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International Migration of Physicians

The international migration of physicians has been the focus of numerous research endeavors, both within the United States and elsewhere. For many countries, especially those located in developing regions, emigration has contributed to the decline in available health care workers, including nurses and physicians. This lack of service providers can, in turn, have an enormous negative impact on the health of local populations. For other countries, such as Australia, Canada, the United Kingdom, and the United States, a shortage of local training resources has led to an undersupply of health professionals, yielding numerous opportunities for internationally trained workers who wish to emigrate. Although some nations may purposefully educate more physicians than are needed locally, others have recruited from nations that can scarcely afford to lose any of their limited human resources. From a population health perspective, the resulting global imbalance in professional workforces needs to be addressed. To do this, one must determine the scope of the problem, then gather data to better appreciate the specific push and pull factors underlying migration.

FAIMER is actively involved in research aimed at quantifying medical migration and understanding the factors that drive the movement of physicians throughout the world. In Africa, for example, FAIMER Institute Fellows have collected detailed information on local educational infrastructure problems that may contribute to the emigration of physicians and nurses. In addition, through various surveys, FAIMER is gathering detailed information on why health care workers leave particular countries, where they intend to go, and what, if any, incentives might be effective in keeping them where they are needed. The chart below summarizes several push and pull factors affecting the migration of physicians in Sub-Saharan Africa.

Push and Pull Factors Underlying Migration of Sub-Saharan African Physicians

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Physician Migration
From: “Factors Affecting Physician Migration from Africa,” presented by Danette McKinley at the 2007 Annual International Conference on Global Health, sponsored by the Global Health Council, Washington, DC. Partners: Vanessa Burch (PHIL 2001), University of Cape Town; David Cameron (PHIL 2005), University of Pretoria; Francois Cilliers (PHIL 2004), Stellenbosch University; Sarah Kiguli (PHIL 2005) & Samuel Luboga (PHIL 2003), Makerere University; Ahuka Longombe (PHIL 2003), Université de Kisangani; Charles Mkony (PHIL 2003), Muhimbili University; Esther Ofoegbu (PHIL 2005), University of Nigeria; Boaz Otieno-Nyunya (PHIL 2001), Moi University; Jacqueline van Wyk (PHIL 2004), University of Kwazulu-Natal

FAIMER collaborates with groups and individuals interested in the global migration of health care workers and its effect on local patient care, physician training, and workforce policies and projections. For example, in collaboration with the Johnson & Johnson Family of Companies, FAIMER collected data to measure the educational capacity constraints of African medical and nursing schools. Putting aside the complex issues related to nurse and physician migration, African institutions are simply not producing sufficient numbers of these health professionals. Determining how training opportunities can be expanded most efficiently is a necessary step toward increasing the supply of health care workers in this region.

Selected FAIMER staff and Fellow publications on this topic are listed below. FAIMER staff members are listed in bold; Fellows are listed with their institute and fellowship year. Click on an article’s title to view its abstract listing in the PubMed database.

Hallock JA, McKinley DW, Boulet JR. Migration of doctors for undergraduate medical education. Medical Teacher. 2007;29(2&3):98-105.

Longombe AO (PHIL 2003), Burch V (PHIL 2001), Luboga S (PHIL 2003), Mkony C (PHIL 2003), Olapade-Olaopa E (PHIL 2002), Otieno-Nyunya B (PHIL 2001), Afolabi B (PHIL 2002), Nwobodo E (PHIL 2004), Kiguli S (PHIL 2005), Burdick WP, Boulet JR, Morahan PS. Research on medical migration from sub-Saharan medical schools: usefulness of a feasibility process to define barriers to data collection and develop a practical study. Education for Health. 2007;20(1):27.

Norcini JJ, Mazmanian PE. Physician migration, education, and health care. Journal of Continuing Education in the Health Professions. 2005;25(1):4-7.

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[last update: April 13, 2010]