Shortage of Doctors, Shortage of Education

Sayinthen Vivekanantham • Dushyanth Gnanappiragasam

� Societe 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

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 val-

idation for the development of translational courses in

developing countries.

Furthermore, access to educational resources from

developed countries should be improved. The Health In-

terNetwork Access to Research Initiative has been suc-

cessful 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 coun-

tries. This would help local health professionals within

developing countries improve their own respective educa-

tional infrastructures. In recent years, financial aid initia-

tives have been focused on supplying material resources to

developing countries, and the effectiveness of such strate-

gies has been debated [5]. Greater sustainability might be

achieved if some of these funds were directed to educa-

tional institutions in developed countries to provide open-

access resources to health professionals in developing

countries. We hope that this will help developing countries

overcome the ‘‘push’’ and ‘‘pull’’ factors causing the emi-

gration of professionals while also improving the quality of

the health workforce.

S. Vivekanantham (&) � D. Gnanappiragasam

Imperial College School of Medicine, Imperial College London,

London SW7 2AZ, UK

e-mail: sayinthen.vivekanantham@gmail.com

D. Gnanappiragasam

e-mail: dushyanth.gnanappiragasam09@imperial.ac.uk

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World J Surg

DOI 10.1007/s00268-014-2494-2

References

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(2014) Shortage of doctors, shortage of data: a review of the global

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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

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

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