South Africa and the Surgical Diaspora—A Hub for Surgical Migration and Training

Abstract

Background The shortage of trained surgeons, anesthesiologists, and obstetricians is a major contributor to the unmet need for surgical care in low- and middle-income countries, and the shortage is aggravated by migration to higher-income countries. Methods We performed a cross-sectional observational study, combining individual-level data of 43,621 physicians from the Health Professions Council of South Africa with data from the registers of 14 high-income countries, and international statistics on surgical workforce, in order to quantify migration to and from South Africa in both absolute and relative terms. Results Of 6670 surgeons, anesthesiologists, and obstetricians in South Africa, a total of 713 (11%) were foreign medical graduates, and 396 (6%) were from a low- or middle-income country. South Africa was an important destination primarily for physicians originating from low-income countries; 2% of all surgeons, anesthesiologists, and obstetricians from low- and middle-income countries were registered in South Africa, and 6% in the other 14 recipient countries. A total of 1295 (16%) South African surgeons, anesthesiologists, and obstetricians worked in any of the 14 studied high-income countries. Conclusion South Africa is an important regional hub for surgical migration and training. A notable proportion of surgical specialists in South Africa were medical graduates from other low- or middle-income countries, whereas migration out of South Africa to high-income countries was even larger.

A cross‐sectional survey on surgeon retention in the COSECSA region after specialist training: Have things changed?

“…1 Between 1973 and 2013, COSECSA had surgeon retention rates of 85.1% in their country of training, 88.3% in their region of training, and 93.4% on the African continent. 6 The challenge of health worker out-migration represents a siphon from the trained pool [7][8][9][10] and current trainee retention rates in the COSECSA region are not known. A clear understanding of the current distribution of COSECSA graduates is necessary to inform future efforts of the College and to guide surgical healthcare and training policies in sub-Saharan Africa.…”