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Essien EA, Mahmood MY, Adiukwu F, Kareem YA, Hayatudeen N, Ojeahere MI, Salihu MO, Sanni KA, Omotoso AB, Pinto da Costa M. Workforce migration and brain drain - A nationwide cross-sectional survey of early career psychiatrists in Nigeria. Glob Ment Health (Camb) 2024; 11:e30. [PMID: 38572258 PMCID: PMC10988168 DOI: 10.1017/gmh.2024.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/07/2024] [Accepted: 02/14/2024] [Indexed: 04/05/2024] Open
Abstract
Background Nigeria's shortage of psychiatrists is exacerbated due to health worker migration. Aim This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria. Methods We conducted a cross-sectional survey covering Nigeria's six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29. Results Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had 'ever' considered migration, 69.2% were planning to leave 'now', and 52.9% had taken 'practical migration steps'. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05-4.88) predicted planning to leave 'now', while being in a relationship (OR = 3.46, 95%CI = 1.06-11.30) predicted taking 'practical migration steps'. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested. Conclusions Systemic changes to address psychiatrists' migration from Nigeria are needed.
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Affiliation(s)
| | | | - Frances Adiukwu
- Department of Mental Health, University of Port Harcourt, Choba, Rivers State, Nigeria
| | | | - Nafisatu Hayatudeen
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
| | | | - Mumeen Olaitan Salihu
- Department of Behavioural Sciences, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Giurgiuca A, Giurgi-Oncu C, Matei VP. Training and retaining mental health professionals: The Romanian experience in the European Union. Asia Pac Psychiatry 2021; 13:e12498. [PMID: 34873851 DOI: 10.1111/appy.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Romania has been a member of the European Union since 2007. According to the World Health Organization, the national burden of mental disorders is high, with 2743.69 disability-adjusted life years per 100.000 population. Moreover, in a country of 19 million people, Romania's mental health system is currently functioning at capacity, with 5.66 adult psychiatrists/100.000 population and only 0.56 child and adolescent psychiatry (CAP) doctors per 100.000 population. METHOD we conducted a simple narrative review of the current literature on the topic of training of psychiatry trainees in Romania. RESULTS Undergraduate training consists of only 4 weeks of clinical and theoretical work for adult and CAP. Psychiatry postgraduate training lasts 5 years and is still duration-oriented. Psychiatric trainees mostly spend their clinical work in inpatient units due to the scarcity of other services or the lack of integration of training programs in the existing psychiatric services. Theoretical training is not nationally formalized, and, during training, yearly assessments tend to be neglected. An ongoing challenge in Romania has been retaining young career psychiatrists. CONCLUSION Although in a trend toward improvement of health services, "brain drain" has been and continues to be a massive phenomenon among Romanian psychiatrists, mainly driven to Western-European countries due to financial reasons, various shortcomings in overall infrastructure, and because of the lack of continuous professional and personal development opportunities. As the world is currently facing an unprecedented mental health crisis, steps must be taken to improve psychiatric training, retain psychiatrists in Romania, and provide better national mental health services.
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Affiliation(s)
- Ana Giurgiuca
- Department of Clinical Neuroscience, Discipline of Psychiatry, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalina Giurgi-Oncu
- Department of Neuroscience, Discipline of Psychiatry, The "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Valentin Petre Matei
- Department of Clinical Neuroscience, Discipline of Psychiatry, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Baessler F, Zafar A, Gargot T, da Costa MP, Biskup EM, De Picker L, Koelkebeck K, Riese F, Ryland H, Kazakova O, Birkle S, Kanellopoulos T, Grassl R, Braicu A, Schultz JH, Casanova Dias M. Psychiatry training in 42 European countries: A comparative analysis. Eur Neuropsychopharmacol 2021; 46:68-82. [PMID: 33678470 DOI: 10.1016/j.euroneuro.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/15/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Psychiatry qualifications are automatically recognized among European Union (EU) countries despite differences in national training programs. A widening gap between the number of psychiatrists, their competencies and the growing burden of mental illnesses in Europe has renewed calls for international standardization of training. Comprehensive information about training programs is missing, which limits thorough comparisons and undermines development of an actionable strategy to improve and harmonize psychiatry training. This study describes and compares the existing postgraduate psychiatry programs in 42 countries in the European region. Representatives of national psychiatry associations completed a semi-structured, 58-item questionnaire. Training structure and working conditions of each country were compared with population needs calculated by the World Health Organization to determine the European mean and contrasted among pre-2004 and post-2004 EU members and countries with unrecognized qualifications. Differences were tested with nonparametric (Wilcoxon) and parametric (Anova) tests. Median training duration was 60 months, significantly shorter in countries with unrecognized qualifications (48 months, χ²16.5, p < 0.001). In 80% of the countries, placement in a non-psychiatric specialty such as neurology or internal medicine was mandatory. Only 17 countries (40%) stipulated a one-month rotation in substance abuse and 11 (26%) in old-age psychiatry. The overall deficit of training versus population need was 22% for substance abuse and 15% for old-age psychiatry. Salaries were significantly higher in pre-2004 EU members (χ²22.9, p < 0.001) with the highest in Switzerland (€5,000). Significant variations in curricula, training structure and salaries exist in Europe. Harmonization of training standards could offer significant benefits for improving mental healthcare.
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Affiliation(s)
- Franziska Baessler
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.
| | - Ali Zafar
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Thomas Gargot
- Psychiatrie de l'Enfant et de l'Adolescent, Pitié Salpêtriére - Charles Foix, Assistance Publique Hôpitaux de Paris, 47/83 boulevard de l'Hôpital, 75013, Paris, France; ISIR, Sorbonne Université, 4 Place Jussieu, 75005, Paris, France; CHART Laboratory - EA 4004, TIM, Paris 8 University, 93526, Saint Denis, France
| | - Mariana Pinto da Costa
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; Hospital de Magalhães Lemos, Porto, Portugal
| | - Ewelina Maria Biskup
- Shanghai University of Medicine and Health Sciences Basic Medical College, Shanghai, China; Division of Internal Medicine, University of Basel, Basel, Switzerland
| | - Livia De Picker
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; University Psychiatric Department Campus Duffel, Duffel, Belgium
| | - Katja Koelkebeck
- LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Florian Riese
- University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Howard Ryland
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Olga Kazakova
- Psychiatric Department, Psychiatric Clinic of Minsk City, Minsk, Belarus
| | - Sarah Birkle
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Germany
| | - Thanos Kanellopoulos
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children`s Hospital, Athens, Greece
| | - Roland Grassl
- University Clinic for Child and Adolescent Psychiatry and Psychotherapy, Vienna, Austria
| | - Alina Braicu
- National Centre for Mental Health, BSMHFT, Birmingham, UK
| | - Jobst-Hendrik Schultz
- Center for Psychosocial Medicine, Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Marisa Casanova Dias
- Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology, and Neurosciences, King's College London, London, UK
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Matutyte L, Belena I, Bezborodovs N, Madissoon D, Pinto da Costa M. Attitudes towards migration from the eastern coast of the Baltic Sea: similar history but different psychiatric trainees? Int Rev Psychiatry 2021; 33:16-22. [PMID: 32603201 DOI: 10.1080/09540261.2020.1777777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article aimed to describe and compare migration tendencies between junior doctors training in psychiatry in the Baltic countries. A cross-sectional survey was circulated in Estonia, Latvia and Lithuania in 2013-2014 as part of the Brain Drain study. The 61-item, anonymous questionnaire covered participants' demographic data, experiences of short-term mobility, long-term migration and trainees' attitudes towards migration. In this sample (n = 95) of psychiatric trainees in the Baltic countries, the majority were female (79.1%), training in adult psychiatry (77.9%). A vast majority (87.0%) of psychiatric trainees in the Baltic countries have 'ever' considered leaving the country; almost half (in Estonia) or more than a half (in Lithuania and Latvia) were considering leaving 'now'; yet a minority took 'practical steps' towards migration. For all trainees in the Baltic states, personal reasons were the most important to stay in their country. Whilst regarding reasons to leave, financial was top in Lithuania, while trainees from Estonia and Latvia indicated personal reasons as key to emigrate. Several psychiatric trainees in the Baltic countries had considered migration, with many calling for improvements in their salaries. These findings call for further investigation and action to support the workforce in the Baltics.
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Affiliation(s)
- Lina Matutyte
- Faculty of Medicine, Clinic of Psychiatry, Vilnius University, Vilnius, Lithuania
| | - Ilona Belena
- Primary Mental Health Service, Vilnius City Clinical Hospital, Vilnius, Lithuania
| | - Nikita Bezborodovs
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
| | | | - Mariana Pinto da Costa
- Hospital de Magalhães Lemos, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, United Kingdom
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Abstract
Mental health disorders cause a large burden on global public health, with many patients living years with the disability. However, many doctors are ill-equipped to treat mental health disorders given inadequate training during their undergraduate years. In some countries, psychiatry is even considered an elective course rather than a core module. There is, therefore, a pressing need to improve the training of medical students in managing mental health disorders. Measures need to be implemented to attract students to choose psychiatry as their career. Given the developments in the fields and the challenges currently faced by trainees and early career psychiatrists, changes may also be made to the training programme in the postgraduate stage to unify the variations across the world in terms of the training duration and format. This paper will describe the ways that undergraduate and postgraduate psychiatry training may be ameliorated to improve the delivery of mental healthcare around the world and to equip doctors to face challenges in the future.
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Affiliation(s)
- Keith Hariman
- Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong, China
| | | | - Mariana Pinto da Costa
- Hospital de Magalhães Lemos, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.,Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Services Development), Queen Mary University of London, London, UK
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