Physician emigration from sub-Saharan Africa to the United States: analysis of the 2011 AMA physician masterfile

Abstract

Background: The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States.

Methods and findings: We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤ 70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs.

Conclusion: Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.

Figure 1. Subgroups of Sub-Saharan African migrant physicians identified in the US physician workforce.

Data source: American Medical Association .

Figure 2. Sub-Saharan African migrant physicians who completed medical school in 2000 or later and are present in the US physician workforce.

Data source: American Medical Association .

Figure 3. Sub-Saharan African-based institutions with the largest numbers of medical graduates appearing in the US physician workforce.

Data source: American Medical Association .

Figure 4. Growth over time of migration among Sub-Saharan African-trained medical graduates appearing in the US physician workforce.

Data source: American Medical Association . As reflected by the exponential equation and the determination coefficient (R²) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, and reflects the rapid emigration growth of sub-Saharan African trained medical graduates. The increase in emigration is particularly significant in cohort 3, which mainly coincides with the implementation period of the SAPs.

Figure 5. Length of service provided to the home country by each graduation cohort of Sub-Saharan African-trained medical graduates before migration to the United States.

Note: Based on n = 6,421 complete graduation and residency records. Estimated mean year of time between graduation and entry in the United States: 6.4 y (SD = 4.6). Data source: American Medical Association .

Figure 6. Emigration trends among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile.

Data source: American Medical Association .

Figure 7. Trends in primary specialty among Sub-Saharan African-trained medical graduates with complete birth country data in the 2011 AMA Physician Masterfile.

Data source: American Medical Association .

Figure 8. Graduation trends among Sub-Saharan African-born graduates of medical schools located in the United States.

Data source: American Medical Association . As reflected by the exponential equation and the determination coefficient (R²) of the smoothed line displayed on the chart, the distribution of the data approaches an exponential curve, reflecting a rapid numerical increase of sub-Saharan African natives graduating from medical school in the US.

Figure 9. American medical schools with the highest number of Sub-Saharan African-born graduates practicing in the United States.

*Note: No information was provided as to which campus of the University of Illinois these sub-Saharan African-born medical graduates attended. Data source: American Medical Association .

Figure 10. Foreign medical schools located outside Sub-Saharan Africa with the highest number of Sub-Saharan African-born medical graduates practicing in the United States.

Data source: American Medical Association .

Figure 11. Graduation and residency trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa.

Data source: American Medical Association .

Figure 12. Recent demographic trends among Sub-Saharan African-born international medical graduates educated outside Sub-Saharan Africa and completing residency in the United States in 2000 or later.

Data source: American Medical Association .