Physician Migration Research Articles

The Migration of Physicians and the Local Supply of Practitioners

The overall distribution of physicians in the United States is uneven, with concentrations in urban areas while some rural places have proportionately very few. This report examines the movement of physicians who have completed their training and choose to move from one location to another. The analysis linked the locations of practice of physicians practicing in the 50 U.S. states in 2006 and 2011 using data from the American Medical Association Physician Masterfile. Age, gender, location practice, activity status, and specialty were included in the data. Physicians who changed address in the five-year period were identified and were compared with nonmovers using descriptive statistics. A summary logistic regression of movers compared with nonmovers was performed to assess the most important correlates of migration. The overall rate of county-to-county relocation for physicians was 19.8% for the five-year period 2006-2011. Analyses indicated that older, male, and urban physicians were less likely to move; that physicians with osteopathic training were more likely to move; and that surgeons and primary care physicians were less likely to move compared with other specialists. The physician workforce in the United States migrates from place to place, and this movement determines the local supply of practitioners at any given time. Programs that intend to influence the local supply of doctors should account for this background tendency to relocate practice in order to achieve goals of more equal geographic distribution.

Ärztlicher Disstress – eine Untersuchung baden-württembergischer Ärztinnen und Ärzte in Krankenhäusern

Current working conditions of physicians in hospitals display characteristics, which on the long term are harmful for the physicians mental and physical health (distress). There are problems concerning the work flow and the organization of working time which finally leads to gratification crises. How physicians perceive their stress-related working conditions is the issue this study wants to investigate. In this study 12 062 physicians in hospitals were invited to an anonymized online-survey. 2064 physicians took part. The basis of this investigation is built by 2 theoretical stress models: The effort-reward-imbalance models of Siegrist and the job-demand-control model of Karasek. Through these theoretical models distress is measured. The study revealed a high prevalence (55,5 %) of distress among physicians in hospitals. Furthermore there were significant differences between gender (59,7 % of female and 51,5 % of male physicians; OR 1,40; 95 %-CI 1,17‑1,66; p < 0,001), between age (61,9 % of under 35-year-old and 49,4 % of over 59-year-old; OR 1,67; 95 %-CI 1,06-2,62; p < 0,001) and between the functional position (24,6 % of chief physician and 63,8 % of junior doctors; OR 5,40; 95 %-CI 3,03-9,65; p < 0,001). An additional analysis of the psychosocial aspects of the working conditions showed that these aspects are rated positively by this sample. These results have to be considered as a cause for concern, because this high prevalence of distress will lead sooner or later to a migration of qualified physicians abroad or to other (less stressful) jobs. In order to prevent a future shortage of qualified physicians, the working conditions have to be adapted to current needs and expectations of the younger generation.

Brain drain: Do economic conditions “push” doctors out of developing countries?

Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975–2004. Using this data, we estimate the impact of changes in economic conditions on physician migration. In our preferred specification that allows for country-specific time trends, we find that a temporary one percentage point decline in GDP per capita increases physician migration in the next period by approximately. 3 percent. In our IV models a one percentage point decline in GDP per capita increases physician migration in the next period by between 3.4 and 3.6 percent. Overall, our results suggest a significant effect of developing country economic conditions on physician migration.

Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile

The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States. We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs. Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.

Health Workforce Brain Drain: From Denouncing the Challenge to Solving the Problem

Giorgio Cometto and colleagues discuss the study by Tankwanchi and colleagues on physician migration to the United States from sub-Saharan Africa and the steps that the US, other destination countries, and SSA countries can take to address the problem. Please see later in the article for the Editors' Summary

Physician Migration in the Global South between Cuba and South Africa

AbstractTransnational physician migration has concerned states' health and migration policies for many years. Recent developments have increased attention to the outcomes of these flows in the global south, where physician emigration is undermining public health policies. Cuba's exporting of medical professionals presents an alternative dynamic, based upon both an ideology of humanitarian solidarity and a need to secure hard currency earnings. The benefits and challenges arising from a bilateral agreement between Cuba and South Africa to supply Cuban doctors to South Africa and training at the Latin American Medical School (ELAM) for South African medical students are addressed. The benefits of skills enhancement and professional development are noted, as well as the economic benefits for both the Cuban government and individual doctors, while concerns with the appropriateness of the medical training provided at ELAM for the South African health context and the sustainability of the current policy are discussed. Policy Implications Strategic bi‐lateral agreements offer a productive route towards more sustainable management of skilled migration. When migration agreements include skills training, attention is needed to ensure the training provided is appropriate to the destination context: attention needs to be paid to the appropriateness of the medical training afforded to South African medical students in Cuba for health requirements in South Africa. International migration agreements can form part of a broader policy suite aimed at realizing public health and other development priorities. However, attention must be paid to the suitability and sustainability of the outcomes of these practices.

Do higher salaries lower physician migration?

It is believed that low wages are an important reason why doctors and nurses in developing countries migrate, and this has led to a call for higher wages for health professionals in developing countries. In this paper, we provide some of the first estimates of the impact of raising health workers' salaries on migration. Using aggregate panel data on the stock of foreign doctors in 16 Organization for Economic Cooperation and Development countries, we explore the effect of a wage increase programme in Ghana on physician migration. We find evidence that 6 years after the implementation of this programme, the foreign stock of Ghanaian doctors abroad had fallen by approximately 10% relative to the estimated counterfactual. This result should be interpreted with caution, however, given the sensitivity of the results to changes in model specification.

The “Brain Drain”: Factors influencing physician migration to Canada

Context: Higher income countries have an average physician density of 300 physicians per 100,000 people. In stark contrast, lower income countries have an average physician density of 17 physicians per 100,000 people. A major cause of this discrepancy is the migration of healthcare professionals from lower income to higher income countries, a phenomenon colloquially known as the “brain drain”. Objective: To explore factors that led International Medical Graduate (IMG) physicians to leave their home countries and migrate to Canada. Methods: An anonymous questionnaire with a mix of open- and close-ended questions was sent to 500 randomly selected IMG physicians practicing in Ontario, Canada. Results were analyzed using a mixed-method design utilizing both descriptive statistics and a thematic analysis approach. Results: 39 physicians met inclusion criteria and completed the survey. The majority were 50 years or older, and over 60% were male. The most common reason for emigration from their home country was the socioeconomic and/or political situation, and the most common reason for selecting Canada was family issues. Suggestions for how brain drain could be stemmed fell into three broad categories: 1) more accurate information about lack of opportunities in Canada, 2) more continuing medical education opportunities in home countries, and 3) address issues such as safety and quality of life in home countries. Conclusions: This survey provides insights into the reasons for emigration and immigration for international medical graduates. The results of this survey can assist stakeholders in working toward appropriate and acceptable solutions to the brain drain.

Clinical Research in the ICU

In times of shrinking departmental budgets, physician attrition, restricted house staff work hours, and reductions in grant funding, there has been a trend towards migration of physicians away from academic medicine. Creative solutions to maintain clinical research programs are frequently necessary. At the University of California Irvine Medical Center, a clinical research program has been created that has allowed research to both survive and thrive in challenging times. The MICU Research Associates Program (MICU-RAP) provides a longitudinal experience for select undergraduate students to facilitate research as part of the MICU team while receiving academic credit and valuable experience. The MICU-RAP student coordinator and faculty advisor work together to recruit research associates, organize weekly meetings, create and implement research protocols, and mentor students and future physician-scientists. Student research associates are trained to develop and maintain a secure database, assist in the authorship of IRB protocols, aid in statistical analyses, and co-author abstracts, posters, and papers. In addition to the research, the MICU-RAP students are exposed to experiences meant to educate and prepare them for a career in health care. A coordinated group of student researchers can provide a significant piece of the infrastructure that physicians wishing to build or sustain a research career need to carry out clinical research when resources are scarce.

Physician Migration Toward Hospital Employment

A growing number of physicians are abandoning small private practice and becoming direct employees of large hospital systems. The latest signs of the continued migration came from a number of surveys and reports generated over the past twelve months. An early 2011 Medical Group Management Association survey found that the share of physician practices that were hospital owned increased to 55% in 2010 – up from 50% in 2008 and approximately 30% in 2003. In addition, a large US-physician recruiting firm said the share of its doctor searches that were for positions with hospitals reached 51% for the 12 months ending in March of 2011, up from 45% from a year earlier and 19% in 2004. Concurrently, the number of searches for physician groups and partnerships dropped. Another national survey of 2,400 physicians found that nearly 3 out of 4 were planning on retiring, working part-time, closing their practices to new patients, becoming employed and/or seeking nonclinical jobs in the next 1 to 3 years. Studies conducted in late 2011 found that 70% of national hospitals and health systems plan to employ more physicians over the next one to three years, while 67% of hospitals and health systems are seeing more requests from independent physician groups about employment opportunities. The data follows another late 2011 report that showed 32% of first-year residents surveyed said they prefer to be employed by a hospital – up from 22% in 2008.

Medical Malpractice Liability and Physician Migration

This paper uses national data on individual physicians and two control groups to provide evidence on the extent to which each of five medical malpractice reforms impacts the decision to move one's medical practice to another state. We find robust evidence that states that have implemented noneconomic damage caps experience less out-migration of physicians than states that do not have these reforms. In addition, we find some evidence that joint and several liability reforms and patient compensation funds also impact the migration decisions of physicians.

Brain Drain and Health Workforce Distortions in Mozambique

IntroductionTrained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector.MethodsAn observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980–2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties.ResultsOf 723 qualifying physicians between 1980–2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector.DiscussionInternal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek to strengthen.

The “brain drain” problem: Migrating medical professionals and global health care

The global migration of physicians and nurses produces serious shortages in the developing world, exemplifying one of the ways that global capitalism sets up dynamics of surplus extraction from periphery to global wealth centers. This paper focuses specifically on the Ghanaian situation, and argues that an ethics of care framework offers a way of approaching the problem productively. Recognizing the various commitments and relationships that tie us together allows for a response that protects individual freedom while responding to the need to maintain adequate numbers of trained health-care workers.

Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan

BackgroundPhysician migration, also known as “brain drain,” results from a combination of a gap in the supply and demand in developed countries and a lack of job satisfaction in developing countries. Many push and pull factors are responsible for this effect, with media and internet playing their parts. Large-scale physician migration can pose problems for both the donor and the recipient countries, with a resulting reinforcement in the economic divide between developed and developing countries. The main objectives of our study were to determine the prevalence of migration intentions in medical undergraduates, to elucidate the factors responsible and to analyze the attitudes and practices related to these intentions.MethodsThis was a cross-sectional, observational, questionnaire-based study, conducted at Dow Medical College of Dow University of Health Sciences, Karachi, between January, 2012 and May, 2012. A total of 323 students responded completely. The questionnaire consisted of 3 sections, and was aimed at collecting demographic details, determining students’ migratory intentions, evaluating reasons for and against migration and assessing attitudes and practices of students related to these intentions.ResultsOut of 323 respondents, 195 wanted to pursue their careers abroad, giving a prevalence rate of 60.4% in our sample. United States was the most frequently reported recipient country. The most common reasons given by students who wished to migrate, in descending order, were: lucrative salary abroad followed by quality of training, job satisfaction, better way of life, relatives, more opportunities, better working environment, terrorism in Pakistan, harassment of doctors in Pakistan, desire to settle abroad, more competition in Pakistan, better management, peer pressure, longer working hours in Pakistan, religious reasons, parent pressure, political reasons and favoritism in Pakistan. A considerable number of respondents had already started studying for licensing examinations, and were also planning of gaining clinical experience in their desired country of interest.ConclusionPhysician migration is a serious condition that requires timely intervention from the concerned authorities. If considerable measures are not taken, serious consequences may follow, which may pose a threat to the healthcare system of the country.

わが国の産業医の平成14年から20年までの就退職数とその特徴

Recently, the number of occupational physicians has greatly increased compared to other types of physician in Japan, and the number of unfilled job vacancies remains high, suggesting a higher turnover of occupational physicians. Job turnover and seniority are important indices for measuring the balance of vacancies and applicants, as well as for improving occupational health services; however, job turnover and career moves of occupational physicians are currently not known. Based on a component model study of physicians, dentists and pharmacists, we made a component model of 4 levels (national, prefectural, urban, and municipal levels) and estimated the turnover and regional migration of occupational physicians. As a reference for the component models, we used the 2008/2006 cross-tabulation data of each type of physician published by the Ministry of Health, Labour and Welfare. The municipality level component model fitted the data best. The increase in occupational physicians for the 2 yr was 283-348, and the decrease was 202-222, indicating that 55-65% of occupational physicians quit their post within 2 yr. The propensity for short tenure is observed not only in occupational medicine, but also in emergency and rehabilitation medicine. It is suspected that 80% of new occupational physicians, except those graduating from the University of Occupational and Environmental Health, quit their positions within two years. This is a remarkably short tenure period compared to the 5.6 yr average seniority of physicians reported in the Basic Survey of Wage Structure. The reasons for the high job turnover of occupational physicians are thought to be unrelated to income or license renewal. We need to survey the actual reasons for the short tenure of occupational physicians to provide insights into lifetime education and career organization of occupational physicians.

The “brain drain” problem: Migrating medical professionals and global health care

The global migration of physicians and nurses produces serious shortages in the developing world, exemplifying one of the ways that global capitalism sets up dynamics of surplus extraction from periphery to global wealth centers. This paper focuses specifically on the Ghanaian situation, and argues that an ethics of care framework offers a way of approaching the problem productively. Recognizing the various commitments and relationships that tie us together allows for a response that protects individual freedom while responding to the need to maintain adequate numbers of trained health-care workers.

Portrayals of Global Health Worker Migration in Canadian Print News Media: Domestic Concerns vs. Global Awareness

The global migration of physicians and nurses has implications for health human resources in both source and recipient countries. Of particular concern to academics and policy experts is the “brain drain” of health professionals from under-resourced nations to developed countries, which promote immigration of physicians and nurses to solve their own health worker shortages. How does the general public in these destination countries understand and respond to concerns over migration and immigration of health professionals? This understanding is likely to be influenced in large part by how the issues are portrayed in the news media. News media treatment of this issue was explored by surveying news articles; newspaper columns/editorials; and op-ed pieces; and letters to the editor published in four prominent Canadian newspapers between May 2004 and January 2009, a time frame that included two federal elections in which physician immigration was highlighted as a political issue. Despite the prominence among academics of concern over the brain drain of physicians and nurses from developing countries to Canada and other Western nations, this issue received little attention in print news media discussions, which focused on domestic physician shortages and the role of international medical graduates in filling Canadian needs. While recent federal elections brought concerns about immigrant physicians into the political spotlight in Canada, they did so by focusing on Canadians' health care provision needs to the exclusion of promoting a broader, global awareness that the immigration of health professionals to developed nations such as Canada exacerbates global health disparities.

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan

BackgroundThe increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration.MethodA self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis.ResultsOf the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34).ConclusionAn alarming percentage of medical graduates from Lahore, Pakistan intend to migrate for post graduate training, mainly to United States. A significant proportion wished to stay in the host country either temporarily or indefinitely. Impact of residency abroad on future career, financial conditions of doctors, job opportunities and better working conditions were some of the motivating factors behind the migration.

The changing patterns of physician migration from Zimbabwe since 1990

PurposeThe paper seeks to investigate the leading causes of physician migration from Zimbabwe and to highlight the patterns of physician migration over the past‐two decades.Design/methodology/approachA mixed methods approach, involving a survey and interviews, was used to collect data for the study.FindingsThe paper demonstrates that personal networks, not recruitment agencies, are the main drivers of physician migration from the country. However, the importance of recruitment agencies as channels of information about job opportunities abroad has grown substantially over the last decade. The research findings suggest that Zimbabwe will continue losing physicians to other countries until economic and political stability has been restored in the country.Originality/valueBy highlighting the patterns and causes of physician migration from Zimbabwe, the paper makes a contribution to the implementation of policy measures aimed at retaining physicians in the country.

International medical graduates in the USA: a qualitative study on perceptions of physician migration

ObjectivesPhysician migration from low-income to high-income nations is a global concern. Despite the centrality of understanding the perspectives of international medical graduates (IMGs) who have experienced migration to understanding the...