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Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature

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Abstract

Introduction

The global surgery workforce is in crisis in many low- and middle-income countries (LMICs). The shortage of surgery, obstetrics, and anesthesia providers is an important cause of the unmet need for surgical care in LMICs. The goal of this paper is to summarize the available literature about surgical physicians in LMICs and to describe ongoing initiatives to supplement the existing surgical workforce data.

Methods

We performed a systematic search and literature review of the English-language literature regarding the number of surgeons, obstetrician–gynecologists, and anesthesiologists practicing in LMICs.

Results

Literature describing the number of surgeons, obstetricians, and anesthesiologists practicing in LMICs represents a small minority of LMICs, and indicates consistently low levels of surgical physicians. Our literature search yielded comprehensive data for only six countries. No national data were found for 23 of the 57 countries considered by the World Health Organization (WHO) to be in health workforce ‘crisis.’ Across LMICs, general surgeon density ranged from 0.13 to 1.57 per 100,000 population, obstetrician density ranged from 0.042 to 12.5 per 100,000, and anesthesiologist density ranged from 0 to 4.9 per 100,000. Total anesthesiologist, obstetrician, and surgeon density was significantly correlated with gross domestic product (GDP) per capita (r 2 = 0.097, p = 0.0002).

Conclusion

The global surgery workforce is in crisis, yet is poorly characterized by the current English-language literature. There is a critical need for systematically collected, national-level data regarding surgery providers in LMICs to guide improvements in surgery access and care. The Harvard Global Surgery Workforce Initiative and the WHO global surgical workforce database are working to address this need by surveying Ministries of Health and surgical professional organizations around the world.

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References

  1. Ozgediz D, Kijjambu S, Galukande M et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371:627–628

    Article  PubMed  Google Scholar 

  2. Ozgediz D, Galukande M, Mabweijano J et al (2008) The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32:1208–1215. doi:10.1007/s00268-008-9473-4

    Article  PubMed  Google Scholar 

  3. Kruk ME, Wladis A, Mbembati N et al (2010) Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 7:e1000242

    Article  PubMed Central  PubMed  Google Scholar 

  4. Grimes CE, Bowman KG, Dodgion CM et al (2011) Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 35:941–950. doi:10.1007/s00268-011-1010-1

    Article  PubMed  Google Scholar 

  5. Dubowitz G, Detlefs S, McQueen KA (2010) Global anesthesia workforce crisis: a preliminary survey revealing shortages contributing to undesirable outcomes and unsafe practices. World J Surg 34:438–444. doi:10.1007/s00268-009-0229-6

    Article  PubMed Central  PubMed  Google Scholar 

  6. Global Health Workforce Alliance (2008) Health workers for all and all for health workers: an agenda for global action. First Global Forum on Human Resources for Health, Kampala, 2–7 March

  7. World Health Organization (2010) WHO global code of practice on the international recruitment of health personnel. WHO, Geneva

    Google Scholar 

  8. Gow J, George G, Mutinta G et al (2011) Health worker shortages in Zambia: an assessment of government responses. J Public Health Policy 32:476–488

    Article  PubMed  Google Scholar 

  9. Rolfe B, Leshabari S, Rutta F et al (2008) The crisis in human resources for health care and the potential of a ‘retired’ workforce: case study of the independent midwifery sector in Tanzania. Health Policy Plan 23:137–149

    Article  PubMed  Google Scholar 

  10. Tjoa A, Kapihya M, Libetwa M et al (2010) Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia. Hum Resour Health 8:15

    Article  PubMed Central  PubMed  Google Scholar 

  11. Petroze RT, Nzayisenga A, Rusanganwa V et al (2012) Comprehensive national analysis of emergency and essential surgical capacity in Rwanda. Br J Surg 99:436–443

    Article  CAS  PubMed  Google Scholar 

  12. Iddriss A, Shivute N, Bickler S et al (2011) Emergency, anaesthetic and essential surgical capacity in the Gambia. Bull World Health Organ 89:565–572

    Article  PubMed Central  PubMed  Google Scholar 

  13. OECD Surgeons in OECD and non-OECD Countries (2012) In: OECD editor, OECD

  14. Lebrun DG, Saavedra-Pozo I, Agreda-Flores F et al (2012) Surgical and anesthesia capacity in Bolivian public hospitals: results from a national hospital survey. World J Surg 36(11):2559–2566. doi:10.1007/s00268-012-1722-x

    Article  PubMed  Google Scholar 

  15. Van Heng Y, Davoung C, Husum H (2008) Non-doctors as trauma surgeons? A controlled study of trauma training for non-graduate surgeons in rural Cambodia. Prehosp Disaster Med 23:483–489 discussion 490–481

    PubMed  Google Scholar 

  16. Poggetti RS (2008) Acute care surgeon South American model. World J Surg 32:1626–1629. doi:10.1007/s00268-008-9659-9

    Article  PubMed  Google Scholar 

  17. Kassum DA, Valji A, Gulyazov S (2003) General surgery in a district hospital in Tajikistan: clinical impact of a partnership between visiting volunteers and host specialists. Can J Surg 46:335–339

    PubMed Central  PubMed  Google Scholar 

  18. Ahmed SM, Hossain MA, Rajachowdhury AM et al (2011) The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health 9:3

    Article  PubMed Central  PubMed  Google Scholar 

  19. Lebrun DG, Dhar D, Sarkar MI et al (2012) Measuring global surgical disparities: a survey of surgical and anesthesia infrastructure in Bangladesh. World J Surg 37(1):24–31. doi:10.1007/s00268-012-1806-7

    Article  Google Scholar 

  20. Essential Surgery Group (2007) Conference on increasing access to surgical services in resource-constrained settings in Sub-Saharan Africa, Bellagio, Bellagio Report, Lake Como, 4–8 June

  21. Bickler S, Ozgediz D, Gosselin R et al (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34:374–380. doi:10.1007/s00268-009-0261-6

    Article  PubMed Central  PubMed  Google Scholar 

  22. Grimes CE, Law RS, Borgstein ES et al (2012) Systematic review of met and unmet need of surgical disease in rural sub-Saharan Africa. World J Surg 36:8–23. doi:10.1007/s00268-011-1330-1

    Article  PubMed  Google Scholar 

  23. Prytherch H, Massawe S, Kuelker R et al (2007) The unmet need for emergency obstetric care in Tanga Region, Tanzania. BMC Pregnancy Childbirth 7:16

    Article  PubMed Central  PubMed  Google Scholar 

  24. Godal T, Quam L (2012) Accelerating the global response to reduce maternal mortality. Lancet 379:2025–2026

    Article  PubMed  Google Scholar 

  25. Pearson L, Shoo R (2005) Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda. Int J Gynaecol Obstet 88:208–215

    Article  CAS  PubMed  Google Scholar 

  26. Murray CJ, Vos T, Lozano R et al (2013) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2197–2223

    Article  Google Scholar 

  27. World Bank Dataset (2012) Population, total. The World Bank, Washington, DC

    Google Scholar 

  28. World Bank Dataset (2013) GDP per capita (current US$). The World Bank, Washington, DC

    Google Scholar 

  29. World Health Organization (2006) World health report 2006: working together for health. WHO, Geneva

    Google Scholar 

  30. Fletcher P, McDonald A, McCartney T et al (2003) Surgery in Jamaica. Arch Surg 138:1150–1153

    Article  PubMed  Google Scholar 

  31. Gnassingbe K, Tekou H, da Silva-Anoma S et al (2011) The paediatric surgeon and his working conditions in Francophone sub-Saharan Africa. Afr J Paediatr Surg 8:298–300

    Article  CAS  PubMed  Google Scholar 

  32. Farmer PE, Kim JY (2008) Surgery and global health: a view from beyond the OR. World J Surg 32:533–536. doi:10.1007/s00268-008-9525-9

    Article  PubMed Central  PubMed  Google Scholar 

  33. Ozgediz D, Riviello R, Rogers SO (2008) The surgical workforce crisis in Africa: a call to action. Bull Am Coll Surg 93:10–16

    PubMed  Google Scholar 

  34. Debas HT, Gosselin R, McCord C et al (2006) Surgery. In: Jamison DT, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries. The International Bank for Reconstruction and Development/The World Bank Group, Washington, DC

    Google Scholar 

  35. Groen RS, Samai M, Kamara TB et al (2012) The unmet surgical disease burden in the developing world. Lancet 379:616

    Article  PubMed  Google Scholar 

  36. Galukande M, von Schreeb J, Wladis A et al (2010) Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PLoS Med 7:e1000243

    Article  PubMed Central  PubMed  Google Scholar 

  37. Reshamwalla S, Gobeze AA, Ghosh S et al (2012) Snapshot of surgical activity in rural Ethiopia: is enough being done? World J Surg 36:1049–1055. doi:10.1007/s00268-012-1511-6

    Article  PubMed  Google Scholar 

  38. Bowman KG, Berry WR, Gawande A (2012) Pediatric emergency and essential care in Zambian hospitals: a nationwide study. American Academy of Pediatrics 2012 National Conference & Exhibition, Ernest N. Morial Convention Center, New Orleans, 20–23 October 2012

  39. Choo S, Perry H, Hesse AA et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 15(9):1109–1115

    PubMed  Google Scholar 

  40. Contini S, Taqdeer A, Cherian M et al (2010) Emergency and essential surgical services in Afghanistan: still a missing challenge. World J Surg 34:473–479. doi:10.1007/s00268-010-0406-7

    Article  PubMed  Google Scholar 

  41. Osen H, Chang D, Choo S et al (2011) Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35:500–504. doi:10.1007/s00268-010-0918-1

    Article  PubMed Central  PubMed  Google Scholar 

  42. Penoyar T, Cohen H, Kibatala P et al (2012) Emergency and surgery services of primary hospitals in the United Republic of Tanzania. BMJ Open 2:e000369

    Article  PubMed Central  PubMed  Google Scholar 

  43. Sherman L, Clement PT, Cherian MN et al (2011) Implementing Liberia’s poverty reduction strategy: an assessment of emergency and essential surgical care. Arch Surg 146:35–39

    Article  PubMed  Google Scholar 

  44. Taira BR, Cherian MN, Yakandawala H et al (2010) Survey of emergency and surgical capacity in the conflict-affected regions of Sri Lanka. World J Surg 34:428–432. doi:10.1007/s00268-009-0254-5

    Article  PubMed  Google Scholar 

  45. Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127; discussion 128

    Google Scholar 

  46. World Health Organization (2012) Emergency and essential surgical care: WHO EESC Global Database. WHO, Geneva

    Google Scholar 

  47. Kushner AL, Groen RS, Kamara TB et al (2012) Assessment of pediatric surgery capacity at government hospitals in Sierra Leone. World J Surg 36(11):2554–2558. doi:10.1007/s00268-012-1737-3

    Article  PubMed  Google Scholar 

  48. Groen RS, Kamara TB, Dixon-Cole R et al (2012) A tool and index to assess surgical capacity in low income countries: an initial implementation in Sierra Leone. World J Surg 36:1970–1977. doi:10.1007/s00268-012-1591-3

    Article  PubMed  Google Scholar 

  49. Henry JA, Windapo O, Kushner AL et al (2012) A survey of surgical capacity in rural southern Nigeria: opportunities for change. World J Surg 36:2811–2818. doi:10.1007/s00268-012-1764-0

    Article  PubMed  Google Scholar 

  50. Chao TE, Burdic M, Ganjawalla K et al (2012) Survey of surgery and anesthesia infrastructure in Ethiopia. World J Surg 36(11):2545–2553. doi:10.1007/s00268-012-1729-3

    Article  PubMed  Google Scholar 

  51. Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065. doi:10.1007/s00268-012-1482-7

    Article  PubMed  Google Scholar 

  52. Notrica MR, Evans FM, Knowlton LM et al (2011) Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg 35:1770–1780. doi:10.1007/s00268-011-1125-4

    Article  PubMed  Google Scholar 

  53. Chu K, Rosseel P, Gielis P et al (2009) Surgical task shifting in Sub-Saharan Africa. PLoS Med 6:e1000078

    Article  PubMed Central  PubMed  Google Scholar 

  54. Chu KM, Ford NP, Trelles M (2011) Providing surgical care in Somalia: a model of task shifting. Confl Health 5:12

    Article  PubMed Central  PubMed  Google Scholar 

  55. Cherian M, Choo S, Wilson I et al (2010) Building and retaining the neglected anaesthesia health workforce: is it crucial for health systems strengthening through primary health care? Bull World Health Organ 88:637–639

    Article  PubMed Central  PubMed  Google Scholar 

  56. World Health Organization (2012) WHO global health observatory data repository. WHO, Geneva

    Google Scholar 

  57. Transparency International. Corruption perceptions index. http://www.transparency.org/. Accessed 21 May 2013

  58. Mullan F, Frehywot S (2007) Non-physician clinicians in 47 sub-Saharan African countries. Lancet 370:2158–2163

    Article  PubMed  Google Scholar 

  59. Mullan F, Frehywot S, Omaswa F et al (2011) Medical schools in sub-Saharan Africa. Lancet 377:1113–1121

    Article  PubMed  Google Scholar 

  60. Sherr K, Mussa A, Chilundo B et al (2012) Brain drain and health workforce distortions in Mozambique. PLoS One 7:e35840

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  61. Hagander LE, Hughes CD, Nash K et al (2013) Surgeon migration between developing countries and the United States: train, retain, and gain from brain drain. World J Surg 37(1):14–23. doi:10.1007/s00268-012-1795-6

    Article  PubMed  Google Scholar 

  62. Terhune KP, Zaydfudim V, Abumrad NN (2010) International medical graduates in general surgery: increasing needs, decreasing numbers. J Am Coll Surg 210:990–996

    Article  PubMed  Google Scholar 

  63. Itani KM, Hoballah J, Kaafarani H et al (2011) Could international medical graduates offer a solution to the surgical workforce crisis? Balancing national interest and global responsibility. Surgery 149:597–600

    Article  PubMed  Google Scholar 

  64. Debas HT (2006) The problem of heavy reliance on international medical graduates to supply the surgical workforce in the United States. Surgery 140:359–361

    Article  PubMed  Google Scholar 

  65. Mullan F (2005) The metrics of the physician brain drain. N Engl J Med 353:1810–1818

    Article  CAS  PubMed  Google Scholar 

  66. Clemens MA, Pettersson G (2008) New data on African health professionals abroad. Hum Resour Health 6:1

    Article  PubMed Central  PubMed  Google Scholar 

  67. MacDonagh R, Jiddawi M, Parry V (2002) Twinning: the future for sustainable collaboration. BJU Int 89(Suppl 1):13–17

    Article  PubMed  Google Scholar 

  68. Gemici G (2006) The metrics of the physician brain drain. N Engl J Med 354:528–530;author reply 528–530

    Article  PubMed  Google Scholar 

  69. Chandra A (2006) The metrics of the physician brain drain. N Engl J Med 354:528–530;author reply 528–530

    Article  PubMed  Google Scholar 

  70. Weiser TG, Makary MA, Haynes AB et al (2009) Standardised metrics for global surgical surveillance. Lancet 374:1113–1117

    Article  PubMed  Google Scholar 

  71. Thompson MJ, Lynge DC, Larson EH et al (2005) Characterizing the general surgery workforce in rural America. Arch Surg 140:74–79

    Article  PubMed  Google Scholar 

  72. Chang DC, Eastman B, Talamini MA et al (2011) Density of surgeons is significantly associated with reduced risk of deaths from motor vehicle crashes in US counties. J Am Coll Surg 212:862–866

    Article  PubMed  Google Scholar 

  73. Hagander L, Hoyler M, Finlayson SR et al (2013) National density of surgeons and anesthesiologists is significantly correlated with maternal mortality. Bethune Round Table, Vancouver (BC), 2013

  74. Adegoke AA, van den Broek N (2009) Skilled birth attendance: lessons learnt. BJOG 116(Suppl 1):33–40

    Article  PubMed  Google Scholar 

  75. Adegoke A, Utz B, Msuya SE et al (2012) Skilled birth attendants: who is who? A descriptive study of definitions and roles from nine Sub Saharan African countries. PLoS One 7:e40220

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  76. Harvey SA, Blandon YC, McCaw-Binns A et al (2007) Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward. Bull World Health Organ 85:783–790

    Article  PubMed Central  PubMed  Google Scholar 

  77. World Health Organization (2008) Spotlight on health workforce statistics. WHO, Geneva

    Google Scholar 

  78. World Health Organization. Technical notes: global health workforce statistics database. WHO, Geneva

  79. OECD (2012) OECD health data: health care resources. OECD Health Statistics (database). http://www.oecd-ilibrary.org/content/data/data-00541-en. Accessed 19 Feb 2013

  80. Mavalankar D, Sriram V (2009) Provision of anaesthesia services for emergency obstetric care through task shifting in South Asia. Reprod Health Matters 17:21–31

    Article  PubMed  Google Scholar 

  81. de Jesus LE, Aguiar AS, de Campos Mdo S et al (2009) Needs and specialization for pediatric surgeons in Brazil [article in Portuguese]. Rev Col Bras Cir 36:356–361

    Article  PubMed  Google Scholar 

  82. Dewan PA (1995) Paediatric surgery in Cambodia. Med J Aust 163:640–642

    CAS  PubMed  Google Scholar 

  83. Chirdan LB, Ameh EA, Abantanga FA et al (2010) Challenges of training and delivery of pediatric surgical services in Africa. J Pediatr Surg 45:610–618

    Article  PubMed  Google Scholar 

  84. Gaym A (2010) Audit of obstetrician-gynecologists in Ethiopia, 1950s–2007: implications for specialty level reproductive health care provision. Ethiop Med J 48:137–148

    PubMed  Google Scholar 

  85. Edwin F, Tettey M, Aniteye E et al (2011) The development of cardiac surgery in West Africa—the case of Ghana. Pan Afr Med J 9:15

    PubMed Central  PubMed  Google Scholar 

  86. Cameron BH, Rambaran M, Sharma DP et al (2010) International surgery: the development of postgraduate surgical training in Guyana. Can J Surg 53:11–16

    PubMed Central  PubMed  Google Scholar 

  87. Smith SR (1984) How might we improve surgical services for rural populations in developing countries? Br Med J (Clin Res Ed) 289:494–495

    Article  Google Scholar 

  88. Lavy C, Tindall A, Steinlechner C et al (2007) Surgery in Malawi: a national survey of activity in rural and urban hospitals. Ann R Coll Surg Engl 89:722–724

    Article  PubMed Central  PubMed  Google Scholar 

  89. Spiegel DA, Choo S, Cherian M et al (2011) Quantifying surgical and anesthetic availability at primary health facilities in Mongolia. World J Surg 35:272–279. doi:10.1007/s00268-010-0904-7

    Article  PubMed  Google Scholar 

  90. Adepoju FG, Ayanniyi AA, Pam V et al (2011) Human resource development for Vision 2020 in developing countries: a change from absolute numbers. Eur J Ophthalmol 21:820–825

    Article  PubMed  Google Scholar 

  91. Ameh EA, Adejuyigbe O, Nmadu PT (2006) Pediatric surgery in Nigeria. J Pediatr Surg 41:542–546

    Article  PubMed  Google Scholar 

  92. Blanchard RJ, Blanchard ME, Toussignant P et al (1987) The epidemiology and spectrum of surgical care in district hospitals of Pakistan. Am J Public Health 77:1439–1445

    Article  CAS  PubMed  Google Scholar 

  93. Natuzzi ES, Kushner A, Jagilly R et al (20011) Surgical care in the Solomon Islands: a road map for universal surgical care delivery. World J Surg 35:1183–1193. doi:10.1007/s00268-011-1097-4

    Google Scholar 

  94. Abdool-Carrim AT, Veller MG (2010) Vascular surgical education in a medium-income country. Eur J Vasc Endovasc Surg 39(Suppl 1):S22–S24

    Article  PubMed  Google Scholar 

  95. Bornman PC, Krige JE (2005) Perspectives on surgery in the new South Africa. World J Surg 29:949–952. doi:10.1007/s00268-005-0141-7

    Article  PubMed  Google Scholar 

  96. Hodges S, Wilson J, Hodges A (2009) Plastic and reconstructive surgery in Uganda: 10 years experience. Paediatr Anaesth 19:12–18

    Article  PubMed  Google Scholar 

  97. Walker IA, Obua AD, Mouton F et al (2010) Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bull World Health Organ 88:897–906

    Article  PubMed Central  PubMed  Google Scholar 

  98. Al Serouri AW, Al Rukeimi A, Bin Afif M et al (2012) Findings from a needs assessment of public sector emergency obstetric and neonatal care in four governorates in Yemen: a human resources crisis. Reprod Health Matters 20:122–128

    Article  PubMed  Google Scholar 

  99. World Health Organization (2012) Global initiative for emergency and essential surgical care. WHO, Geneva

    Google Scholar 

  100. World Health Organization (2011) Mental health atlas. WHO, Geneva

    Google Scholar 

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Acknowledgments

The authors wish to acknowledge the collaboration of Dr. Meena Nathan Cherian of the WHO Department of Health Systems Policies and Workforce, and Dr. Amani Siyam of Human Resources for Health and the WHO Department of Health Systems Policies and Workforce.

Conflict of interest

The authors report no potential or real conflicts of interest.

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Authors and Affiliations

  1. Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Marguerite Hoyler, Craig D. McClain, John G. Meara & Lars Hagander

  2. Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, USA

    Marguerite Hoyler, John G. Meara & Lars Hagander

  3. Department of Surgery, University of Utah School of Medicine, University of Utah Center for Global Surgery, Salt Lake City, UT, USA

    Samuel R. G. Finlayson

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA

    Craig D. McClain

  5. Department of Pediatric Surgery and International Pediatrics, Faculty of Medicine, Lund University Children’s Hospital, 22185, Lund, Sweden

    Lars Hagander

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  1. Marguerite Hoyler
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  2. Samuel R. G. Finlayson
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Correspondence to Lars Hagander.

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Hoyler, M., Finlayson, S.R.G., McClain, C.D. et al. Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature. World J Surg 38, 269–280 (2014). https://doi.org/10.1007/s00268-013-2324-y

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