title: Migration, medical education, and health care: a view from Pakistan.
abstract: OBJECTIVE
  To review physician flows in Pakistan in the contexts of capacity to educate and provide for anticipated health needs.
  
  
  METHODS
  Literature review was used to refine estimates and assumptions about physician supply and demand. Net physician supply was calculated from data on physician inflows and estimates of migration and other causes of physician loss. Projections of anticipated needs up to 2020 were calculated, assuming different levels of physician need or demand. Reasons for emigration were extracted from interviews, questionnaires, and reports; health indicators and migration figures were obtained from literature and Web sites.
  
  
  RESULTS
  Approximately 74,000 physicians were practicing in Pakistan in 2005. Annually, local medical schools and international medical graduate certification provide 5,400 physicians, soon to reach 6,800; 1,150 physicians emigrate; and an estimated 570 physicians stop practicing for various reasons. The current ratio (0.473) of physicians to 1,000 population is inadequate to maintain the nation's health. Future Physician Workforce Shortages (PWSs) for Pakistan range between 57,900 and 451,102 physicians in 2020, depending on assumptions about future need.
  
  
  CONCLUSIONS
  Pakistan cannot meet its needs for health care given the current levels of production and dependency on physicians in the organization of the system. Although outmigration contributes to the problem, it is the growing demand for health care from increases in population; adverse conditions that generate ill-health; and increasing expectations that dramatically increase the PWSs. The anticipated shortfall in Pakistan reflects a global pattern. Definition of physician roles and improvement of standards through refined assessment require serious consideration.
authors.affiliation: Aga Khan University, Karachi, Pakistan. jamsheer.talati@aku.edu
authors.forename: Jamsheer J
authors.initials: JJ
authors.lastname: Talati
authors.forename: Gregory
authors.initials: G
authors.lastname: Pappas
mesh_terms: D002568:Certification; D003906:Developing Countries; D004501:Education, Medical; D004641:Emigration and Immigration / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D014943:Global Health; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data / Q000639:trends*; D006280:Health Workforce / Q000639:trends*; D006801:Humans; D007391:International Cooperation; D008297:Male; D008507:Medically Underserved Area; D019982:Organizational Case Studies; D010154:Pakistan; D010820:Physicians / Q000600:supply & distribution*; D011158:Population Growth