South Africa and the Surgical Diaspora-A Hub for Surgical Migration and Training

Abstract

Background: The shortage of trained surgeons, anesthesiologists, and obstetricians is a major contributor to the unmet need for surgical care in low- and middle-income countries, and the shortage is aggravated by migration to higher-income countries.

Methods: We performed a cross-sectional observational study, combining individual-level data of 43,621 physicians from the Health Professions Council of South Africa with data from the registers of 14 high-income countries, and international statistics on surgical workforce, in order to quantify migration to and from South Africa in both absolute and relative terms.

Results: Of 6670 surgeons, anesthesiologists, and obstetricians in South Africa, a total of 713 (11%) were foreign medical graduates, and 396 (6%) were from a low- or middle-income country. South Africa was an important destination primarily for physicians originating from low-income countries; 2% of all surgeons, anesthesiologists, and obstetricians from low- and middle-income countries were registered in South Africa, and 6% in the other 14 recipient countries. A total of 1295 (16%) South African surgeons, anesthesiologists, and obstetricians worked in any of the 14 studied high-income countries.

Conclusion: South Africa is an important regional hub for surgical migration and training. A notable proportion of surgical specialists in South Africa were medical graduates from other low- or middle-income countries, whereas migration out of South Africa to high-income countries was even larger.

Fig. 1

Inclusion of South African foreign medical graduates and the subgroup of surgeons, anesthesiologists, and obstetricians. The HPCSA iRegister database includes South African physicians from the Health Professions Council of South Africa [21]. n_total = number of physicians, n_SAO = number of surgeons, anesthesiologists, and obstetricians

Fig. 2

The leading source and destination countries for surgery, anesthesia, and obstetric specialists, who have migrated in and out of South Africa. In addition to the 8 origin countries displayed here, an additional 49 countries sent at least 1 SAO specialist to South Africa, although no country in the “other” category sent more than 25 SAO specialists

Fig. 3

a and b. The South African dependency on foreign medical graduates in surgery, anesthesia, and obstetrics. a by World Bank income group, b by WHO region, including only low- and middle-income source countries. Dependency is the number of foreign medical graduates divided by the total number of physicians

Fig. 4

The South African dependency on foreign medical graduates from low- and middle-income countries, by specialty. Dependency is the number of foreign medical graduates divided by the total number of physicians in each specialty

Fig. 5

a and b The proportion of SAO specialists abroad in South Africa and 14 high-income countries (HICs), a by World Bank income group, and b by country, displaying the top countries. The proportion was defined as A/(A + B), where A is the number of SAO specialists who have emigrated and B is the number of SAO specialists remaining in the source country or region

Fig. 6

a and b. The correlation between the proportion of surgery, anesthesia, and obstetric specialists abroad in South Africa and a gross national income per capita, b and the remaining density of SAO specialists per 100,000 population. The proportion was defined as A/(A + B), where A is the number of SAO specialists from a source country who have emigrated to South Africa, and B is the number of SAO specialists remaining in the source country. Bubble sizes represent source country population size