Abstract
Background
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.
Methods
We conducted an internet-based nationwide survey of surgeons living in the US who originated from LMICs.
Results
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.
Conclusions
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.
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References
Lavy C et al (2011) State of surgery in tropical Africa: a review. World J Surg 35(2):262–271. doi:10.1007/s00268-010-0885-6
Ameh EA, Adejuyigbe O, Nmadu PT (2006) Pediatric surgery in Nigeria. J Pediatr Surg 41(3):542–546
The College of Surgeons of East, Central and Southern Africa (COSECSA) (2011) http://www.cosecsa.org/. Accessed 10 Dec 2011
Ozgediz D et al (2008) Africa’s neglected surgical workforce crisis. Lancet 371(9613):627–628
Ozgediz D et al (2008) The neglect of the global surgical workforce: experience and evidence from Uganda. World J Surg 32(6):1208–1215. doi:10.1007/s00268-008-9473-4
Funk LM et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061
Ozgediz D, Riviello R, Rogers SO (2008) The surgical workforce crisis in Africa: a call to action. Bull Am Coll Surg 93(8):10–16
Riviello R, Ozgediz D (2008) International medical graduates and the global surgical workforce: the perspective from the other side. J Am Coll Surg 207(1):143–144
Debas HT (2006) The problem of heavy reliance on international medical graduates to supply the surgical workforce in the United States. Surgery 140(3):359–361
MacGowan WA (1987) Surgical manpower worldwide. Bull Am Coll Surgery 72(6):5–7, 9
Choo S et al (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health 15:1109–1115
Weiser TG et al (2009) Standardised metrics for global surgical surveillance. Lancet 374(9695):1113–1117
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(3):438–444. doi:10.1007/s00268-009-0229-6
User’s Guide to the WHO Global (2011) Code of practice on the international recruitment of health personnel
The World Health Report 2006 (2006) Working together for health. WHO, Geneva
Awases M (2004) Migration of health professionals in six countries: a synthesis report. WHO Regional Office for Africa
Sheldon GF et al (2008) The global health workforce shortage: role of surgeons and other providers. Adv Surg 42:63–85
Sheldon GF (2007) Workforce issues in general surgery. Am Surg 73(2):100–108
Terhune KP, Zaydfudim V, Abumrad NN (2010) International medical graduates in general surgery: increasing needs, decreasing numbers. J Am Coll Surg 210(6):990–996
Williams TE Jr, Ellison EC (2008) Population analysis predicts a future critical shortage of general surgeons. Surgery 144(4):548–554; discussion 554–556
Horvath K, Pellegrini C (2006) Selecting international medical graduates (IMGs) for training in U.S. surgical residencies. Surgery 140(3):347–350
Sheldon GF (2006) Globalization and the health workforce shortage. Surgery 140(3):354–358
Cooper RA (2008) The U.S. physician workforce: where do we stand? OECD health working paper no. 37
Lynge DC et al (2008) A longitudinal analysis of the general surgery workforce in the United States, 1981–2005. Arch Surg 143(4):345–350; discussion 351
Hagopian A et al (2004) The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. Hum Resour Health 2(1):17
Mullan F (2005) The metrics of the physician brain drain. N Engl J Med 353(17):1810–1818
The Looming Crisis in the Health Workforce (2008) How can OECD countries respond? OECD Organisation for Economic Co-operation and Development
Patel V (2003) Recruiting doctors from poor countries: the great brain robbery? BMJ 327(7420):926–928
Buchan J et al (2009) Does a code make a difference–assessing the English code of practice on international recruitment. Hum Resour Health 7:33
Health Workers for All and All for Health Workers (2008) The Kampala Declaration and Agenda for Global Action
WHO (2010) Global code of practice on the international recruitment of health personnel
Taylor AL et al (2011) Stemming the brain drain–a WHO global code of practice on international recruitment of health personnel. N Engl J Med 365(25):2348–2351
Ahmad OB (2005) Managing medical migration from poor countries. BMJ 331(7507):43–45
Syed NA et al (2008) Reasons for migration among medical students from Karachi. Med Educ 42(1):61–68
Benamer H, Bredan A, Bakoush O (2009) The Libyan doctors’ brain drain: an exploratory study. BMC Res Notes 2:242
Anderson FW et al (2007) Who will be there when women deliver? Assuring retention of obstetric providers. Obstet Gynecol 110(5):1012–1016
Arah OA, Ogbu UC, Okeke CE (2008) Too poor to leave, too rich to stay: developmental and global health correlates of physician migration to the United States, Canada, Australia, and the United Kingdom. Am J Public Health 98(1):148–154
Kaushik M et al (2008) Quality of medical training and emigration of physicians from India. BMC Health Serv Res 8:279
Oberoi SS, Lin V (2006) Brain drain of doctors from southern Africa: brain gain for Australia. Aust Health Rev 30(1):25–33
NewsScope (2012) Director of communications on the NewsScope
GHD Online (2011) Aug 10, 2011 and July 26, 2011. http://www.ghdonline.org
Directory of Ethnic Medical Associations (2011) http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates/imgs-in-united-states/directory-ethnic-medical-associations.page?
World Health Organization (2004) The migration of skilled health personnel in the Pacific Region: a summary report: 2004. World Health Organization, Geneva
Astor A et al (2005) Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Soc Sci Med 61(12):2492–2500
Joudrey R, Robson K (2010) Practising medicine in two countries: South African physicians in Canada. Sociol Health Illn 32(4):528–544
Vujicic M et al (2004) The role of wages in the migration of health care professionals from developing countries. Hum Resour Health 2(1):3
Arah OA (2007) The metrics and correlates of physician migration from Africa. BMC Public Health 7:83
Klein D et al (2009) Push, pull, and plant: the personal side of physician immigration to Alberta, Canada. Fam Med 41(3):197–201
Ricketts TC (2010) The migration of surgeons. Ann Surg 251(2):363–367
Chen PG et al (2011) International medical graduates in the USA: a qualitative study on perceptions of physician migration. BMJ Open 1(2):e000138
Hong SD (1999) Adjustment of Korean-American physicians in Korea: aspect of personal satisfaction. J Korean Med Sci 14(4):359–364
Finlay (2011) ‘Garang’s seeds’: influences on the return of Sudanese-Canadian refugee physicians to post-conflict South Sudan. J Refugee Stud 24(1):187–206
Economics Focus (2011) Drain or gain? Poor countries can end up benefiting when their brightest citizens emigrate. The Economist May 24, 2011
Forcier MB, Simoens S, Giuffrida A (2004) Impact, regulation and health policy implications of physician migration in OECD countries. Hum Resour Health 2(1):12
Mills EJ et al (2011) The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ 343:d7031
Marchal B, Kegels G (2003) Health workforce imbalances in times of globalization: brain drain or professional mobility? Int J Health Plann Manage 18(Suppl 1):S89–S101
Kirigia JM et al (2006) The cost of health professionals’ brain drain in Kenya. BMC Health Serv Res 6:89
Nyarko Y (2011) The returns to the brain drain and brain circulation in sub-Saharan Africa: some computations using data from Ghana. NBER Working Paper 16813
Schenarts PJ et al (2008) Comparison of surgical residency applicants from U.S. medical schools with U.S.-born and foreign-born international medical school graduates. J Surg Educ 65(6):406–412
Aranha GV (1998) The international medical graduate in US academic general surgery. Arch Surg 133(2):130–133
Cooper RA et al (2002) Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood) 21(1):140–154
Akl EA et al (2007) Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Soc Sci Med 64(6):1278–1284
Labonte R, Packer C, Klassen N (2006) Managing health professional migration from sub-Saharan Africa to Canada: a stakeholder inquiry into policy options. Hum Resour Health 4:22
Achieving the Health-Related MDGs (2011) It takes a workforce! http://www.who.int/hrh/workforce_mdgs/en/index.html-.Tt0_T1tRVGc.email. Accessed 13 Jan 2012
Physician Working (2006) Map 219. http://www.worldmapper.org/display.php?selected=219. 13 Jan 2012
World Bank Classification (2011) http://data.worldbank.org
World Health Organization (2007) (updated edition). Working for health: an introduction to the World Health Organization. ISBN 92 4 156313 5
Census Regions and Divisions of the United States (2012) http://www.census.gov/geo/www/us_regdiv.pdf. Accessed 11 Jan 2012
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Hagander, L.E., Hughes, C.D., Nash, K. et al. Surgeon Migration Between Developing Countries and the United States: Train, Retain, and Gain from Brain Drain. World J Surg 37, 14–23 (2013). https://doi.org/10.1007/s00268-012-1795-6
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DOI: https://doi.org/10.1007/s00268-012-1795-6