Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany

Medicolegal analysis of physical violence toward physicians in Egypt

This study analyzed physical violence against physicians in Egypt from a medicolegal perspective. 88%, 42%, and 13.2% of participants were exposed to verbal, physical, and sexual violence. Concerning the tools of violence, 75.2% of attackers used their bodies. Blunt objects (29.5%), sharp instruments (7.6%), and firearm weapons (1.9%) were used. The commonest manners of attacks were pushing/pulling (44.8%), throwing objects (38.1%), and fists (30.5%). Stabbing (4.8%) and slashing (2.9%) with sharp instruments were also reported. Traumas were mainly directed towards upper limbs (43.8%), trunks (40%), and heads (28.6%). Considering immediate effects, simple injuries were reported that included contusions (22.9%), abrasions (16.2%), and cut wounds (1.9%). Serious injuries included firearm injuries (4.8%), internal organs injuries (3.8%), fractures (2.9%), and burns (1.9%). Most (90.5%) of injuries healed completely, whereas 7.6% and 1.9% left scars and residual infirmities, respectively. Only 14.3% of physicians proceeded to legal action. The current study reflects high aggression, which is disproportionate to legal actions taken by physicians. This medicolegal analysis could guide protective measures for healthcare providers in Egypt. In addition, a narrative review of studies from 15 countries pointed to violence against physicians as a worldwide problem that deserves future medicolegal analyses.

Understanding why oral health professionals migrate: A qualitative investigation of Iranian dentists who have moved to Canada (Oral health professionals' migration)

BACKGROUND

The migration of health professionals from Low- and Middle-Income Countries (LMICs) to High-Income countries (HICs) is an ongoing phenomenon that has been accelerating with globalisation. While there has been growing research around the migration of physicians and nurses, there is less understanding of the motives surrounding the migration of dentists, and even less about their migration from specific countries.

OBJECTIVES

This qualitative study explores the migration motivations of Iranian dentists who have moved to Canada.

METHODS

Semi-structured interviews of 18 Iranian-trained dentists in Canada were conducted to obtain information about their motives for migration. Interviews were coded and categorised into themes using qualitative thematic analysis.

RESULTS

Motivations to migrate were grouped into four analytical areas: socio-political; economic; professional; and personal. An inverse relationship was identified between the strongest motives to migrate and the topics respondents were least comfortable discussing. Socio-political-related motives were predominant with respondents focusing on their dissatisfaction with the social ethos and restrictions on personal freedom within Iran.

CONCLUSION

Country-specific context is critical to fully understand health professional migration; in particular, the dynamics and interplay between socio-political, economic, and professional/personal factors within the home country. While Iranian dentists' motives to migrate have some similarities to other health professionals who migrated from Iran, and dentists from other countries, differences need to be considered to fully understand migration patterns.

The relationship between unemployment anxiety, job satisfaction and migration attitude among the next generation of Turkish nurses: A cross-sectional study

BACKGROUND

The global nursing shortage is complex and multifaceted. Despite the policy of increasing the number of nurses, concerns about the sustainability of the nursing workforce in Turkey continue.

AIM

To evaluate the relationship between unemployment anxiety, job satisfaction, and migration attitudes among Turkish nursing candidates.

METHODS

A cross-sectional study was conducted with 1100 nursing candidates between April and June 2022. The data gathered from the "Personal Form, Job Satisfaction, and Brain Drain Attitudes Scale" were analyzed using logistic regression and decision tree analysis.

RESULTS

Of the participants, 67.1% were female, and the mean age was 22.6 ± 1.7 years. Being male (OR = 1.317, 95% Cl 0.994-1.743) having a low income (OR = 1.754, 95% Cl 1.334-2.306), feeling insecure about the future (OR = 2.340, 95% Cl 1.312-4.175), expecting a lower wage than desired (OR = 2.015, 95% Cl 1.132-3.586), and employment precariousness (OR = 1.786, 95% Cl 1.355-2.353) increase the possibility of experiencing high unemployment anxiety. On the other hand, family support for living abroad (OR = 0.579, 95% CI 0.408-0.821) and job satisfaction (OR = 0.799, 95% CI 0.692-0.921) decrease unemployment anxiety (p < 0.05). According to the results of the decision tree analysis, the host country's pull factors are the best predictors of the nursing candidates' intention to work abroad as nurses (p < 0.05).

CONCLUSION

The increasing prevalence of unemployment anxiety and migration tendencies among nursing candidates requires the evaluation of policies aimed at increasing the number of nursing graduates in Turkey.

Drivers of health workers' migration, intention to migrate and non-migration from low/middle-income countries, 1970-2022: a systematic review

BACKGROUND

The migration of healthcare workers (HWs) from low/middle-income countries (LMICs) is a pressing global health issue with implications for population-level health outcomes. We aimed to synthesise the drivers of HWs' out-migration, intention to migrate and non-migration from LMICs.

METHODS

We searched Ovid MEDLINE, EMBASE, CINAHL, Global Health and Web of Science, as well as the reference lists of retrieved articles. We included studies (quantitative, qualitative or mixed-methods) on HWs' migration or intention to migrate, published in either English or French between 1 January 1970 and 31 August 2022. The retrieved titles were deduplicated in EndNote before being exported to Rayyan for independent screening by three reviewers.

RESULTS

We screened 21 593 unique records and included 107 studies. Of the included studies, 82 were single-country studies focusing on 26 countries, while the remaining 25 included data from multiple LMICs. Most of the articles focused on either doctors 64.5% (69 of 107) and/or nurses 54.2% (58 of 107). The UK (44.9% (48 of 107)) and the USA (42% (45 of 107)) were the top destination countries. The LMICs with the highest number of studies were South Africa (15.9% (17 of 107)), India (12.1% (13 of 107)) and the Philippines (6.5% (7 of 107)). The major drivers of migration were macro-level and meso-level factors. Remuneration (83.2%) and security problems (58.9%) were the key macro-level factors driving HWs' migration/intention to migrate. In comparison, career prospects (81.3%), good working environment (63.6%) and job satisfaction (57.9%) were the major meso-level drivers. These key drivers have remained relatively constant over the last five decades and did not differ among HWs who have migrated and those with intention to migrate or across geographical regions.

CONCLUSION

Growing evidence suggests that the key drivers of HWs' migration or intention to migrate are similar across geographical regions in LMICs. Opportunities exist to build collaborations to develop and implement strategies to halt this pressing global health problem.

Are We Facing a Radical Change in the Migration Behavior of Medical Graduates from Less Developed Countries? Demographic Profile vs. Social Push Factors

The phenomenon of migration among medical personnel from less developed countries is a large one, with negative effects on the origin country, but more worrying is graduates' propensity to migrate during or immediately after university studies. The analysis of the labor market in the health sector from the last two decades shows us greater attractiveness of employment in (more) economically developed states compared to the demand from the health sector in graduates' origin countries. This research's purpose is to identify the determinants of the propensity to study and work abroad of medical students as a defined factor for better employment, and to identify the push factors in the origin country. As a result of the dichotomous nature of the dependent variables, logistic regression was applied. The independent variables (gender, residence, medical specialization, grades and perceived economic status) were used to identify the odds of the intention to migrate for studies. The results highlighted a higher propensity to migrate for studies among medical students, with opportunities offered by universities differing across countries and geographical areas. Moreover, students with a lower level of household income have openness to migrate, the tuition fees being managed through part-time/temporary employment during studies.

Medical professionals' job satisfaction and telemedicine readiness during the COVID-19 pandemic: solutions to improve medical practice in Egypt

BACKGROUND

The COVID-19 pandemic has impacted medical professionals' job satisfaction and was a call to adopt telemedicine. Finding out how far medical professionals are satisfied and ready to use telemedicine would be important to improve medical practice.

METHODS

Data was collected from 959 medical professionals from both the governmental and private health sectors in Egypt in 2021 using a specifically designed online questionnaire, to evaluate job satisfaction, perception of telemedicine, and propose solutions to improve medical practice.

RESULTS

The study revealed low to moderate job satisfaction at governmental (27.2%) and private (58.7%) sectors. Underpayment was the most reported challenge at both sectors (37.8% and 28.3%, respectively). Dissatisfaction with government salary was independently predicted by working at the Ministry of Health and Population (OR = 5.54, 95%CI = 2.39,12.8; p < 0.001). Wage increase (46.10%), medical training of professionals (18.1%), and management of non-human resources (14.4%) were the most proposed solutions to improve medical practice in Egypt. During the COVID-19 pandemic, 90.7% of medical professionals had practiced telemedicine with moderate level of perception of its benefits (56%).

CONCLUSIONS

During the COVID-19 pandemic, medical professionals reported low to moderate job satisfaction and a moderate level of perception of telemedicine. It is recommended to analyze the healthcare financing system and provide continuous training of medical professionals to improve medical practice in Egypt.

Driving forces of GPs' migration in Europe: an exploratory qualitative study

BACKGROUND

The shortage of GPs is a worldwide phenomenon, which encourages the migration of GPs and consequently exacerbates the GP shortage. This shortage imposes a threat for the entire healthcare system.

AIM

To explore the driving forces of GPs' migration in Europe and their reasons to stay in the new country, to migrate further, or to return to their home country.

DESIGN & SETTING

An exploratory, qualitative study of European GPs who have migrated within Europe.

METHOD

Individual interviews were conducted until data saturation and audio-recordings were transcribed. Thematic analysis was performed using NVivo.

RESULTS

Fifteen interviews with GPs from eight different European countries were conducted. The reasons why European GPs migrate and decide to stay or to leave were grouped under the following three themes: professional development; personal reasons; and the situation in the home country or the organisation of health care. New professional challenges, better working environment, and higher quality training programmes were mentioned as the main reasons for migration. Personal reasons, such as family's satisfaction with the living environment, closeness to other family members, and financial considerations, seemed to influence the decision to stay or leave the most.

CONCLUSION

Migration caused by dissatisfaction with the working and living environment is something countries could potentially work on in order to retain their GPs. As some countries in Europe rely more and more on international recruitment to combat the GP shortage, which in turn worsens the situation in other countries, a more unified Europe-wide approach to GP shortage and migration is needed.

Burnout syndrome (BOS) among resident doctors in an Egyptian tertiary care university hospital: Prevalence and determinants during the COVID-19 pandemic

OBJECTIVES

The current study aimed to detect the BOS prevalence and determinants among residents working during the second wave of the COVID-19 pandemic in an Egyptian tertiary university referral hospital.

METHODS

A cross-sectional study evaluating the working period from June to November 2020 during the COVID-19 pandemic second wave, through a five sections questionnaire evaluating: 1 - sociodemographic characteristics, 2 - job characteristics, 3 - negative thoughts related to their job, 4 - resident's health problems, and 5 - evaluating BOS through Maslach Burnout Inventory (MBI) scale (including emotional exhaustion [EE], depersonalization [DP], and personal accomplishment [PA] as subscales).

RESULTS

We included 230 residents with a median age of 27 years. The median MBI sub-scales (IQ Range) values were 30.0 (20, 39), 21.0 (15, 30), and 29.5 (22, 36) for EE, DP, and PA, respectively. About 51.0% and 83.0% of the residents were high in EE and DP, while 8.7% were low in PA. The median EE and DP were higher in younger age (⩽27 years; p = .002 and .024), males (p = .001 and <.001), working >90 hours weekly (p = .016 and <.001), exposure to harassment (p < .001), and having COVID-19 infection (p = .002 and .001). Residents working in surgical departments reported higher DP scores than those in non-surgical departments (p = .03). There was a mild positive correlation between working hours per week and the total scores in EE and DP, r = .24 (p < .001) and r = .23 (p = .001) respectively, while it was found to have a negative correlation with the PA (r = -.133 and p = .044).

CONCLUSIONS

The BOS is evident and considerably high among the residents working during the COVID-19 pandemic. Younger age, males, working in surgical departments, and those who got COVID-19 infection were most vulnerable.

Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review

BACKGROUND

Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK.

METHODS

A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework.

RESULTS

40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts.

CONCLUSIONS

Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748.

Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany

Background

The integration of immigrating physicians has become a challenge for many societies and health care systems worldwide. Facilitating the integration process may benefit both the uptaking country and the immigrating physicians. Previous studies have approached this problem from a system integration perspective. The present study explores the degree of social integration of an exemplary group of Middle Eastern physicians following their migration to Germany from an individual perspective.

Methods

Based on social constructivist epistemology, a series of fifteen interviews and two focus groups with immigrated Middle Eastern physicians (n = 23, purposively sampled) were conducted between 2017 and 2020 in Germany. The audio recordings were transcribed, translated into English and analysed deductively based on Esser’s model of social integration, consisting of four dimensions: acculturation, positioning, interaction and identification.

Results

The social integration of the participants showed a multifaceted picture. The early phase was characterized by disorientation and trial and error. Cultural differences were of major importance. Acculturation was facilitated by German language acquisition and increased over time, although some cultural difficulties remained. Professional positioning was facilitated by the need for physicians and a relatively low-hurdle relicensing procedure. Interaction and identification depended on the efforts of the individual physicians.

Conclusions

This study provides a comprehensive picture of the individual social integration of Middle Eastern physicians in Germany. Language and cultural adaptation are identified as being of primary importance. Social integration can be facilitated through orientation programmes or cross-cultural training that benefits the uptaking countries as well as the immigrating physicians.

Teaching Quality Improvement: The Use of Education Theories Across the Medical Education Spectrum

It is well recognized that the principles and practices of patient safety and quality improvement (QI) need to be included in medical education. The implementation of patient safety and QI learning experiences at the undergraduate medical education (UME) and graduate medical education (GME) levels has been variable. Consistent teaching of QI across the UME-GME-continuing medical education (CME) spectrum may result in a systemic change of improved patient care and patient safety in clinical practice. We propose using education theories to frame the development of QI curricula for a longitudinal integration in medical education and clinical practice. The basic principles of four education theories, namely, reflective practice, deliberate practice, social constructivism, and organizational learning, are briefly described, and examples of their applications to QI teaching are discussed. The incorporation of education theory into the design and implementation of a longitudinal QI curriculum threaded across the UME-GME-CME spectrum may empower learners with a comprehensive and lasting understanding of QI principles and training in patient safety practice, which are essential prerequisites for the formation of a physician workforce capable of creating sustainable change in patient care.

Perceptions of medical doctors living in Ethiopia about physician migration: a qualitative study

OBJECTIVES

Migration of physicians is one of the most pressing global health problems of our time with the greatest implications in sub-Saharan African countries. Although other studies have explored and produced important quantitative data about the impact of medical migration in the health sector of Ethiopia, the motive behind Ethiopian physician migration have been explored less thoroughly. This article explores the perceptions of a group of physicians about the complicated and continuously evolving driving forces of physician migration in Ethiopia.

DESIGN

Qualitative study using in-depth, virtual semistructured interviews.

PARTICIPANTS

Using purposive sampling, 12 physicians participated.

SETTING

Skype interviews with 12 participants working in Tikur Anbessa Specialised Hospital in Addis Ababa, Ethiopia.

RESULTS

Four themes emerged reflecting the perceptions of Ethiopian medical doctors on the driving forces of physician migration: (1) Economic push and pull factors; (2) Professional push and pull factors; (3) Social and Political push and pull factors and (4) Medical migration governance.

CONCLUSION

The emigration of Ethiopian physicians is made after weighing the push and pull factors. Push factors are more crucial than pull factors, and financial reasons play the leading role. Junior physician unemployment, politicisation of hospital administration, and poor medical migration governance are growing problems. Junior physician unemployment is a recent phenomenon in Ethiopia and with a potential to be a leading push factor if appropriate intervention is not taken. The findings of this study are worrying and urge for comprehensive solutions to be devised by policy-makers to deal with physician migration in Ethiopia.

Impact of COVID-19 pandemic on TB prevention and care in Addis Ababa, Ethiopia: a retrospective database study

OBJECTIVE

The current COVID-19 pandemic in Ethiopia could cause severe dysfunction in tuberculosis (TB) treatment, diagnostic services, and prevention and control efforts. In this study, we evaluated the effect of COVID-19 on TB service indicators in Addis Ababa, where more than two-thirds of the country's COVID-19 morbidity was recorded.

DESIGN

We performed a comparative retrospective study to evaluate the impact of COVID-19 on TB services during the pre-COVID-19 era (from April 2019 to March 2020) and the COVID-19 era (from April 2020 to March 2021) in Addis Ababa, Ethiopia. We extracted data on total TB detection rate, TB treatment success rate, isoniazid prophylaxis therapy, and drug susceptibility tests and others from the health information system. Using Poisson regression, we estimated the incidence rate ratios and the absolute number difference of the indicators (number per quarter and year) in the COVID-19 and pre-COVID-19 eras.

RESULTS

Compared with the pre-COVID-19 era, the total TB detection, bacteriologically confirmed TB, TB treatment success rate, latent TB infection treatment and community health workers' engagement in TB detection decreased, respectively, by 11%, 11.8%, 17%, 44.7% and 77.2% during the COVID-19 period. Rifampicin resistance increased by 27.7% during the same period. Comparative analysis showed a significant decline in these TB service indicators (p<0.001) CONCLUSION: The COVID-19 pandemic has had a negative impact on TB service indicators in Addis Ababa. This highlights the importance of reinforcing TB services, including adopting alternative digital health technology to screen for TB and integrating TB and COVID-19 services to mitigate COVID-19's challenges to TB prevention and care.

Factors Influencing Physicians Migration—A Case Study from Romania

Brain drain is a phenomenon that, over time, has followed an upward trend. It is an important component represented by physicians’ migration. For the country of destination, the migration of physicians offers several advantages, whereas the country of origin loses skilled and sometimes highly trained individuals. This process will be reflected both in the efficiency of the health system (severe employment shortage) and in the quality of the health system services. After Romania’s accession to the EU, the migration of doctors intensified, significantly increasing the shortage of physicians. The purpose of this article is to identify the push factors that influence the physicians’ decision to migrate from Romania. For this, a panel regression analysis was applied, highlighting that physicians’ migration is influenced by several factors, such as the number of beds in hospitals, the number of emigrants, unemployment rate, and income. At the same time, we analyzed the extent to which public policy measures addressed to the remuneration of medical staff influenced the propensity towards external mobility of the practicing doctors, already employed and/or graduates. The results confirm that public policies can be a tool for redistributing the labor force allocation on the labor market. Moreover, the results of our analysis highlight that specific measures do not solve the system crises facing the health sector. Systemic, multidimensional changes are needed, adapted to the needs of medical services specific to the geographical area and adequate to the health status of the population.

Prevalence, Associated Factors, and Consequences of Burnout Among Egyptian Physicians During COVID-19 Pandemic

Objectives: COVID-19 has been recognized as a pandemic by the World Health Organization, and physicians are at the frontline to confront the disease. Burnout syndrome (BOS) is a syndrome resulting from chronic workplace stress that has not been successfully managed. The objective of this study is to evaluate the frequency and associated risk factors of BOS among a sample of Egyptian physicians during the COVID-19 pandemic.

Methods: Using Maslach Burnout Inventory Human Services Survey, a cross-sectional electronic survey was conducted to assess BOS among the target group.

Results: Two hundred and twenty physicians participated in the study. The frequency of BOS among the research group was 36.36%. The possibility of development of BOS increased two times with the need to buy personal protective equipment (PPE) from participants' own money, with harassment by patients' families, and was less likely to develop in doctors with older age. While male gender was a predictor of depersonalization (DP), female gender showed a significant association with higher emotional exhaustion (EE). Infection or death from COVID-19 among colleagues or relatives showed significant association with elevated EE and lowered personal achievement (PA), respectively.

Conclusion: COVID-19 pandemic added new factors to the development of BOS in our research group. Several measures should be taken to support physicians at this stage. These measures include psychological support, organizing work hours, adjusting salaries, and providing personal protective equipment and training on safety measures.