Measuring the migration of surgical specialists

Lantz, Adam; Holmer, Hampus; Finlayson, Samuel R.G.; Ricketts, Thomas C.; Watters, David; Gruen, Russell L.; Johnson, Walter D.; Hagander, Lars

doi:10.1016/j.surg.2020.04.014

Cited by 11 publications

(20 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…18 There has been a focus in the literature pertaining to global surgery on the migration of specialists from low income countries to high income countries. 19 There is also a comprehensive body of literature which describes the patterns of decision-making around specialist training preferences from medical students through to resident medical officers, and issues of retention and attrition of specialist trainees, with a smaller group of literature looking at these questions specifically in relation to surgical specialties. [20][21][22][23] But the research team found no published scientific studies looking into the decision-making process or experience of general surgeons who have completed their specialist training and are seeking to secure an SMO role in the New Zealand context.…”

Section: Discussionmentioning

confidence: 99%

How do New Zealand‐trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

Espiner

MacCormick

Weston

2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background In the context of increasing shortages in the New Zealand medical specialist workforce, this research seeks to answer the question ‘Are we effectively retaining our New Zealand‐trained general surgeons?’ Methods Semi‐structured interviews were undertaken with 16 general surgeons. Participants work in New Zealand and internationally. Interviews were transcribed, coded and themed. Thematic analysis was used to interpret the findings. Results This research finds that we are failing to effectively retain New Zealand‐trained general surgeons through haphazard workforce planning and a lack of transparent recruitment processes. General surgeons who choose to take their first SMO role overseas are pushed to do so due to a lack of certainty about job opportunities in New Zealand, bullying, and relative ease of negotiation for job composition and conditions at international hospitals. General surgeons who take their first SMO role in New Zealand feel that securing a job is down to luck, existing relationships with influential people in surgical departments and timing. Conclusion The failure to retain New Zealand‐trained general surgeons in the New Zealand specialist workforce is amenable to improvements in workforce planning, improved coordination between clinical and administrative leadership in DHBs, and better career development support for trainees prior to receiving their FRACS and embarking on post‐fellowship subspecialist training. Further research into the experiences of trainees and SMOs in general surgery and other surgical subspecialties is required to build a complete picture of the path from trainee to SMO, and areas where interventions could improve retention of New Zealand‐trained general surgeons.

show abstract

Section: Discussionmentioning

confidence: 99%

How do New Zealand‐trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

Espiner

MacCormick

Weston

2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…African surgeons often migrate to HICs where there are more opportunities for career advancement, more sophisticated training and practice, better political stability, efficient social and health systems, and higher remuneration for work [ 100 – 103 ], and Africa’s specialist SAOs constitute the highest proportion practicing abroad globally (67·9%) [ 104 ]. Trauma provider brain drain occurs to higher income regions as well as within the continent.…”

Section: Search Resultsmentioning

confidence: 99%

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Alayande,

Chu,

Jumbam

et al. 2022

Curr Trauma Rep

View full text Add to dashboard Cite

Purpose of Review Sub-Saharan Africa is a diverse context with a large burden of injury and trauma-related deaths. Relative to high-income contexts, most of the region is less mature in prehospital and facility-based trauma care, education and training, and trauma care quality assurance. The 2030 Agenda for Sustainable Development recognizes rising inequalities, both within and between countries as a deterrent to growth and development. While disparities in access to trauma care between the region and HICs are more commonly described, internal disparities are equally concerning. We performed a narrative review of internal disparities in trauma care access using a previously described conceptual model. Recent Findings A broad PubMed and EMBASE search from 2010 to 2021 restricted to 48 sub-Saharan African countries was performed. Records focused on disparities in access to trauma care were identified and mapped to de Jager’s four component framework. Search findings, input from contextual experts, comparisons based on other related research, and disaggregation of data helped inform the narrative. Only 21 studies were identified by formal search, with most focused on urban versus rural disparities in geographical access to trauma care. An additional 6 records were identified through citation searches and experts. Disparity in access to trauma care providers, detection of indications for trauma surgery, progression to trauma surgery, and quality care provision were thematically analyzed. No specific data on disparities in access to injury care for all four domains was available for more than half of the countries. From available data, socioeconomic status, geographical location, insurance, gender, and age were recognized disparity domains. South Africa has the most mature trauma systems. Across the region, high quality trauma care access is skewed towards the urban, insured, higher socioeconomic class adult. District hospitals are more poorly equipped and manned, and dedicated trauma centers, blood banks, and intensive care facilities are largely located within cities and in southern Africa. The largest geographical gaps in trauma care are presumably in central Africa, francophone West Africa, and conflict regions of East Africa. Disparities in trauma training opportunities, public–private disparities in provider availability, injury care provider migration, and several other factors contribute to this inequity. National trauma registries will play a role in internal inequity monitoring, and deliberate development implementation of National Surgical, Obstetrics, and Anesthesia plans will help address disparities. Human, systemic, and historical factors supporting these disparities including implicit and explicit bias must be clearly identified and addressed. Systems approaches, strategic trauma policy frameworks, and global and regional coalitions, as modelled by the Global Alliance for Care of the Injured and the Bellagio group, are key. Inequity in access can be reduced by prehospital initiatives, as used in Ghana, and community-based insurance, as modelled by Rwanda. Summary Sub-Saharan African countries have underdeveloped trauma systems. Consistent in the narrative is the rural-urban disparity in trauma care access and the disadvantage of the poor. Further research is needed in view of data disparity. Recognition of these disparities should drive creative equitable solutions and focused interventions, partnerships, accompaniment, and action.

show abstract

“…Another well-known issue refers to the local workforce migration toward developed countries. Lantz et al estimated than 12.8% and 12.1% of surgical specialists who graduated, respectively, in Africa and South East Asia work in HICs ( 21 ). This percentage is estimated to be even higher when adding up medical students to the number of newly-graduated doctors or consultants.…”

Section: Causes Behind the Difficult Access To Surgical Care In Lmicsmentioning

confidence: 99%

Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges

Pulvirenti

Gortan

Cumba³

et al. 2022

Front. Pediatr.

View full text Add to dashboard Cite

Low-middle income countries (LMICs) are currently experiencing an important population growth, leading to a substantial raise in the number of children living in those areas. As a consequence, the existing gap between the need for surgical and anesthetic care and the available therapeutic options will increase. To overcome this, an improvement in the available expertise, infrastructures, and supplies will be mandatory. The implementation of educational and training programs for local healthcare providers should be a top priority. Alongside, the population's awareness on the necessity to seek for medical care should be deployed, together with an eased access to health facilities. Based on the existing literature and our 20-years' experience in humanitarian missions, our article aims to investigate the status of pediatric surgery in LMICs, and the role of western aids in the implementation of this ever-increasing field of expertise.

show abstract

Measuring the migration of surgical specialists

Cited by 11 publications

References 24 publications

How do New Zealand‐trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

How do New Zealand‐trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

Disparities in Access to Trauma Care in Sub-Saharan Africa: a Narrative Review

Pediatric Surgery and Anesthesia in Low-Middle Income Countries: Current Situation and Ethical Challenges

Contact Info

Product

Resources

About