High-end physician migration from India

Abstract

Objective To examine the relation between the quality of physicians and migration among alumni of All India Institute of Medical Sciences (AIIMS), New Delhi, India over the period 1989-2000. Methods In a retrospective cohort study, data on graduates of AIIMS were collected from entrance exam qualifier lists, the AIIMS alumni directory, convocation records, the American Medical Association and informal alumni networks. The data were analysed by use of 2x2 contingency tables and logistic regression models. Findings Nearly 54% of AIIMS graduates during 1989-2000 now reside outside India. Students admitted under the general category are twice as likely to reside abroad (95% confidence interval: 1.53-2.99) as students admitted under the affirmative-action category. Recipients of multiple academic awards were 35% more likely to emigrate than non-recipients of awards (95% confidence interval: 1.04-1.76). Multivariate analyses do not change these basic conclusions. Conclusion Graduates from higher quality institutions account for a disproportionately large share of emigrating physicians. Even within high-end institutions, such as AIIMS, better physicians are more likely to emigrate. Interventions should focus on the highly trained individuals in the top institutions that contribute disproportionately to the loss of human resources for health. Our findings suggest that affirmative-action programmes may have an unintended benefit in that they may help retain a subset of such personnel.

Private sector contributions and their effect on physician emigration in the developing world

“…About 11% of physicians practising in the United Kingdom and 5% of those practising in the United States of America were trained in India. 14,25 India is the country from which the largest number of physicians of any given nationality living in OECD countries have emigrated.…”

“…12 Physicians in low-and middle-income countries often emigrate because of the poor incomes and inadequate resources available in their home countries and the better professional prospects and higher standards of living available to them abroad. 13,14 There is considerable recruitment of such physicians by high-income countries. 15 Of the physicians working in Australia in 1999, Canada in 2002, the United Kingdom of Great Britain and Northern Ireland in 2002 and the United States of America in 2004, 23-28% were immigrants, mostly from Asia, the Caribbean and sub-Saharan Africa; India alone accounted for nearly 60 000 of the physicians.…”

Should Medical Education Fight International Brain Drain?

“…The migration of physicians to certain specialties or to wealthier nations illustrates the interplay between patients' access to care and physicians' personal interests and alerts policymakers to the fact that physicians and other health workers often allow income and lifestyle considerations to determine their choice of the "greenest pasture" [1][2][3][4][5][6][7][8]. Using the United States as an example, medical students are not seeking primary care residencies despite shortage of primary care physicians but are seeking residencies such as emergency medicine, anesthesiology, and radiology that favor income and lifestyle [8].…”

“…Health worker migration is a major contributor to shortages [1][2][3][4][5][6]. Migration includes within-country migration-especially pronounced among physicians-where health care professionals move from rural to urban areas.…”

“…India is said to be the biggest exporter of physicians; Indian physicians account for 5 percent and 10 percent of American and British physicians, respectively [5]. In one Indian medical school, the All India Institute of Medical Sciences, 54 percent of graduates reside outside India [1]. In fact, some medical schools view the migration of graduates with pride, believing it is a testament to the quality of education.…”