Postgraduate training abroad and migration intentions of medical doctors and students in Gaza: a cross-sectional survey.

BACKGROUND

The migration of medical professionals is a global health challenge, as emigration can weaken local health systems. Factors contributing towards this problem include inadequate job opportunities, low job satisfaction, and difficulty in accessing or substandard residency training. Longstanding political instability in Gaza, occupied Palestinian territory, has affected the health-care system. For instance, medical doctors working in governmental hospitals have received less than half of their salaries every few months for the past 10 years. We explored the intentions of medical professionals and students to do their residency training abroad and their career plans afterwards.

METHODS

Between September and November, 2018, we surveyed medical doctors and students in Gaza about their migration intentions. We sent emails and used a social media platform to invite potential participants to complete a validated, online, self-administered structured questionnaire administered via Qualtrics (Provo, UT, USA). Questions were included about sociodemographic, educational, and practice characteristics, intention to train abroad, preferred destination, reasons for and barriers to training abroad, and their intentions of returning to Palestine after training. We used Microsoft Excel 2016 to analyse the results.

FINDINGS

Of 148 medical doctors and students who responded to our survey, 116 completed the questionnaire and were included in the analysis. 75 (65%) participants were men, 90 (78%) were aged 21-35 years, and 70 (60%) were single. Most participants were either residents in training (n=48 [41%]), interns (n=12 [10%]), or medical students in their final year (n=33 [28%]). 65 (56%) participants preferred surgical specialities, 33 (28%) medical specialties, and the remainder preferred academic research (four [3%]) and family medicine (14 [12%]). 106 participants intended to travel abroad. The top four destination countries were the UK (n=40 [35%]), the USA (n=20 [17%]), Germany (n=20 [17%]), and Australia (n=12 [10%]). 93 (80%) intended to travel for specialty training and 12 (10%) for subspecialty training. 34 (32%) of 106 intended to return to Palestine after working abroad for more than 10 years, 15 (14%) for 5-10 years, 25 (24%) for less than 5 years, and 14 (13%) directly after training, whereas 18 (17%) intended never to return to Palestine. Financial expenses related to travelling, institution examinations, and visa applications were the major barriers to training abroad (listed by 57 [49%] participants). Most respondents (n=83 [72%]) felt that society expects clinicians to be trained abroad and that they are more qualified than those trained in Palestine (n=74 [64%]).

INTERPRETATION

A very high proportion of the medical doctors and students we surveyed intended to train abroad and return to Palestine, although a minority intended never to return. Our findings should be interpreted cautiously because of the possibility of selection bias (ie, those intending to migrate were more likely to respond to our survey and because intention might not translate to action). Qualitative research is needed to obtain a greater understanding of the key influences on intention to migrate to inform strategies to retain the health-care workforce.

FUNDING

None.