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World Journal of Surgery
Published in: World Journal of Surgery 1/2013

01-01-2013

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

Published in: World Journal of Surgery | Issue 1/2013

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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.
Literature
1.
2.
Ameh EA, Adejuyigbe O, Nmadu PT (2006) Pediatric surgery in Nigeria. J Pediatr Surg 41(3):542–546PubMedCrossRef
3.
4.
5.
6.
Funk LM et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061PubMedCrossRef
7.
Ozgediz D, Riviello R, Rogers SO (2008) The surgical workforce crisis in Africa: a call to action. Bull Am Coll Surg 93(8):10–16PubMed
8.
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):143–144PubMedCrossRef
9.
Debas HT (2006) The problem of heavy reliance on international medical graduates to supply the surgical workforce in the United States. Surgery 140(3):359–361PubMedCrossRef
10.
MacGowan WA (1987) Surgical manpower worldwide. Bull Am Coll Surgery 72(6):5–7, 9
11.
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
12.
Weiser TG et al (2009) Standardised metrics for global surgical surveillance. Lancet 374(9695):1113–1117PubMedCrossRef
13.
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 PubMedCrossRef
14.
User’s Guide to the WHO Global (2011) Code of practice on the international recruitment of health personnel
15.
The World Health Report 2006 (2006) Working together for health. WHO, Geneva
16.
Awases M (2004) Migration of health professionals in six countries: a synthesis report. WHO Regional Office for Africa
17.
Sheldon GF et al (2008) The global health workforce shortage: role of surgeons and other providers. Adv Surg 42:63–85PubMedCrossRef
18.
Sheldon GF (2007) Workforce issues in general surgery. Am Surg 73(2):100–108PubMed
19.
Terhune KP, Zaydfudim V, Abumrad NN (2010) International medical graduates in general surgery: increasing needs, decreasing numbers. J Am Coll Surg 210(6):990–996PubMedCrossRef
20.
Williams TE Jr, Ellison EC (2008) Population analysis predicts a future critical shortage of general surgeons. Surgery 144(4):548–554; discussion 554–556
21.
Horvath K, Pellegrini C (2006) Selecting international medical graduates (IMGs) for training in U.S. surgical residencies. Surgery 140(3):347–350
22.
23.
Cooper RA (2008) The U.S. physician workforce: where do we stand? OECD health working paper no. 37
24.
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
25.
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):17PubMedCrossRef
26.
27.
The Looming Crisis in the Health Workforce (2008) How can OECD countries respond? OECD Organisation for Economic Co-operation and Development
28.
Patel V (2003) Recruiting doctors from poor countries: the great brain robbery? BMJ 327(7420):926–928PubMedCrossRef
29.
Buchan J et al (2009) Does a code make a difference–assessing the English code of practice on international recruitment. Hum Resour Health 7:33PubMedCrossRef
30.
Health Workers for All and All for Health Workers (2008) The Kampala Declaration and Agenda for Global Action
31.
WHO (2010) Global code of practice on the international recruitment of health personnel
32.
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):2348–2351PubMedCrossRef
33.
34.
Syed NA et al (2008) Reasons for migration among medical students from Karachi. Med Educ 42(1):61–68PubMedCrossRef
35.
Benamer H, Bredan A, Bakoush O (2009) The Libyan doctors’ brain drain: an exploratory study. BMC Res Notes 2:242PubMedCrossRef
36.
Anderson FW et al (2007) Who will be there when women deliver? Assuring retention of obstetric providers. Obstet Gynecol 110(5):1012–1016PubMedCrossRef
37.
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):148–154PubMedCrossRef
38.
Kaushik M et al (2008) Quality of medical training and emigration of physicians from India. BMC Health Serv Res 8:279PubMedCrossRef
39.
Oberoi SS, Lin V (2006) Brain drain of doctors from southern Africa: brain gain for Australia. Aust Health Rev 30(1):25–33PubMed
40.
NewsScope (2012) Director of communications on the NewsScope
41.
42.
43.
World Health Organization (2004) The migration of skilled health personnel in the Pacific Region: a summary report: 2004. World Health Organization, Geneva
44.
Astor A et al (2005) Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Soc Sci Med 61(12):2492–2500PubMedCrossRef
45.
Joudrey R, Robson K (2010) Practising medicine in two countries: South African physicians in Canada. Sociol Health Illn 32(4):528–544PubMedCrossRef
46.
Vujicic M et al (2004) The role of wages in the migration of health care professionals from developing countries. Hum Resour Health 2(1):3PubMedCrossRef
47.
Arah OA (2007) The metrics and correlates of physician migration from Africa. BMC Public Health 7:83PubMedCrossRef
48.
Klein D et al (2009) Push, pull, and plant: the personal side of physician immigration to Alberta, Canada. Fam Med 41(3):197–201PubMed
49.
50.
Chen PG et al (2011) International medical graduates in the USA: a qualitative study on perceptions of physician migration. BMJ Open 1(2):e000138PubMedCrossRef
51.
Hong SD (1999) Adjustment of Korean-American physicians in Korea: aspect of personal satisfaction. J Korean Med Sci 14(4):359–364PubMed
52.
Finlay (2011) ‘Garang’s seeds’: influences on the return of Sudanese-Canadian refugee physicians to post-conflict South Sudan. J Refugee Stud 24(1):187–206CrossRef
53.
Economics Focus (2011) Drain or gain? Poor countries can end up benefiting when their brightest citizens emigrate. The Economist May 24, 2011
54.
Forcier MB, Simoens S, Giuffrida A (2004) Impact, regulation and health policy implications of physician migration in OECD countries. Hum Resour Health 2(1):12PubMedCrossRef
55.
Mills EJ et al (2011) The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ 343:d7031PubMedCrossRef
56.
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–S101PubMedCrossRef
57.
Kirigia JM et al (2006) The cost of health professionals’ brain drain in Kenya. BMC Health Serv Res 6:89PubMedCrossRef
58.
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
59.
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):406–412PubMedCrossRef
60.
Aranha GV (1998) The international medical graduate in US academic general surgery. Arch Surg 133(2):130–133PubMedCrossRef
61.
Cooper RA et al (2002) Economic and demographic trends signal an impending physician shortage. Health Aff (Millwood) 21(1):140–154CrossRef
62.
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):1278–1284PubMedCrossRef
63.
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 4:22PubMedCrossRef
64.
65.
66.
67.
World Health Organization (2007) (updated edition). Working for health: an introduction to the World Health Organization. ISBN 92 4 156313 5
68.
Metadata
Title
Surgeon Migration Between Developing Countries and the United States: Train, Retain, and Gain from Brain Drain
Publication date
01-01-2013
Published in
World Journal of Surgery / Issue 1/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-012-1795-6

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Acknowledgments

2012 Acknowledgements