2013年-世界发展银行全球_Physician_Emigration_from_Sub-Saharan_Africa_to_the_United_States___Analysis_of_the_2011_AMA_Physician_Masterfile_28页_2mb

Summary of "Physician Emigration from Sub-Saharan Africa to the United States: Analysis of the 2011 AMA Physician Masterfile"

Core Content

This study analyzes the emigration of physicians from Sub-Saharan Africa (SSA) to the United States using data from the 2011 American Medical Association Physician Masterfile (AMA-PM). It highlights the significant impact of this migration on the health workforce of SSA countries and explores the factors driving this trend.

Main Findings

• Total SSA-trained Physicians in the US (2011): 10,819 physicians were born or trained in 28 SSA countries.

  • SSA-trained: 7,370 (68%)
  • US-trained: 2,126 (20%)
  • Trained elsewhere: 1,323 (12%)

• Active Physicians: 96% of the total (10,377) were active physicians under 70 years of age.

• Migration Trends:

  • Migration increased from 2002 to 2011 in all but South Africa.
  • Nigeria: +1,113 (increase >50%)
  • Ghana: +243 (>50% increase)
  • Ethiopia: +274 (>100% increase)
  • Sudan: +244 (>200% increase)
  • Liberia: 77% of its estimated physicians were in the US in 2011.

• Average Time in the US: SSA-trained physicians have been in the US for an average of 18 years.

  • They practiced for 6.5 years before migrating to the US.
  • Nearly half emigrated during the implementation of structural adjustment programs (1984-1999).

• Key Destination Countries:

  • The US is a major destination for SSA-trained physicians, alongside the UK and other high-income nations.
  • The UK had the largest proportion of SSA medical emigrants, while the US had a significant share.
  • The US consistently reported more African physicians than the UK when using "country of medical education" as a criterion.

• Factors Influencing Migration:

  • Limited medical education capacity in SSA.
  • Widespread communicable and non-communicable diseases.
  • Civil wars and political instability in some countries (e.g., Liberia).
  • Many SSA-born physicians trained abroad and now practice in the US.

• Remittances and Impact:

  • Migrant physicians send remittances to their home countries, which can support families but do not contribute significantly to health workforce development.
  • The loss of skilled health professionals leads to a significant drain on SSA's health systems, potentially causing system collapse and loss of lives.

• Economic and Health Implications:

  • SSA accounts for about 14% of the world's population but only 3% of global health professionals.
  • By 2005, 17.5% of SSA-born health professionals had emigrated.
  • The World Health Report 2006 notes that the loss of health workers in fragile systems can result in "fatal flows" rather than mere brain drain or gain.

Key Information

• Data Sources:

  • WHO Global Health Workforce Statistics.
  • 2011 AMA-PM data.
  • Other sources like the OECD, ECFMG, and US Census Bureau.

• Methodology:

  • The study used a proxy for the year of immigration by subtracting 5 years from the year of residency completion.
  • It analyzed the migration of physicians from SSA countries, focusing on those born or trained in the region.
  • Outliers, such as physicians from questionable medical schools (KIMSOK, SCCOM, SLSOM), were excluded.

• Statistical Analysis:

  • Migration proportion (p) and emigration percentage growth rate (r) were calculated.
  • Time spent in the US was estimated using current age and year of entry.
  • The study also compared birth country data with other variables to assess missing data patterns.

• Limitations:

  • Incomplete data on birth country and residency completion dates.
  • Potential inaccuracies in the AMA-PM, including undercounting and overcounting.
  • The study excluded older physicians (over 70 years) and North African countries due to different health contexts.

Conclusion

Physician emigration from SSA to the US is increasing, with most countries experiencing substantial losses. Without comprehensive policies to address this trend, the US will continue to be a leading destination for SSA-trained physicians, exacerbating the brain drain and negatively impacting the health systems of origin countries. The study emphasizes the need for policy interventions to mitigate the consequences of this migration.