HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.095844v1 98/1/148    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via ISI Web of Science (1) Google Scholar Articles by Arah, O. A. Articles by Okeke, C. E. PubMed PubMed Citation Articles by Arah, O. A. Articles by Okeke, C. E. Related Collections Global Health Health Policy Health Professionals Public Health Practice Public Health Workers Immigration

Onyebuchi A. Arah, MD, PhD, DSc, MPH, Uzor C. Ogbu, MD, MSc and Chukwudi E. Okeke, MD

Onyebuchi A. Arah is with the Department of Social Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands, and the Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, the Netherlands. Uzor C. Ogbu is with the Department of Social Medicine, Academic Medical Center of the University of Amsterdam, Amsterdam, and the Center for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven. Chukwudi E. Okeke is with the Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu.

Correspondence: Requests for reprints should be sent to Onyebuchi A. Arah, MD, PhD, Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands (e-mail: o.a.arah{at}amc.uva.nl).

Objectives. We analyzed the relationship between physician migration from developing source countries to more developed host countries (brain drain) and the developmental and global health profiles of source countries.

Methods. We used a cross-section of 141 countries that lost emigrating physicians to the 4 major destinations: the United States, Canada, Australia, and the United Kingdom. For each source country, we defined physician migration density as the number of migrant physicians per 1000 population practicing in any of the 4 major destination countries.

Results. Source countries with better human resources for health, more economic and developmental progress, and better health status appear to lose proportionately more physicians than the more disadvantaged countries. Higher physician migration density is associated with higher current physician (r=0.42, P< .001), nurse (r=0.27, P=.001), and public health (r=0.48, P=.001) workforce densities and more medical schools (r=0.53, P<.001).

Conclusions. Policymakers should realize that physician migration is positively related to better health systems and development in source countries. In view of the "train, retain, and sustain" perspective of public health workforce policies, physician retention should become even more important to countries growing richer, whereas poorer countries must invest more in training policies.