Monitoring Sub-Saharan African physician migration and recruitment post-adoption of the WHO code of practice: temporal and geographic patterns in the United States

Abstract

Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.

Fig 1. Projected numbers of active and semi-retired Sub-Saharan African (SSA) migrant physicians in the 2015 American Medical Association (AMA) Physician Masterfile.

Note: Based on available residency completions and expected completions of active and semi-retired Sub-Saharan African migrant physicians in the 2013 AMA Physician Masterfile [27]; SSA-IMGs, international medical graduates trained in SSA-based medical schools; SSA-BFTs, SSA-born, but foreign-trained physicians (including US medical graduates and international medical graduates trained in non-SSA-based medical schools).

Fig 2. Cumulative distribution curves for Sub-Saharan African international medical graduates’ (SSA-IMGs) ages at time of graduation and at time of entry into the United States.

Data source: From the 2011 American Medical Association Physician Masterfile data in Tankwanchi [37].

Fig 3. Geography of loss: Spatial distribution of Sub-Saharan African migrant physicians across the United States.

Note: SSA-IMGs, international medical graduates trained in Sub-Saharan African-based medical schools; SSA-BFTs, Sub-Saharan African-born, but foreign-trained physicians (i.e., graduates of US and other non-SSA foreign medical schools). Data sources: Redi-Med Data Interactive Medical Database System [51]; Environmental Systems Research Institute [62]; Association of American Medical Colleges [63].

Fig 4. Main residency institutions of Sub-Saharan African migrant physicians in the Eastern Region of the United States.

Note: Full names of residency programs appearing on the map are provided as supporting information (S1 Table). Data sources: Redi-Med Data Interactive Medical Database System [51]; Environmental Systems Research Institute [62]; Association of American Medical Colleges [63].