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: [email protected]
D. Gnanappiragasam
e-mail: [email protected]
123
World J Surg
DOI 10.1007/s00268-014-2494-2
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
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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