care systems of source countries, particularly developing countries, from which the majority of foreign nurses and physicians coming to the United States emigrate. Even emigration from the United Kingdom and other developed countries affects developing countries because it triggers recruitment from developing countries to replace this emigration. To achieve a higher level of self-sufficiency, the United States must establish a national health care workforce policy that gives priority to building adequate educational infrastructure, while also providing assistance to developing countries to train and retain adequate numbers of health professionals.