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- Lantz, Adam, et al.
(author)
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Measuring the migration of surgical specialists
- 2020
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In: Surgery (United States). - : Elsevier BV. - 0039-6060 .- 1532-7361. ; 168:3, s. 550-557
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Journal article (peer-reviewed)abstract
- Background: The lack of access to essential surgical care in low-income countries is aggravated by emigration of locally-trained surgical specialists to more affluent regions. Yet, the global diaspora of surgeons, obstetricians, and anesthesiologists from low-income and middle-income countries has never been fully described and compared with those who have remained in their country of origin. It is also unclear whether the surgical workforce is more affected by international migration than other medical specialists. In this study, we aimed to quantify the proportion of surgical specialists originating from low-income and middle-income countries that currently work in high-income countries. Methods: We retrieved surgical workforce data from 48 high-income countries and 102 low-income and middle-income countries using the database of the World Health Organization Global Surgical Workforce. We then compared this domestic workforce with more granular data on the country of initial medical qualification of all surgeons, anesthesiologists, and obstetricians made available for 14 selected high-income countries to calculate the proportion of surgical specialists working abroad. Results: We identified 1,118,804 specialist surgeons, anesthesiologists, or obstetricians from 102 low-income and middle-income countries, of whom 33,021 (3.0%) worked in the 14 included high-income countries. The proportion of surgical specialists abroad was greatest for the African and South East Asian regions (12.8% and 12.1%). The proportion of specialists abroad was not greater for surgeons, anesthesiologists, or obstetricians than for physicians and other medical specialists (P = .465). Overall, the countries with the lowest remaining density of surgical specialists were also the countries from which the largest proportion of graduates were now working in high-income countries (P = .011). Conclusion: A substantial proportion of all surgeons, anesthesiologists, and obstetricians from low-income and middle-income countries currently work in high-income countries. In addition to decreasing migration from areas of surgical need, innovative strategies to retain and strengthen the surgical workforce could involve engaging this large international pool of surgical specialists and instructors.
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| 2. |
- Lantz, Adam
(author)
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Strengthening the global surgical workforce: Aspects of access, migration and quality
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background. Over five billion people worldwide lack access to safe and affordable surgery and anesthesia care when required. There is a critical unmet need for surgical care, especially in low-income and middle-income countries (LMICs). The shortage of surgical providers is one of the most influential barriers to receiving surgical care, and the maldistribution is aggravated by doctors emigrating to more affluent regions, where many physicians also nurture an interest in working abroad.Aims. The aims of this thesis were: I. To quantify the global supply and distribution of surgeons, anesthesiologists and obstetricians by country and to build a World Health Organization (WHO) surgical workforce database. II. To calculate high-income countries’ (HICs) dependency on recruiting surgeons, anesthesiologists and obstetricians from LMICs. III. To measure the proportion of surgeons, anesthesiologists and obstetricians from LMICs now working in an HIC. IV. To quantify and analyze the surgical workforce in South Africa who were educated in another LMIC, and South African surgical specialists who had emigrated to an HIC. V. To investigate how LMICs perceive short-term visits from surgeons, anesthesiologists and obstetricians from an HIC. VI. To investigate Swedish orthopedic surgeons’, anesthesiologists’ and obstetricians’ experience of, interest in, barriers to, and perceived value of international clinical work, and to assess whether there were any differences based on gender, specialty and seniority.Methods. To address these aims we: I. Collected existing and new data on the number and the distribution of surgical specialists globally. II. Collected details of the number of surgical specialists and data on their country of initial medical qualification who were now working in an HIC. III. Combined data on the number and the distribution of surgical specialists globally with the number of surgical specialists and their country of initial medical qualification now working in an HIC. IV. Collected data on the number of surgical specialists in South Africa and their country of initial medical qualification. V. Analyzed studies involving visiting surgical teams from HICs working in LMICs. VI. Surveyed all Swedish orthopedic surgeons, anesthesiologists and obstetricians. Results. There were two million specialist surgeons, anesthesiologists and obstetricians worldwide. Low-income countries had 0.7 such providers per 100,000 population (interquartile range [IQR]: 0.5–1.9), compared with 56.9 (IQR: 32.0–85.3) in HICs. HICs’ dependency on surgeons, anesthesiologists and obstetricians with a medical degree from an LMIC was 12%. Half of all surgeons, anesthesiologists, and obstetricians who had emigrated from an LMIC to an HIC came from a country in workforce crisis. In low-income countries and lower-middle income countries, the proportion of surgical specialists abroad was 6.0% and 11.0%, respectively, compared with 1.2% and 3.0% in upper-middle income countries and HICs, respectively. Of all surgical specialists currently working in South Africa, 6% were educated in another LMIC. At least 16% of South African surgical specialists had emigrated to work in an HIC. Surgical short-term visits from doctors who underwent their training in an HIC are insufficiently described from the perspective of stakeholders in LMICs. Swedish doctors have a broad experience of, and interest in, operating abroad, with differences based on gender, specialty, and seniority. Multiple personal and institutional benefits of working abroad were reported, with significant differences found between doctors from LMICs compared to those from HICs. Participation is limited primarily by family commitments at home, followed by difficulties in finding the right contacts, medico-legal challenges, and fear of not having the right competence.Significance. Most of the world’s surgical patients are either served by non-physicians or non-specialists, or else they are not treated at all. This research has provided data on the global surgical workforce with respect to access, migration and quality. Surgical workforce density has been acknowledged as a standard national health system indicator by the WHO, the World Bank, and The Lancet Commission on Global Surgery. It is currently used to track Sustainable Development Goal 3.8.1.
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| 3. |
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| 4. |
- Rudolfson, Niclas, et al.
(author)
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South Africa and the Surgical Diaspora-A Hub for Surgical Migration and Training
- 2023
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In: World Journal of Surgery. - 1432-2323. ; 47:7, s. 1684-1691
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Journal article (peer-reviewed)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.
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| 5. |
- Velin, Lotta, et al.
(author)
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Systematic review of low-income and middle-income country perceptions of visiting surgical teams from high-income countries
- 2022
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In: BMJ Global Health. - : BMJ Publishing Group. - 2059-7908. ; 7:4
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Research review (peer-reviewed)abstract
- Background The shortage of surgeons, anaesthesiologists and obstetricians in low-income and middle-income countries (LMICs) is occasionally bridged by foreign surgical teams from high-income countries on short-term visits. To advise on ethical guidelines for such activities, the aim of this study was to present LMIC stakeholders perceptions of visiting surgical teams from high-income countries. Method We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in November 2021, using standardised search terms in PubMed/Medline (National Library of Medicine), EMBASE (Elsevier), Global Health Database (EBSCO) and Global Index Medicus, and complementary hand searches in African Journals Online and Google Scholar. Included studies were analysed thematically using a meta-ethnographic approach. Results Out of 3867 identified studies, 30 articles from 15 countries were included for analysis. Advantages of visiting surgical teams included alleviating clinical care needs, skills improvement, system-level strengthening, academic and career benefits and broader collaboration opportunities. Disadvantages of visiting surgical teams involved poor quality of care and lack of follow-up, insufficient knowledge transfers, dilemmas of ethics and equity, competition, administrative and financial issues and language barriers. Conclusion Surgical short-term visits from high-income countries are insufficiently described from the perspective of stakeholders in LMICs, yet such perspectives are essential for quality of care, ethics and equity, skills and knowledge transfer and sustainable health system strengthening. More in-depth studies, particularly of LMIC perceptions, are required to inform further development of ethical guidelines for global surgery and support ethical and sustainable strengthening of LMIC surgical systems.
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