LAST week, international health leaders meeting at the annual World Health Assembly in Geneva made history by endorsing new guidelines to prevent health-worker brain drain from developing countries.

Nations unanimously adopted a voluntary global code that sets ethical principles around the movement of health workers. It was only the second time in the assembly's history that nations agreed to an ethical code.

The Global Code of Practice on the International Recruitment of Health Personnel acknowledges the right of health workers to migrate, while also acknowledging the right to the highest attainable standard of health. It calls on rich nations to meet their own internal demands without taking health workers away from countries that can least afford to lose them.

The shortage of primary care physicians is attributed to many reasons. Among them are low compensation compared with specialists, a lack of interest by medical school graduates, liability problems and a growing number of primary care doctors opting for early retirement. How primary care is viewed, discussed and taught in many medical schools, is cited.

"Primary care is one of the lowest paid physician professions today," said Ralph Schmeltz, for more than 40 years a practicing internal medicine doctor prior to retiring last July, and president-elect of the Pennsylvania Medical Society.

Health care reform's mandate that all Americans have health insurance soon will run into the reality of a lack of new primary care doctors such as Andrew Fisher at all levels.