With Lack of Opportunities for Mexican Doctors, Should They Join the Export Revolution?

The outlook is pretty dim for doctors working in Mexico. The job market offers limited opportunities for health professionals in the country, who believe that only through policy support from the federal government, things will then turn positive.

Mexican president Andrés Manuel López Obrador got grilled in early May after announcing the hiring of 500 Cuban health professionals to be enrolled into the ranks of the country’s public health system. López Obrador claimed it as a necessary measure to combat Mexico’s deficit of health specialists, but doctors and universities argued otherwise, pointing to the long lines of unemployed nationals who wait for a shot at working in one of the country’s several public health institutions.

The outcry forced the government to announce over 13,700 job openings for health professionals, but the cat was out of the bag already. Doctors all over the country have protested not only the lack of job opportunities, but also poor and even dangerous working conditions they face on a daily basis. They have taken to the streets, social media and the papers to showcase a concerning picture: long working hours with little pay, very short-term contracts, abuse by their superiors and, for those working in crime-ridden areas, the threat of being shot while on the job.

The problem can’t be solved overnight. Mexico has around 305,400 doctors (between general practitioners and specialists), according to the government’s own data, and not all of them can fit comfortably in the nation’s (public and private) health system.

“[Telemedicine] could help relieve pressure on health systems by allowing some basic services to be provided across borders”–WTO

Why not export, then? Developments in telemedicine were accelerated by the Covid-19 pandemic, making it easier for health professionals to provide their services to patients located hundreds or even thousands of miles away.

Experts in trade policy and entrepreneurs in the industry of health-at-a-distance see potential in the export of medical services, especially from Latin American countries. So, why not do it?

Are there Any Doctors in the Continent?

Though still scarce, international telemedicine is already a reality in Latin America. Platforms like Midoconline have doctors on board who treat patients from different countries. From general practitioners to specialists, and also nutritionists and psychologists, the service is already being exported, said Fernando Carvajal, CEO and founder of the platform.

“In most cases, clients are Mexicans that left the country and wish to be attended by a doctor from their home country,” explained Carvajal in an interview. “There are also foreigners who visited Mexico for work and who really enjoyed how they were treated by doctors in the country, so they keep consulting with them once they go back home.”

Carvajal considers the US and Central America to be the most lucrative markets for the export of medical services from Mexico, due mostly to their proximity and, in the case of Central America, the lack of a language barrier. Also, there’s already a burgeoning “health tourism” industry in Mexico thanks to the interest of US residents willing to travel south of the border to undergo medical procedures for a fraction of the cost in the US. Telemedicine seems like the next logical step and could be linked to health tourism, added Carvajal.

The benefits go beyond business. A report by the World Trade Organization (WTO) states that the import of medical services “could help relieve pressure on health systems by allowing some basic services to be provided across borders (e.g. simple functions, radiology diagnosis and second opinions).” A paper published by the Inter-American Development Bank (IADB) makes echo of the WTO’s point, adding that telemedicine could help in the professional development of doctors in the exporting countries, which would in turn end up benefiting the development of the nation’s health system as a whole.

Doctor’s Prescription (From Miles Away)

When asked about English skills as a potential barrier of entry for doctors interested in exporting their services to the US, Fernando Carvajal brushed the point aside. “We have a department to make them bilingual,” he explained, adding that regulations are the real barrier.

“The biggest challenge for [international] telehealth is the regulation of medical prescriptions. In every country, prescription drugs can only be purchased with a medical prescription from a doctor in the country, which I find absurd,” he stated. “That has to change. There should be, maybe, an international organization that allows doctors to certify their credentials and experience in order to prescribe medication in other countries.”

“The biggest challenge for [international] telehealth is the regulation of medical prescriptions”–Fernando Carvajal

Regulatory hurdles go beyond prescription drugs, though. The IADB points to other issues, such as data privacy, certification, state laws and the lack of specific regulations for telemedicine in each country as major problems for the development of medical services as an export.

Some of this hurdles are adressed in the US-Mexico-Canada Agreement (USMCA). Though it makes no specific mention of telemedicine, Chapter 15 provides guidelines for the agreement between governments for the recognition of profesional qualifications, licensing or registration of profesional services, which include health services. Chapter 19 forces the three countries to have laws in place for the protection of consumers’ personal data in digital trade.

In its report, the WTO recommends the “easing of territorial restrictions on telemedicine, with appropriate regulatory oversight” to make the best out of the technology available.