Unwanted Foreign Doctors: What is not Being Said about the Brain Drain

Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs

PURPOSE

Approximately 25% of practicing physicians in the United States are graduates of medical schools in other countries; they are called international medical graduates (IMGs). Their transition into the U.S. health care system may be difficult and challenging. This study sought to identify the similarities and differences between IMGs and U.S. medical graduates (USMGs) working together in residency training programs.

METHOD

In 2006, the authors conducted a cross-sectional survey study of house officers (interns and residents) at six internal medicine (IM) community-based residency programs in Baltimore, Maryland. The survey asked about demographics, relocation for residency training, practice experience, and career plans and included four previously validated instruments: the Iowa Fatigue Scale, Cohen's Perceived Stress Scale, Rosenberg's Self-Esteem Scale, and the Personal Growth Scale.

RESULTS

Of 225 potential house officers, 176 (78%) responded. In multivariable modeling, independent characteristics that differentiated IMGs from USMGs were that IMGs had (1) a native language other than English (odds ratio [OR] 18.3, 95% CI: 5.8-57.3), (2) less debt (<$50K) upon graduation from medical school (OR 7.3, 2.5-21.2), and (3) experiences practicing medicine before residency training (OR 41.02, 1.6-1017). With modeling to control for these three differences, the authors found IMGs to have lower fatigue (OR 2.7; 1.2-6.0), higher self-esteem (OR 3.0; 1.2-7.5), and greater personal growth scores (OR 3.6; 1.6-8.2).

CONCLUSIONS

Differences exist between the IMGs and USMGs who are working together in community-based IM residency training programs. Considering such differences may help educators and program directors trying to support and train this diverse cadre of trainees.

Operation hernia: humanitarian hernia repairs in Ghana

Ghana has a high incidence of inguinal hernias and the healthcare system is unable to deliver an adequate repair rate. This results in morbidity and mortality and has a knock-on effect on the local economy. A project has been set up to try and reduce the burden of these hernias by establishing Africa's first Hernia Centre. This is supported by structured visits by European surgeons to the centre. In October 2006, a team of four surgeons, two specialist registrars, one hernia nurse specialist, and three nurses was assembled in order to open the Hernia Centre, which will provide a base for the delivery of hernia services in the West of Ghana. A 2-year teaching programme has been formulated, tailored to the needs of local surgeons and nurses, with the aim of developing an integrated team that will initially deliver up to 50 hernia repairs each month. It is planned that the centre will be supported by structured periodic visits from surgeons and nurses based in Plymouth, the European Hernia Society, and any other volunteers wishing to support the link.

Migration, medical education, and health care: a view from Pakistan

PURPOSE

To review physician flows in Pakistan in the contexts of capacity to educate and provide for anticipated health needs.

METHOD

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.

Operation Hernia to Ghana

Inguinal hernia repair and Caesarian section are the two most commonly occurring operations in Africa. Trained surgeons are few, distances between hospitals are large and strangulated hernia is the most common cause of intestinal obstruction. Numerous deaths and cases of permanent disability occur because patients with inguinal hernias requiring elective or urgent surgery are not properly cared for, or they do not actually reach hospital. Operation Hernia was a humanitarian mission between the European Hernia Society and the Plymouth-Takoradi (Ghana) Link conceived specifically to treat and teach groin hernia surgery in the Western region of Ghana.