title: 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.
abstract: OBJECTIVE
  We analyzed the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries.
  
  
  METHODS
  We used a cross-section of 141 countries that lost emigrating physicians to the 4 major destinations: the United States, Canada, Australia, and the United Kingdom. For each source country, we defined physician migration density as the number of migrant physicians per 1000 population practicing in any of the 4 major destination countries.
  
  
  RESULTS
  Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician (r=0.42, P< .001), nurse (r=0.27, P=.001), and public health (r=0.48, P=.001) workforce densities and more medical schools (r=0.53, P<.001).
  
  
  CONCLUSIONS
  Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.
authors.affiliation: Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. o.a.arah@amc.uva.nl
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.forename: Uzor C
authors.initials: UC
authors.lastname: Ogbu
authors.forename: Chukwudi E
authors.initials: CE
authors.lastname: Okeke
mesh_terms: D001315:Australia; D002170:Canada; D004641:Emigration and Immigration / Q000706:statistics & numerical data* / Q000639:trends; D014943:Global Health; D006801:Humans; D007182:Income; D016014:Linear Models; D010820:Physicians / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006113:United Kingdom; D014481:United States