Early career retention of Malawian medical graduates: a retrospective cohort study

Abstract

ObjectiveThere have been longstanding concerns over Malawian doctors migrating to high‐income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector.MethodsWe obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi‐squared tests were employed to investigate relationships by graduation year and gender.ResultsWe traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54–2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61–0.86, P < 0.0001).ConclusionsWhile most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work.

The use of specialty training to retain doctors in Malawi: A discrete choice experiment

“…We had initially planned to use COM graduate lists along with Ministry of Health routine data to identify eligible participants, however these were quickly found to be out of date. We therefore complemented these routine data sources with up-to-date data on participants obtained through social media: an innovative process described elsewhere (Mandeville et al., 2014b). As our focus was on national retention policies, non-Malawian citizens and those who had completed any undergraduate training outside of Malawi were excluded (n = 20).…”

“…Concerns over continued health worker emigration, however, led to the implementation of a six-year emergency programme in 2005 that included a 52% salary increase for doctors (Management Sciences for Health, 2010). Despite this, a study tracing COM graduates from 2006 to 2012 found that the odds of junior doctors being outside Malawi and the public sector increased with time after graduation, with most doctors outside Malawi in specialty training (Mandeville et al., 2014b). While enrolment to medical school tripled under the emergency programme, this was not matched by funding for specialty training (Management Sciences for Health, 2010).…”

Malawian impressions of expatriate physicians: A qualitative study

“…However, although many Malawian students express a desire to leave Malawi, most recent Malawian graduates were found to stay in Malawi to practice, with most working for the COM, government, and non-governmental organisations. 10,13,21 Nonetheless, little is known about whether those who have experiences abroad are more likely to leave the country for work, and more research is needed on the future career endeavours of the sub-population of trainees and physicians who have had experiences abroad. Additionally, global health programmes can use our findings to optimise their roles in nurturing a clinical environment that promotes local empowerment and self-sustainability.…”

“…13,14 From 2006 to 2014, the graduating class increased from 15 to 56 students, with plans for continued growth. 13,15 The COM offers postgraduate Master of Medicine degrees in internal medicine, paediatrics, general surgery, ophthalmology, orthopaedics, obstetrics and gynaecology, psychiatry, anaesthesia and intensive care, nephrology, and emergency medicine.…”

“…13,14 From 2006 to 2014, the graduating class increased from 15 to 56 students, with plans for continued growth. 13,15 The COM offers postgraduate Master of Medicine degrees in internal medicine, paediatrics, general surgery, ophthalmology, orthopaedics, obstetrics and gynaecology, psychiatry, anaesthesia and intensive care, nephrology, and emergency medicine. 11,14 We identified our initial interview candidates through mixed sampling methods; we used criterion sampling among COM fourth-year medical students with clinical experience, and we approached interns, registrars, and faculty from across a breadth of specialties to obtain broad perspectives.…”