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

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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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Authors and Affiliations

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

    Lars E. Hagander, Christopher D. Hughes, Karan Ganjawalla, Allison Linden & John G. Meara

  2. Department of Plastic and Oral Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, MA, 02115, USA

    Lars E. Hagander, Christopher D. Hughes, Karan Ganjawalla, Allison Linden & John G. Meara

  3. Department of Pediatric Surgery, Faculty of Medicine, Lund University, Lund, Sweden

    Lars E. Hagander

  4. Columbia University Medical School, New York, NY, USA

    Katherine Nash

  5. Department of Surgery, Georgetown University Hospital, Washington, DC, USA

    Allison Linden

  6. Clinical Research Center, Children’s Hospital Boston, Boston, MA, USA

    Yolanda Martins

  7. Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA

    Yolanda Martins

  8. Division of General Pediatrics, Harvard Medical School, Boston, MA, USA

    Yolanda Martins

  9. Operation Giving Back, American College of Surgeons, Chicago, IL, USA

    Kathleen M. Casey

Authors
  1. Lars E. Hagander
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Correspondence to Lars E. Hagander.

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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

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