Exploration of the potential causes for the migration of Lebanese medical graduates into the US physician workforce
Akl, Elie A.
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Background . The international migration of physicians is a global public health problem and a priority issue for international organizations such as the World Health Organization (WHO) and the World Trade Organization (WTO). Lebanon is a source country with the highest emigration factor in the Middle East and North Africa. Purpose . To describe the past and future trends and the characteristics of the migration of Lebanese medical graduates (LMGs) into the US physician workforce and to explore its potential causes. Study design . The three research methods were: (1) a registry analysis of the American Medical Association Physicians' Professional Data dataset (AMA-PPD); (2) a qualitative study including focus groups and semi-structured personal interviews of Lebanese medical students; and (3) a survey study of Lebanese medical students. Results . In 2004, there were 2,710 LMGs in the US constituting 0.3% of all active physicians and 1.3% of international medical graduates (IMGs). 40% of LMGs of the last 25 years were active in the US in 2004. Between 1978 and 2004 the number of total LMGs in the US increased by an average of 71 per year. The percentage of females was lower among LMGs (17%) compared with US medical graduates (USMGs) (26%) and IMGs (30%). Compared with USMGs and IMGs, LMGs were more likely to be board certified (OR=1.43; 95% CI=1.14 to 1.78 and OR=2.04; 95% CI=1.65 to 2.53 respectively). The intention of a Lebanese medical student to migrate is affected by a number of push and pull factors, following the push pull theory, related to the following dimensions: residency training, professional career, financial, political and social. One of the major factors affecting LMGs decision to migrate is how training abroad provides a competitive advantage in an oversaturated Lebanese job market. Additional factors include: repel factors abroad and retain factors in Lebanon; societal expectations; marketing of abroad training; and an established culture of migration. Ninety six percent of Lebanese medical students intend to travel abroad for specialty (78%) or subspecialty training (18%). The top 4 destination countries are the US (74%), France (12%), the UK (8%) and Canada (4%). Of those who intend to train abroad, 25% intend to return to Lebanon directly; 64% intend to return to after working abroad temporarily; and 11% intend to never return. Male sex was associated with staying abroad either temporarily or permanently after completing training. Conclusion . The migration of LMGs to the US has been worsening and will likely continue to worsen in the future. Gaining a competitive advantage in an oversaturated Lebanese job market is one of the major factors affecting LMGs decision to train abroad. Lebanese policy makers will need to set policies and develop strategies for both the retention of physicians and the return of migrant physicians.