Surgeon migration between developing countries and the United States: train, retain, and gain from brain drain.
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.
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. lars.hagander@childrens.harvard.edu
Lars E
LE
Hagander
Christopher D
CD
Hughes
Katherine
K
Nash
Karan
K
Ganjawalla
Allison
A
Linden
Yolanda
Y
Martins
Kathleen M
KM
Casey
John G
JG
Meara
D000368:Aged; D003906:Developing Countries; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013043:Specialties, Surgical / Q000193:education; D011795:Surveys and Questionnaires; D014481:United States