Make employers of foreign-trained doctors and nurses pay a fee that repays the country that trained them
In short
- Rich countries can no longer hire health workers from other countries without paying anything toward their training.
- Hospitals and companies that hire health workers trained abroad pay a fee.
- The fee goes straight to the nursing schools and medical schools of the country the workers came from.
- The workers themselves stay free to move to another country, with no limit and no cost placed on them.
If this comes true
At a nursing school by the sea, twice as many students as last year line up in a new practice room built with the fees, and graduates working in hospitals abroad teach them tips for drawing blood over video calls.
Perhaps
Hospitals that dislike the fee might hold back from hiring people who earned their credentials abroad, and the path may narrow for nurses who wanted to move.
Water so far 💧 0
The proposal in detail
The fee covers medical jobs that take a long period of training, including public money, before a person earns a license, such as doctors, nurses, midwives, and pharmacists. When a hospital, a care facility, or a staffing agency in one country hires someone who finished their basic training in another country, the employer pays the fee. The amount is based on the public cost of training one person in that job in the country they came from, and it is set higher the more serious that country's shortage of health workers is. Staffing agencies that actively recruit from countries short of workers pay an additional surcharge. The government of the receiving country collects the fees together, and through a shared fund that many countries join, the money goes to the pay of teachers at training schools in the sending country, to practice equipment, and to scholarships. It does not go into the general budget of the sending country's government, and its uses are made public so that it cannot vanish along the way. The workers themselves bear no cost at all, and banning them from moving or changing jobs, or demanding a deposit when they leave the country, is not allowed. The fee is reduced or waived for health workers who fled as refugees, for people who studied again in the receiving country and earned a new license, and for people who worked for a set number of years in their home country.
BenefitsTurns the gain from poaching into training power for the countries that train
Today, when an employer hires a health worker that another country trained, it does not have to pay for the training, so it is far cheaper than training its own. The fee removes this free-rider gain and gives rich countries a reason to train health workers at home. At the same time, money returns to the sending country's training schools in proportion to the number of people who leave, so the schools can hire more teachers and train more people than leave. It does not stop the flow of people but fills in what is lost on the other side of the flow, so the workers' freedom to move and the sending country's health care can both be protected. Because the money goes straight to the places where training happens rather than into a government's general budget, its uses are easy to see and it is less likely to vanish along the way. Putting a heavy burden on staffing agencies that recruit from countries short of workers also holds back mass poaching from the weakest countries. In the long run, the total number of health workers in the world grows, and the relationship between countries changes from fighting over a limited number of people to helping each other train them.
DrawbacksRaises costs for employers and may become a wall for people who move
For hospitals in receiving countries that are struggling with staff shortages, the fee is simply a rise in costs. If hiring falls, places that have been held up by people from abroad, such as care facilities for older people and night emergency rooms, could quickly stop running, and patients in that country would have to wait. If hospitals that do not want to pay the fee reject people who earned their credentials abroad at the paperwork stage, or keep their pay low, it becomes a wall for those who want to move, and the freedom the plan is meant to protect is in fact narrowed. Workers may also be hurt by the sense that people are being given a price and traded between countries. In the sending country too, there is no guarantee that the money that arrives will really be used for training, or that the people trained will stay in the country. If pay stays low and working conditions stay bad, the people trained will leave again, and the fee may become nothing more than fuel for a system that sends people out. Running a shared fund across many countries would take a long time for agreement and oversight, and if some countries do not join, hiring would flow to them and fairness would break down.
Learn the background
There is a shortage of doctors and nurses all over the world, but the shortage is not evenly spread. Rich countries, with high pay and good working conditions, have hired health workers that poor countries trained with tax money, and have saved the cost of training their own. In the sending countries, newly graduated nurses leave for other countries in large groups, rural clinics are left empty, and some regions end up with no one to attend births. There are international agreements that ask countries not to poach workers, but whether to follow them is up to each country, and for hospitals in rich countries struggling with staff shortages, hiring from abroad remains the cheapest and fastest fix. On the other hand, moving to another country in search of a better life is every person's right, and stopping people from leaving is wrong. Protecting the workers' freedom could cause the sending country's health care to collapse, while protecting its health care could tie down the workers' freedom, and this dilemma has been the reason no one has touched the problem. Meanwhile, the question of who pays the cost of training has been left behind all along.
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This proposal was written in Japanese by AI (claude-opus-5-5, policy version 2026-10-23b) and translated by AI (claude-sonnet-5-5). Nobody has checked the facts. Read the original (日本語) How the AI writes