Educational and labor wastage of doctors in Mexico: towards the construction of a common methodology

Abstract

BACKGROUND: This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. METHODS: Secondary sources were used, mainly the Statistical yearbooks of the National Association of Universities and Higher Education Institutions (ANUIES in Spanish). Also, the 2000 Population Census was used to estimate the different sources of labor market wastage. The formulas were modified to estimate educational and labor wastage rates. RESULTS: Out of every 1000 students who started a medical training in 1996, over 20% were not able to finish the training by 2000. Furthermore, out of every 1000 graduates, 31% were not able to find a remunerated position in the labor market that would enable them to put into practice the abilities and capacities obtained at school. Important differences can be observed between generalists and specialists, as well as between men and women. In the case of specialists and men, lower wastage rates can be observed as compared to the wastage rates of generalists and women. A large percentage of women dedicate themselves exclusively to household duties, which in labor terms represents a wastage of their capacity to participate in the production of formal health services. CONCLUSION: Women are becoming a majority in most medical schools, yet their participation in the labor market does not reflect the same trend. Among men, policies should be formulated to incorporate doctors in the specific health field for which they were trained. Regarding women, specific policies should target those who are dedicated full-time to household activities in order to create the possibility of having them occupy a remunerated job if they are willing to do so. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need.

Figure 1

Total enrolment in the career of medicine by sex, 1990–2001. Throughout the period, the proportional participation of women maintained a constant growth. According to the annual statistical book from ANUIES, the percentage of women enrolled in medicine jumped from 43.9% in 1990 to 50.4% in 2001. It 1999 the number of women enrolled outnumbered men for the first time, by 1038.

Figure 2

Global rate of attrition (GRA) in medicine by group pertaining to the same period of study, 1977–2001. To calculate the attrition in the medical profession, a series was constructed for each graduating group, from the first admission in 1977 up to the 1997–2001 graduating class. Once the series was completed, it could be established that the lowest level of drop-outs took place during the period 1985–1989, with a rate of 165.0 per thousand students, while the highest level was registered in the 1990–1994 class, with a rate of 493.5.

Figure 3

Incoming students and attrition by cohort, 1977–2001. An indicator that allows us to determine the wastage is the rate of final efficiency in the career of medicine at the national level. To this purpose, a series of graduating classes with the same cohort was constructed; this led to the identification of the highest final efficiency, which was achieved in the 1985 and the 1995 graduating classes, with a rate of 834.9 and 804.3, respectively. The second-highest rate was reached during the period 1995–1999.

Figure 4

Possible outcomes for individuals, from medical schools to the labor market. The diagram shows that doctors enrolled at medical schools can follow one of two patterns: the first refers to students obtaining their diploma, and the second, to students dropping out or not fulfilling the established requirements to graduate. Once in the labor market, graduates can be divided into two subgroups: those who are ready to be immediately employed and those who are not. In turn, those who are ready can be employed, unemployed, underemployed or fully dedicated to household activities. Those who are not ready to be immediately employed are divided into students that go on for a specialization degree and those who are inactive. A proportion of those initially enrolled will later be represented by the rate of attrition.