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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 160-167
DOI: 10.1055/s-0043-1778086
Research Article

Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan

Muhammad Shakir 
1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
,
Ahmed Altaf 
1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
,
Hammad Atif Irshad 
2   Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
,
Muhammad Ali Akbar Khan
2   Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
,
Syed Ather Enam
1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
› Institutsangaben Funding None.
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Abstract

Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes.

Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis.

Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan (p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association (p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals.

Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.

Keywords

migration intention - brain drain - trainees - fellowship - neurosurgery

Ethics Approval

Our study was approved by Aga Khan University Ethical Review Committee.


Consent for Publication

All authors have approved the results, reviewed the manuscript, and consented for publication.


Data Availability Statement

Datasets are available from the corresponding author upon reasonable request.


Authors' Contributions

M.S. and A.A. conceptualized the study and designed the methodology for the study. H.A.I., and M.A.A.K. contributed significantly to the analysis and interpretation of the data. H.A.I. contributed significantly to data collection and data acquisition. M.A.A.K. wrote the initial manuscript and H.A.I., A.A., and A.E. made final edits to the manuscript. All authors reviewed the final manuscript and approved its submission for publication.


Supplementary Material



Publikationsverlauf

Artikel online veröffentlicht:
10. Mai 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Docquier F, Lohest O, Marfouk A. Brain Drain in Developing Countries. 2007 . Accessed November 28, 2023 at: https://econpapers.repec.org/RePEc:ctl:louvec:2007004
    PubMedGoogle Scholar
  • 2 Adovor E, Czaika M, Docquier F, Moullan Y. Medical brain drain: how many, where and why?. J Health Econ 2021; 76: 102409
    CrossrefPubMedGoogle Scholar
  • 3 Nadir F, Sardar H, Ahmad H. Perceptions of medical students regarding brain drain and its effects on Pakistan's socio-medical conditions: a cross-sectional study. Pak J Med Sci 2023; 39 (02) 401-403
    CrossrefPubMedGoogle Scholar
  • 4 Meo SA, Sultan T. Brain drain of healthcare professionals from Pakistan from 1971 to 2022: evidence-based analysis. Pak J Med Sci 2023; 39 (04) 921-925
    PubMedGoogle Scholar
  • 5 Imran N, Azeem Z, Haider II, Bhatti MR. Brain drain: a harsh reality. International migration of pakistani medical graduates. J Postgrad Med Inst. 2011 ;26(1 SE-Original Article). Accessed November 28, 2023 at: https://jpmi.org.pk/index.php/jpmi/article/view/1206
    PubMedGoogle Scholar
  • 6 Hossain N, Shah N, Shah T, Lateef SB. Physicians' migration: perceptions of Pakistani medical students. J Coll Physicians Surg Pak 2016; 26 (08) 696-701
    PubMedGoogle Scholar
  • 7 Zafar SN, McQueen KAK. Surgery, public health, and Pakistan. World J Surg 2011; 35 (12) 2625-2634
    CrossrefPubMedGoogle Scholar
  • 8 Shamim MS, Tahir MZ, Godil SS, Kumar R, Siddiqui AA. A critical analysis of the current state of neurosurgery training in Pakistan. Surg Neurol Int 2011; 2: 183
    CrossrefPubMedGoogle Scholar
  • 9 Javed S, Pahwa B, Chaurasia B. Pakistan signatory to global neurosurgery. Brain Spine 2022; 3: 101710
    CrossrefPubMedGoogle Scholar
  • 10 Ali NU, Shaikh Y, Sharif S, Amin F. The challenges in neurosurgery training in a third world country. World Neurosurg 2021; 152: 19-23
    CrossrefPubMedGoogle Scholar
  • 11 Dean AGSKSM. OpenEpi;Open Source Epidemiologic Statistics for Public Health, Version. 2013 . Accessed November 28, 2023 at: http://www.openepi.com/Menu/OE_Menu.htm
    PubMedGoogle Scholar
  • 12 Hagopian A, Thompson MJ, Fordyce M, Johnson KE, Hart LG. The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain. Hum Resour Health 2004; 2 (01) 17
    CrossrefPubMedGoogle Scholar
  • 13 Mullan F. The metrics of the physician brain drain. N Engl J Med 2005; 353 (17) 1810-1818
    CrossrefPubMedGoogle Scholar
  • 14 Talati JJ, Syed NA. Surgical training programs in Pakistan. World J Surg 2008; 32 (10) 2156-2161
    CrossrefPubMedGoogle Scholar
  • 15 Ali NUA, Ali SM, Sharif S, Amin F. Benchmarking of neurosurgery training in Pakistan. Asian J Neurosurg 2021; 16 (02) 300-306
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 16 Ali FS, Zuberi BF, Rasheed T, Shaikh MA. Why doctors are not satisfied with their job-current status in tertiary care hospitals. Pak J Med Sci 2019; 35 (01) 205-210
    PubMedGoogle Scholar
  • 17 Sheikh A, Naqvi SHA, Sheikh K, Naqvi SHS, Bandukda MY. Physician migration at its roots: a study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Global Health 2012; 8 (01) 43
    CrossrefPubMedGoogle Scholar
  • 18 Khan AS. People struggling to make ends meet amid rising cost of living. DAWN January 3, 2023
    Google Scholar
  • 19 Kao AC, Jager AJ, Koenig BA. et al. Physician perception of pay fairness and its association with work satisfaction, intent to leave practice, and personal health. J Gen Intern Med 2018; 33 (06) 812-817
    CrossrefPubMedGoogle Scholar
  • 20 Kato Y, Liew BS, Sufianov AA. et al. Review of global neurosurgery education: horizon of neurosurgery in the developing countries. Chin Neurosurg J 2020; 6 (01) 19
    CrossrefPubMedGoogle Scholar
  • 21 Balouch MS, Balouch MM, Balouch MS, Qayyum W, Zeb Z. Career aspirations of junior doctors in Pakistan: exploring reasons behind the brain drain. J Ayub Med Coll Abbottabad 2022; 34 (03) 501-506
    CrossrefPubMedGoogle Scholar
  • 22 Saqib SU, Memon AH, Saleem O, Shariff A. Current standards of postgraduate surgical education and training in Pakistan: time to bridge the gaps in lieu of national necessity. J Pak Med Assoc 2021; 71 (01) S56-S60
    Google Scholar
  • 23 Bakhshi SK, Waqas M, Alam MM, Shamim MS, Qadeer M. Neurosurgery training in Pakistan: follow-up survey and critical analysis of national training programmes. J Pak Med Assoc 2016; 66 (10) S75-S77
    Google Scholar
  • 24 Fava A, Gorgoglione N, De Angelis M, Esposito V, di Russo P. Key role of microsurgical dissections on cadaveric specimens in neurosurgical training: setting up a new research anatomical laboratory and defining neuroanatomical milestones. Front Surg 2023; 10: 1145881
    CrossrefPubMedGoogle Scholar
  • 25 Agha RA, Fowler AJ. The role and validity of surgical simulation. Int Surg 2015; 100 (02) 350-357
    CrossrefPubMedGoogle Scholar
  • 26 Oliveira LM, Figueiredo EG. Simulation training methods in neurological surgery. Asian J Neurosurg 2019; 14 (02) 364-370
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 27 Misau YA, Al-Sadat N, Gerei AB. Brain-drain and health care delivery in developing countries. J Public Health Africa 2010; 1 (01) e6
    CrossrefPubMedGoogle Scholar
  • 28 Akl EA, Maroun N, Major S. et al. Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Soc Sci Med 2007; 64 (06) 1278-1284
    CrossrefPubMedGoogle Scholar
  • 29 Epstein NE. Morbidity and mortality conferences: their educational role and why we should be there. Surg Neurol Int 2012; 3 (Suppl. 05) S377-S388
    CrossrefPubMedGoogle Scholar
  • 30 Waqas M, Siddiqui UT, Shamim MS. Follow-up bibliometric analysis of neurosurgical publications from Pakistan and institutional comparison with other countries using h-Index and i-10 Index. Asian J Neurosurg 2019; 14 (01) 126-130
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Javeed F, Abbas A, Ahmed W, Rehman L, Afzal A. Critical assessment of various neurosurgery training programs of Pakistan. Turk Neurosurg 2022; 32 (04) 555-559
    PubMedGoogle Scholar
  • 32 Sarpong K, Fadalla T, Garba DL. et al. Access to training in neurosurgery (Part 1): Global perspectives and contributing factors of barriers to access. Brain Spine 2022; 2: 100900
    CrossrefPubMedGoogle Scholar
  • 33 Kejela S, Tiruneh AG. Determinants of satisfaction and self-perceived proficiency of trainees in surgical residency programs at a single institution. BMC Med Educ 2022; 22 (01) 473
    CrossrefPubMedGoogle Scholar
  • 34 Zaed I, Jaaiddane Y, Chibbaro S, Tinterri B. Burnout among neurosurgeons and residents in neurosurgery: a systematic review and meta-analysis of the literature. World Neurosurg 2020; 143: e529-e534
    CrossrefPubMedGoogle Scholar
  • 35 Lambert TW, Smith F, Goldacre MJ. Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation. J R Soc Med 2018; 111 (01) 18-30
    CrossrefPubMedGoogle Scholar