Department of Primary Care Health Sciences, Oxford University, Radcliffe Observatory Quarter, Oxford , OX2 6GG, UK.
Hum Resour Health. 2012 Sep 25;10:35. doi: 10.1186/1478-4491-10-35.
Economically developed countries have recruited large numbers of overseas health workers to fill domestic shortages. Recognition of the negative impact this can have on health care in developing countries led the United Kingdom Department of Health to issue a Code of Practice for National Health Service (NHS) employers in 1999 providing ethical guidance on international recruitment. Case reports suggest this guidance had limited influence in the context of other NHS policy priorities.
The temporal association between trends in new professional registrations from doctors qualifying overseas and relevant United Kingdom government policy is reported. Government policy documents were identified by a literature review; further information was obtained, when appropriate, through requests made under the Freedom of Information Act. Data on new professional registration of doctors were obtained from the General Medical Council (GMC).
New United Kingdom professional registrations by doctors trained in Africa and south Asia more than doubled from 3105 in 2001 to 7343 in 2003, as NHS Trusts sought to achieve recruitment targets specified in the 2000 NHS Plan; this occurred despite ethical guidance to avoid active recruitment of doctors from resource-poor countries. Registration of such doctors declined subsequently, but in response to other government policy initiatives. A fall in registration of South African-trained doctors from 3206 in 2003 to 4 in 2004 followed a Memorandum of Understanding with South Africa signed in 2003. Registrations from India and Pakistan fell from a peak of 4626 in 2004 to 1169 in 2007 following changes in United Kingdom immigration law in 2005 and 2006. Since 2007, registration of new doctors trained outside the European Economic Area has remained relatively stable, but in 2010 the United Kingdom still registered 722 new doctors trained in Africa and 1207 trained in India and Pakistan.
Ethical guidance was ineffective in preventing mass registration by doctors trained in resource-poor countries between 2001 and 2004 because of competing NHS policy priorities. Changes in United Kingdom immigration laws and bilateral agreements have subsequently reduced new registrations, but about 4000 new doctors a year continue to register who trained in Africa, Asia and less economically developed European countries.
经济发达国家已经招募了大量海外卫生工作者来填补国内短缺。英国卫生部于 1999 年发布了《国民保健服务（NHS）雇主行为准则》，认识到这对发展中国家的医疗保健可能产生的负面影响，并提供了国际招聘方面的道德指导。案例报告表明，在其他 NHS 政策优先事项的背景下，这一指导的影响力有限。
报告了海外医生新专业注册趋势与英国政府相关政策之间的时间关联。通过文献综述确定政府政策文件；在适当情况下，根据《信息自由法》的要求获取了更多信息。医生新专业注册数据来自英国医学总会（GMC）。
非洲和南亚培训的医生在英国的新专业注册人数从 2001 年的 3105 人增加到 2003 年的 7343 人，增幅超过一倍，因为 NHS 信托基金试图实现 2000 年 NHS 计划中规定的招聘目标；尽管有道德指导，避免从资源匮乏的国家积极招聘医生，但这种情况仍在发生。此后，这种医生的注册人数下降，但这是对其他政府政策举措的回应。2003 年与南非签署谅解备忘录后，南非培训的医生注册人数从 2003 年的 3206 人降至 2004 年的 4 人。2005 年和 2006 年英国移民法发生变化后，印度和巴基斯坦的注册人数从 2004 年的 4626 人峰值降至 2007 年的 1169 人。自 2007 年以来，在欧洲经济区以外接受培训的新医生的注册人数相对稳定，但 2010 年，英国仍注册了 722 名在非洲培训的新医生和 1207 名在印度和巴基斯坦培训的新医生。
由于 NHS 政策优先事项的竞争，2001 年至 2004 年期间，道德指导未能阻止资源匮乏国家的大量医生注册。英国移民法的变化和双边协议随后减少了新的注册人数，但每年仍有约 4000 名新医生注册，他们在非洲、亚洲和经济欠发达的欧洲国家接受培训。
