World J Surg DOI 10.1007/s00268-014-2494-2
Shortage of Doctors, Shortage of Education Sayinthen Vivekanantham • Dushyanth Gnanappiragasam
Ó Socie´te´ Internationale de Chirurgie 2014
We read Hoyler et al.’s [1] article on the shortage of doctors in the developing world with interest. In certain developing countries, despite there being 24 % of the world’s health burden, there remains only 3 % of the world’s health workforce [2]. This mismatch arises in part due to the discrepancy between the supply and demand of healthcare workers, with emigration being a significant contributor [1]. With an increasing life expectancy, the incidence of surgically treatable conditions is increasing in developing countries [2]. As Hoyler et al. [1] outlined, strategies to overcome this deficit include analysis of data on migration trends. A study conducted on health professionals who emigrated from developing countries found that the most important factor for leaving was professional reasons [3]. ‘‘Push factors’’ include undefined career structures and limited intellectual stimulation; in addition, ‘‘pull factors’’ included abundant opportunities for gaining additional qualifications and experience [4]. We believe that among other initiatives to improve healthcare in developing countries, improving the quality of the educational infrastructure is extremely important and possibly central to not only creating a better-quality workforce, but also offering a stronger incentive for trainees not to migrate. This may include, but is not limited to, using financial aid to increase the number of places in
S. Vivekanantham (&) D. Gnanappiragasam Imperial College School of Medicine, Imperial College London, London SW7 2AZ, UK e-mail: [email protected] D. Gnanappiragasam e-mail: [email protected]
healthcare courses, improving training facilities within teaching and clinical settings, formalizing the training structures within the healthcare systems, and developing training programs in more rural areas. However, notably, training must be focused on the specific healthcare needs of different regions. Such strategies have already been utilized in certain parts of the world. One example includes the establishment of a medical degree focused on primary care in an attempt to increase the number of students that decide to join the primary care workforce (Universidae do Algarve, Portugal). The setup and outcome measures of these established courses could act as a template and validation for the development of translational courses in developing countries. Furthermore, access to educational resources from developed countries should be improved. The Health InterNetwork Access to Research Initiative has been successful in allowing developing countries to access the latest research articles. We believe that similar initiatives should focus on making educational resources from institutions open access also, especially for health courses, given the increasing availability of the internet in developing countries. This would help local health professionals within developing countries improve their own respective educational infrastructures. In recent years, financial aid initiatives have been focused on supplying material resources to developing countries, and the effectiveness of such strategies has been debated [5]. Greater sustainability might be achieved if some of these funds were directed to educational institutions in developed countries to provide openaccess resources to health professionals in developing countries. We hope that this will help developing countries overcome the ‘‘push’’ and ‘‘pull’’ factors causing the emigration of professionals while also improving the quality of the health workforce.
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World J Surg
References 1. Hoyler M, Finlayson SR, McClain CD, Meara JG, Hagander L (2014) Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature. World J Surg 38(2):269–280. doi:10.1007/s00268-013-2324-y 2. World Health Organization (2006) World Health Organization 2006—working together for health. Geneva: World Health Organ, pp. 209. pdf files are available at http://www.who.int/whr/2006/en/. Accessed 20 Jan 2014
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3. Hagander LE, Hughes CD, Nash K, Ganjawalla K, Linden A, Martins Y et al (2012) Surgeon migration between developing countries and the United States: train, retain, and gain from brain drain. World J Surg 37(1):14–23. doi:10.1007/s00268-012-1795-6 4. Pang T, Lansang MA, Haines A (2002) Brain drain and health professionals. BMJ 324(7336):499–500 5. Djankov S, Garcia-Montalvo J, Reynal-Querol M (2006) Does foreign aid help? Social Science Research Network (SSRN) paper 896550. Available at http://papers.ssrn.com/sol3/papers.cfm?ab stract_id=896550. Accessed 20 Jan 2014
Shortage of Doctors, Shortage of Education Sayinthen Vivekanantham • Dushyanth Gnanappiragasam
Ó Socie´te´ Internationale de Chirurgie 2014
We read Hoyler et al.’s [1] article on the shortage of doctors in the developing world with interest. In certain developing countries, despite there being 24 % of the world’s health burden, there remains only 3 % of the world’s health workforce [2]. This mismatch arises in part due to the discrepancy between the supply and demand of healthcare workers, with emigration being a significant contributor [1]. With an increasing life expectancy, the incidence of surgically treatable conditions is increasing in developing countries [2]. As Hoyler et al. [1] outlined, strategies to overcome this deficit include analysis of data on migration trends. A study conducted on health professionals who emigrated from developing countries found that the most important factor for leaving was professional reasons [3]. ‘‘Push factors’’ include undefined career structures and limited intellectual stimulation; in addition, ‘‘pull factors’’ included abundant opportunities for gaining additional qualifications and experience [4]. We believe that among other initiatives to improve healthcare in developing countries, improving the quality of the educational infrastructure is extremely important and possibly central to not only creating a better-quality workforce, but also offering a stronger incentive for trainees not to migrate. This may include, but is not limited to, using financial aid to increase the number of places in
S. Vivekanantham (&) D. Gnanappiragasam Imperial College School of Medicine, Imperial College London, London SW7 2AZ, UK e-mail: [email protected] D. Gnanappiragasam e-mail: [email protected]
healthcare courses, improving training facilities within teaching and clinical settings, formalizing the training structures within the healthcare systems, and developing training programs in more rural areas. However, notably, training must be focused on the specific healthcare needs of different regions. Such strategies have already been utilized in certain parts of the world. One example includes the establishment of a medical degree focused on primary care in an attempt to increase the number of students that decide to join the primary care workforce (Universidae do Algarve, Portugal). The setup and outcome measures of these established courses could act as a template and validation for the development of translational courses in developing countries. Furthermore, access to educational resources from developed countries should be improved. The Health InterNetwork Access to Research Initiative has been successful in allowing developing countries to access the latest research articles. We believe that similar initiatives should focus on making educational resources from institutions open access also, especially for health courses, given the increasing availability of the internet in developing countries. This would help local health professionals within developing countries improve their own respective educational infrastructures. In recent years, financial aid initiatives have been focused on supplying material resources to developing countries, and the effectiveness of such strategies has been debated [5]. Greater sustainability might be achieved if some of these funds were directed to educational institutions in developed countries to provide openaccess resources to health professionals in developing countries. We hope that this will help developing countries overcome the ‘‘push’’ and ‘‘pull’’ factors causing the emigration of professionals while also improving the quality of the health workforce.
123
World J Surg
References 1. Hoyler M, Finlayson SR, McClain CD, Meara JG, Hagander L (2014) Shortage of doctors, shortage of data: a review of the global surgery, obstetrics, and anesthesia workforce literature. World J Surg 38(2):269–280. doi:10.1007/s00268-013-2324-y 2. World Health Organization (2006) World Health Organization 2006—working together for health. Geneva: World Health Organ, pp. 209. pdf files are available at http://www.who.int/whr/2006/en/. Accessed 20 Jan 2014
123
3. Hagander LE, Hughes CD, Nash K, Ganjawalla K, Linden A, Martins Y et al (2012) Surgeon migration between developing countries and the United States: train, retain, and gain from brain drain. World J Surg 37(1):14–23. doi:10.1007/s00268-012-1795-6 4. Pang T, Lansang MA, Haines A (2002) Brain drain and health professionals. BMJ 324(7336):499–500 5. Djankov S, Garcia-Montalvo J, Reynal-Querol M (2006) Does foreign aid help? Social Science Research Network (SSRN) paper 896550. Available at http://papers.ssrn.com/sol3/papers.cfm?ab stract_id=896550. Accessed 20 Jan 2014
