Tankwanchi Akhenaten Benjamin Siankam, Vermund Sten H, Perkins Douglas D
Program in Community Research and Action, Department of Human and Organizational Development, Peabody College of Education and Human Development, Vanderbilt University, Nashville, Tennessee, United States of America.
Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America.
PLoS One. 2015 Apr 13;10(4):e0124734. doi: 10.1371/journal.pone.0124734. eCollection 2015.
Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.
数据监测是世界卫生组织《国际卫生人员招聘全球行为准则》的一项关键建议，该准则是2010年5月通过的一个全球框架，旨在解决资源有限国家的卫生人力留存问题以及国际移民的伦理问题。利用2013年美国医学协会医师主档案（AMA主档案）中出生于非洲且在非洲接受教育的医生的数据，我们监测了《世界卫生组织行为准则》通过后撒哈拉以南非洲（SSA）医生进入美国医师队伍的情况。根据观测数据，我们用线性回归法预测到2015年的情况，并用GPS Visualizer和ArcGIS绘制了移民医生的所在地。2013年AMA主档案识别出11787名活跃的出生于SSA的医生，仅占2013年美国医师队伍的1.3%（11787/940456），但超过了世界卫生组织报告的34个SSA国家的医生总数（N = 11519）。我们估计，15.7%（1849/11787）的人是在《行为准则》通过后进入美国医师队伍的。与2002年（N = 7830）和2010年（N = 9938）《行为准则》实施前的估计相比，SSA移民进入美国医师队伍的年录取率在上升。这种上升在很大程度上是由于在SSA以外地区医学院就读的出生于SSA的医生数量不断增加，这代表着移民年轻化的趋势。预测估计表明，2015年美国医师队伍中将有12846名SSA移民医生，其中超过2900名将是《行为准则》实施后的新招募人员。大多数SSA移民医生都在美国大城市地区定居，而这些地区的医师密度已经是最高的。《行为准则》并没有减缓SSA到美国的医生移民。为了阻止医生“人才外流”，必须激励在SSA的专业执业，并通过主要针对早期职业（年龄≤35岁）的SSA医生的更有力干预措施，降低美国移民的吸引力。
