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Cited by 119Global Health Workforce IssuesGlobal Health and SurgeryMigration and Labor Dynamics

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

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Tankwanchi, Akhenaten Benjamin Siankam, Özden, Çağlar, Vermund, Sten H.·2013·PLoS Medicine
DOI 10.1371/journal.pmed.1001513PMC PMC3775724
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Abstract

BACKGROUND: The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States. METHODS AND FINDINGS: We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs. CONCLUSION: Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.

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Figure 1 Subgroups of Sub-Saharan African migrant physicians identified in the US physician workforce. Data source: American Medical Association [115].
Figure 1 Subgroups of Sub-Saharan African migrant physicians identified in the US physician workforce. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 2 Sub-Saharan African migrant physicians who completed medical school in 2000 or later and are present in the US physician workforce. Data source: American Medical Association [115].
Figure 2 Sub-Saharan African migrant physicians who completed medical school in 2000 or later and are present in the US physician workforce. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 3 Sub-Saharan African-based institutions with the largest numbers of medical graduates appearing in the US physician workforce. Data source: American Medical Association [115].
Figure 3 Sub-Saharan African-based institutions with the largest numbers of medical graduates appearing in the US physician workforce. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 4 Growth over time of migration among Sub-Saharan African-trained medical graduates appearing in the US physician workforce. Data source: American Medical Association [115]. As reflected by the exponential equation and the determination coefficient (R2) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, and reflects the rapid emigration growth of sub-Saharan African trained medical graduates. The increase in emigration is particularly significant in cohort 3, which mainly coincides with the implementation period of the SAPs.
Figure 4 Growth over time of migration among Sub-Saharan African-trained medical graduates appearing in the US physician workforce. Data source: American Medical Association [115]. As reflected by the exponential equation and the determination coefficient (R2) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, and reflects the rapid emigration growth of sub-Saharan African trained medical graduates. The increase in emigration is particularly significant in cohort 3, which mainly coincides with the implementation period of the SAPs.CC BY · PubMed Central
Figure 5 Length of service provided to the home country by each graduation cohort of Sub-Saharan African-trained medical graduates before migration to the United States. Note: Based on n = 6,421 complete graduation and residency records. Estimated mean year of time between graduation and entry in the United States: 6.4 y (SD = 4.6). Data source: American Medical Association [115].
Figure 5 Length of service provided to the home country by each graduation cohort of Sub-Saharan African-trained medical graduates before migration to the United States. Note: Based on n = 6,421 complete graduation and residency records. Estimated mean year of time between graduation and entry in the United States: 6.4 y (SD = 4.6). Data source: American Medical Association [115].CC BY · PubMed Central
Figure 6 Emigration trends among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile. Data source: American Medical Association [115].
Figure 6 Emigration trends among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 7 Trends in primary specialty among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile. Data source: American Medical Association [115].
Figure 7 Trends in primary specialty among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 8 Graduation trends among Sub-Saharan African-born graduates of medical schools located in the United States. Data source: American Medical Association [115]. As reflected by the exponential equation and the determination coefficient (R2) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, reflecting a rapid numerical increase of sub-Saharan African natives graduating from medical school in the US.
Figure 8 Graduation trends among Sub-Saharan African-born graduates of medical schools located in the United States. Data source: American Medical Association [115]. As reflected by the exponential equation and the determination coefficient (R2) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, reflecting a rapid numerical increase of sub-Saharan African natives graduating from medical school in the US.CC BY · PubMed Central
Figure 9 American medical schools with the highest number of Sub-Saharan African-born graduates practicing in the United States. *Note: No information was provided as to which campus of the University of Illinois these sub-Saharan African-born medical graduates attended. Data source: American Medical Association [115].
Figure 9 American medical schools with the highest number of Sub-Saharan African-born graduates practicing in the United States. *Note: No information was provided as to which campus of the University of Illinois these sub-Saharan African-born medical graduates attended. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 10 Foreign medical schools located outside Sub-Saharan Africa with the highest number of Sub-Saharan African-born medical graduates practicing in the United States. Data source: American Medical Association [115].
Figure 10 Foreign medical schools located outside Sub-Saharan Africa with the highest number of Sub-Saharan African-born medical graduates practicing in the United States. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 11 Graduation and residency trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa. Data source: American Medical Association [115].
Figure 11 Graduation and residency trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa. Data source: American Medical Association [115].CC BY · PubMed Central
Figure 12 Recent demographic trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa and completing residency in the United States in 2000 or later. Data source: American Medical Association [115].
Figure 12 Recent demographic trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa and completing residency in the United States in 2000 or later. Data source: American Medical Association [115].CC BY · PubMed Central

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Citations

Cites

Show all 89 references

Research works printed but not linked: 12

  1. Alkire S, Chen L (2005) Medical exceptionalism in international migration: should doctors and nurses be treated differently? Tamas K, Palme J, editors. Globalizing migration regimes: new challenges to transnational cooperation. Burlington: Ashgate Publishing Company. pp. 100–117.
  2. American Medical Association - How the data elements of the AMA physician Masterfile are collected, maintained, and verified. Available: http://www.ama-assn.org/ama1/pub/upload/mm/eProfiles/mm/primarysource.pdf. Accessed 14 February 2013.
  3. American Medical Association – More about AMA database licensing. Available: http://www.ama-assn.org/ama/pub/about-ama/physician-data-resources/ama-database-licensing/more-about-ama-database-licensing.page? Accessed 17 February 2013.
  4. P Curtis, 2005, GMC launches inquiries into private medical schools, The Guardian
  5. J West, 2005, NTLA orders ‘bogus’ St. Luke University closed, Liberian Observer
  6. The Structural Adjustment Participatory Review International Network (2004) Structural adjustment: The SAPRI report. The policy roots of economic crisis, poverty and inequality. London & New York: Zed Books. 242 p.
  7. Cornia AG, Jolly R, Stewart F (1987) Adjustment with a human face: country case studies. Oxford: Clarendon Press. 328 p.
  8. TL Friedman, 2010, Start-ups, not bailouts, The New York Times
  9. H Goodall, 2008, More foreign science and engineering grad students flock to U.S., new survey finds, Chron High Educ
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  12. S Brill, 2013, Bitter pill: why medical bills are killing us, Time Magazine

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Metadata

Authors
Tankwanchi, A. B. S., Özden, Ç., & Vermund, S. H.
Affiliations
  • Vanderbilt University (US)
  • World Bank (US)
Corresponding author
Tankwanchi, Akhenaten Benjamin Siankam
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2013-09-17
Volume
10
Issue
9
Pages
e1001513
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1001513
PMC
PMC3775724
OpenAlex
W2150437981
Cited by
117
References
89
Citations by year
2026: 5 · 2025: 6 · 2024: 10 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 12 · 2019: 5 · 2018: 4 · 2017: 10 · 2016: 19 · 2015: 11 · 2014: 15 · 2013: 2
FWCI
24.31
Type
journal article
Language
en
Update notices
correction (2013-12-16)
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Funders
  • World Bank Group
  • Vanderbilt University
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Social Sciences › Sociology and Political Science › Migration and Labor Dynamics
Keywords
physician emigration, brain drain, sub-Saharan Africa, physician migration, structural adjustment programs, residency training, migration trends, Liberia, Nigeria, South Africa, Ghana, Ethiopia, Sudan, health workforce policy
MeSH terms
Adult, American Medical Association, Demography, Emigration and Immigration, Foreign Medical Graduates, Humans, Internship and Residency, Medicine, Middle Aged, Physicians, Schools, Medical, United States, Africa South of the Sahara, Internationality

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