World Journal of Surgery

, Volume 37, Issue 1, pp 14–23 | Cite as

Surgeon Migration Between Developing Countries and the United States: Train, Retain, and Gain from Brain Drain

  • Lars E. Hagander
  • Christopher D. Hughes
  • Katherine Nash
  • Karan Ganjawalla
  • Allison Linden
  • Yolanda Martins
  • Kathleen M. Casey
  • John G. Meara



The critical shortage of surgeons in many low- and middle-income countries (LMICs) prevents adequate responses to surgical needs, but the factors that affect surgeon migration have remained incompletely understood. The goal of this study was to examine the importance of personal, professional, and infrastructural factors on surgeon migration from LMICs to the United States. We hypothesized that the main drivers of surgeon migration can be addressed by providing adequate domestic surgical infrastructure, surgical training programs, and viable surgical career paths.


We conducted an internet-based nationwide survey of surgeons living in the US who originated from LMICs.


66 surgeons completed the survey. The most influential factors for primary migration were related to professional reasons (p ≤ 0.001). Nonprofessional factors, such as concern for remuneration, family, and security were significantly less important for the initial migration decisions, but adopted a more substantial role in deciding whether or not to return after training in the United States. Migration to the United States was initially considered temporary (44 %), and a majority of the surveyed surgeons have returned to their source countries in some capacity (56 %), often on multiple occasions (80 %), to contribute to clinical work, research, and education.


This study suggests that surgically oriented medical graduates from LMICs migrate primarily for professional reasons. Initiatives to improve specialist education and surgical infrastructure in LMICs have the potential to promote retention of the surgical workforce. There may be formal ways for LMICs to gain from the international pool of relocated surgeons.


Health Workforce Source Country Return Migration International Medical Graduate Migration Factor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Lars E. Hagander
    • 1
    • 2
    • 3
  • Christopher D. Hughes
    • 1
    • 2
  • Katherine Nash
    • 4
  • Karan Ganjawalla
    • 1
    • 2
  • Allison Linden
    • 1
    • 2
    • 5
  • Yolanda Martins
    • 6
    • 7
    • 8
  • Kathleen M. Casey
    • 9
  • John G. Meara
    • 1
    • 2
  1. 1.Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUSA
  2. 2.Department of Plastic and Oral SurgeryChildren’s Hospital BostonBostonUSA
  3. 3.Department of Pediatric Surgery, Faculty of MedicineLund UniversityLundSweden
  4. 4.Columbia University Medical SchoolNew YorkUSA
  5. 5.Department of SurgeryGeorgetown University HospitalWashingtonUSA
  6. 6.Clinical Research Center, Children’s Hospital BostonBostonUSA
  7. 7.Center for Population SciencesDana-Farber Cancer InstituteBostonUSA
  8. 8.Division of General PediatricsHarvard Medical SchoolBostonUSA
  9. 9.Operation Giving BackAmerican College of SurgeonsChicagoUSA

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