Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians

Akl, Elie A.; Maroun, Nancy; Major, Stella; Chahoud, Bechara

doi:10.1186/1472-6963-7-49

Cited by 37 publications

(27 citation statements)

References 18 publications

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“…[7][8][9][10] International migration studies likewise usually derive their data from destination (high income) countries, and none has compared the rates of emigration with medical students' characteristics. [11][12][13][14][15][16][17] Nepal is an Asian country with a population of 28 million; its mountainous topography and poverty (annual gross domestic product $300 (£193; €245) per capita) pose barriers to adequate healthcare. According to WHO's statistics, Nepal ranks near the bottom of countries in the region, 18 and like many other nations it struggles with inequitable distribution of its health workers.…”

Section: Introductionmentioning

confidence: 99%

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college

Zimmerman

Shakya

Pokhrel³

et al. 2012

BMJ

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Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas.Design Observational cohort study.Setting Medical college registry, with internet, phone, and personal follow-up of graduates.Participants 710 graduate doctors from the first 22 classes ) of Nepal's first medical college, the Institute of Medicine. Main outcome measuresCareer practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student.Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal.Conclusions A cluster of medical students' characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy makers in medical education who are committed to producing doctors for underserved areas of their country could use this evidence to revise their entrance criteria for medical school. IntroductionDoctors tend to migrate from medically less well served areas to better served areas. This paradoxical flow occurs over a continuum that includes internal migration (often from rural to urban areas) and external migration (from low income to high income countries). Both result in adverse outcomes for patients in the areas of origin.1 2 In recent policy documents, the World Health Organization and others have issued calls to "build the evidence base" on retention of healthcare workers in underserved areas. [3][4][5][6] Existing retention studies, mainly from high income countries, report associations of rural upbringing and male sex with career practice in a rural setting. [7][8][9][10] International migration studies likewise usually derive their data from destination (high income) countries, and none has compared the rates of emigration with medical students' characteristics...

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Section: Introductionmentioning

confidence: 99%

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college

Zimmerman

Shakya

Pokhrel³

et al. 2012

BMJ

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“…An alarming percentage of students from Lebanese medical schools intend to migrate for postgraduate training, mainly to the USA, and only a minority intends to return directly to Lebanon after finishing training abroad. This is mainly due to the lack of financial incentives, political instability, or deficiencies in leading residency programmes 8 9…”

Section: Introductionmentioning

confidence: 99%

Prevalence of burnout syndrome among medical residents: experience of a developing country

Ashkar

Romani

Musharrafıeh

et al. 2010

Postgraduate Medical Journal

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“…Second, the intention to train abroad may not translate into actual abroad training or eventual migration. However, this is likely to be the case given the extent and the trend of the migration of Lebanese medical graduates in the past [9] and the fact that abroad training represents a critical step in the migration of physicians [13]. Third, the high percentage of students expressing an intention to train abroad (96%) probably reduced our power to show the significance of associations.…”

Section: Discussionmentioning

confidence: 98%

“…Indeed, Lebanon has the highest emigration factor in the Middle East and North Africa and the 7th highest in the World [8]. The United Sates (US) physician workforce, alone, included in 2004 about *Address correspondence to this author at the Department of Medicine, State University of New York at Buffalo ECMC-CC 142, 462 Grider St. Buffalo, NY 14215, USA; Tel: ++ 1 716-898-5793; Fax: ++1 716-898-3119; E-mail: elieakl@buffalo.edu 40% of Lebanese medical graduates of the preceding 25 years [9]. After adjusting for country population size, Lebanon ranked 2 nd as source country of international medical graduates practicing in the US [9].…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Lebanese Medical Students' Decisions to Train Abroad: Evaluation of a Conceptual Framework

Akl

Maroun²,

Li³

et al. 2012

TOPHJ

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Abstract:Objective: To evaluate a conceptual framework portraying the factors underlying the intentions of medical students to train abroad.Methods: Eligible subjects were students in the pre-final and final years of medical studies in Lebanon. A survey questionnaire based on the conceptual framework inquired about demographic and educational characteristics, influencing factors, and intentions to train abroad. We assessed each of the factors for its frequency, distribution, and association with the intention to train abroad.Results: Of 576 eligible students, 425 (74%) participated. The frequency of the framework factors varied from 16% to 94% and was the highest for factors related to training and professional career. The factors independently associated with the intention to train abroad related to residency training, concern with professional career and political conditions. The intention to train abroad was also associated with thinking that the general public considers doctors trained abroad as more qualified (OR=6.3; 95% CI=1.2-33.2); receiving information about abroad training from doctors trained or training abroad (OR= 9.7; 95% CI=1.7-56.6); having relatives or friends living abroad (OR=6.9; 95% CI=1.4-35.7); and witnessing residents traveling to retrain abroad (OR=22.2; 95% CI=4.5-111.1).Conclusions: Issues related to residency training, concerns about future career, and political conditions are the main motivators for Lebanese medical students to train abroad. The proposed conceptual framework provides a useful tool, but requires further evaluation.

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Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians

Cited by 37 publications

References 18 publications

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college

Medical students' characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal's first medical college

Prevalence of burnout syndrome among medical residents: experience of a developing country

Factors Influencing Lebanese Medical Students' Decisions to Train Abroad: Evaluation of a Conceptual Framework

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