Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Glob Health Res Policy. 2023 Jun 27;8(1):23. doi: 10.1186/s41256-023-00307-0.
The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the "brain drain", has been a topic of discussion in global health spheres for years. With the call to decolonize global health in mind, and considering that West Africa, as a region, is a main source of physicians emigrating to HICs, this rapid review aims to synthesize the reasons for, and implications of, the brain drain, as well as recommendations to mitigate physician emigration from West African countries to HICs.
A literature search was conducted on PubMed, EMBASE and The Cochrane Library. Main inclusion criteria were the inclusion of West African trained physicians' perspectives, the reasons and implications of physician emigration, and recommendations for management. Data on the study design, reasons for the brain drain, implications of brain drain, and proposed solutions to manage physician emigration were extracted using a structured template. The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles.
A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs' recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs.
The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.
从低收入和中等收入国家（LMICs）向高收入国家（HICs）移民的医生，俗称“人才流失”，多年来一直是全球卫生领域讨论的话题。考虑到全球卫生去殖民化的呼吁，以及西非作为一个主要的医生移民到 HICs 的地区，本快速审查旨在综合“人才流失”的原因和影响，以及减轻西非国家医生移民到 HICs 的建议。
在 PubMed、EMBASE 和 The Cochrane Library 上进行了文献检索。主要纳入标准包括纳入西非培训医生的观点、医生移民的原因和影响，以及管理建议。使用结构化模板提取关于研究设计、人才流失原因、人才流失影响以及管理医生移民建议的数据。使用 Hawker 工具作为偏倚风险评估工具来评估纳入的文章。
共有 17 篇文章纳入最终审查。医生移民的原因包括工作条件和薪酬差、职业机会有限、生活水平低和社会政治动荡。医生移民的影响包括加剧医生与人口比例低和医疗保健系统削弱。建议包括制定限制 HICs 从 LMICs 招聘的国际政策、HICs 为 LMICs 补偿的途径、投资于相互医学教育的合作，以及纳入在 HICs 工作的医生的虚拟或短期咨询服务，为 LMICs 的患者提供护理。
医学人才流失是一个全球卫生公平问题，需要 LMICs 和 HICs 合作实施可能的解决方案。未来的研究应研究政策和创新方法，以让 HICs 和 LMICs 共同参与管理人才流失。
