AN EXPLORATORY STUDY OF FACTORS INFLUENCING PAKISTANI PHYSICIANS’ RETENTION AND RESETTLEMENT CAREER DECISIONS

Authors

  • Muhammad Arif College of Public Health and Health Informatics, Qassim University, Saudi Arabia
  • John Fraser School of Rural Medicine, University of New England
  • Mary Cruickshank Federation University

DOI:

https://doi.org/10.55519/JAMC-03-S1-9810

Keywords:

Recruitment, Retention, Migration, Resettlement, Career decision-making, Doctors/ physicians, Pakistan

Abstract

Background: The recruitment, retention and migration of health workers is a global phenomenon. The literature shows push factors associated with leaving rural areas and developing countries in general are explored in depth. However importantly, some health workers behave differently and decide to stay in or return to a developing country. Less is known about the reasons/ pull factors of this groups’ decision making. Methods: This paper aims to explore the perceptions of Pakistani physicians regarding their career decisions to remain in their country, or resettle back after working abroad for some time. Thirteen Pakistani physicians were interviewed via telephones who were working in Pakistan and Australia. Results: The motivation for Pakistani physicians to remain or resettle back into their country stems from the perceived better quality of life in Pakistan compared to the better standard of life overseas. Other reasons include a perceived differentiation between locals and non-locals abroad and the availability of a permanent job in Pakistan. Conclusion: The main factors that contributed to Pakistani physicians’ retention and resettlement decisions were mostly personal and family or societal factors and there was a minimal role for professional or health system related factors in their career decisions, except for the availability of permanent jobs in Pakistan.

Author Biography

Mary Cruickshank, Federation University

Dr Mary Cruickshank is an Adjunct Professor of Nursing at Federation University Australia and an Adjunct Professor at the ASEAN Institute for Health Development, Mahidol University, Thailand.  Mary has several years’ experience of senior management and leadership roles across Health in the higher education sector and more specifically in Nursing and Midwifery. She has held academic positions at five universities in Australia and has served as Professor and Head of School at three of those universities. Mary recently finished her term as Professor and Head of School of Nursing, Midwifery and Healthcare in the Faculty of Health at Federation University.  Dr Cruickshank has had extensive experience in leading the development of high-quality, innovative, and accredited undergraduate and postgraduate health curricula with many programs using online pedagogies. Mary is an experienced researcher in the healthcare field and has conducted numerous national and international projects with a focus on building leadership roles in health. She has published widely in areas including health workforce and capacity-building, clinical health, organisational culture, evidence-based practice, nursing, health education and rural health. Mary has supervised many PhD candidates to successful completion, and she has been a peer reviewer for several national and international journals throughout her academic career.

References

Ibrahim H, Al Sharif FZ, Satish KP, Hassen L, Nair SC. Should I stay or should I go now? The impact of “pull” factors on physicians decisions to remain in a destination country. Int J Health Plann Manage 2019;34(4):e1909–20.

Bandita S, Jeevan B, Neha C, Kathmandu BA. Migration of health workers from Nepal / International Labour Organization, ILO Country Office for Nepal - Kathmandu: ILO, 2017.

Diallo K. Data on migration of health-care workers: sources, uses, and challenges. Bull World Health Organ 2004;82(8):601–7.

Joint Learning Initiative. Human Resources for Health: Overcoming the Crisis. Global Equity Initiative Harvard University; 2004.

WHO. World Health Report: Working Together for Health. Geneva: World Health Organization; 2006.

Awases M, Bary A, Nyoni J. Migration of health professionals in six countries: a synthesis report. In: Migration of health professionals in six countries: a synthesis report. 2004; p.68.

Brown RPC, Connell J. The migration of doctors and nurses from South Pacific Island Nations. Soc Sci Med 2004;58(11):2193–2210.

Hagopian A, Ofosu A, Fatusi A, Biritwum R, Essel A, Hart LG, et al. The flight of physicians from West Africa: views of African physicians and implications for policy. Soc Sci Med 2005;61:1750–60.

Akl EA, Maroun N, Major S, Afif C, Chahoud B, Choucair J, et al. Why are you draining your brain? Factors underlying decisions of graduating Lebanese medical students to migrate. Soc Sci Med 2007;64:1278–84.

Oman KM, Moulds R, Usher K. Professional satisfaction and dissatisfaction among Fiji specialist trainees: what are the implications for preventing migration? Qual Health Res 2009;19(9):1246–58.

Benamer HT, Bredan A, Bakoush O. The Libyan doctors' brain drain: an exploratory study. BMC Res Notes 2009;2:242.

Pantenburg B, Kitze K, Luppa1 M, König HH, Riedel-Heller SG. Physician emigration from Germany: insights from a survey in Saxony, Germany. BMC Health Serv Res 2018;18)1):341.

Schumann M, Maaz1 A, Peters H. Doctors on the move: a qualitative study on the driving factors in a group of Egyptian physicians migrating to Germany. Global Health 2019;15(1):2.

Luboga S, Hagopian A, Ndiku J, Bancroft E, McQuide P. Satisfaction, motivation, and intent to stay among Ugandan physicians: a survey from 18 national hospitals. Int J Health Plann Manage 2011;26(1):2–17.

Asampong E, Harrison J, Yarney L, Opoku-Mensah K, Karim A, Fobil J. Back to my roots: a study of “Returning” emigrated health professionals in the greater Accra region of Ghana. Afr Today 2013;59(4):119–30.

Henderson LN, Tulloch J. Incentives for retaining and motivating health workers in Pacific and Asian countries. Hum Resour Health 2008;6(1):1–20.

Mullan F. The metrics of the physician brain drain. N Engl J Med 2005;35(17):1810–8.

Shah SM, Zaidi S, Ahmed J, Rehman SU. Motivation and retention of physicians in primary healthcare facilities: a qualitative study from Abbottabd, Pakistan. Int J Health Policy Manag 2016;5(8):467–75.

Motlhatlhedi K, Nkomazana O. Home is home—Botswana’s return migrant health workers. PLoS One 2018;13(11):e0206969.

Araujo E, Maeda A. How to Recruit and Retain Health Workers in Rural and Remote Areas in Developing Countries: A Guidance Note. World Bank; 2013.

Arif M. To Remain, Migrate Abroad or Resettle: An exploratory Study of Pakistani Physicians’ Career Decisions [Doctoral thesis]. Armidale (NSW): University of New England; 2011. [Internet]. [cited 2021 July]. Available from https://epublications.une.edu.au/vital/access/manager/Repository/une:7328

Arif M, Cruichank M, Fraser J. To remain, migrate abroad or resettle: a complex dynamic process affecting Pakistani physicians’ career decisions. Asia Pac J Health Manag 2019;14:3.

Syed NA, Khimani F, Andrades M, Ali SK, Paul R. Reasons for migration among medical students from Karachi. Med Educ 2008;42(1):61–8.

Hossain N, Shah N, Shah T, Lateef SB. Physicians’ migration: perceptions of Pakistani medical students. J Coll Physicians Surg Pak 2016;26(8):696–701.

Sheikh A, Naqvi HA, Sheikh K, Naqvi HS, Bandukda MY. Physician migration at its roots: a study contributing towards a career choice abroad among students at a medical school in Pakistan. Global Health 2012;8:43.

Malik AA, Yamamoto SS, Souares A, Malik Z, Sauerborn R. Motivational determinants among physicians in Lahore, Pakistan. BMC Health Serv Res 2010;10(201):1–11.

Makasa E. Africa’s medical brain drain: why I want to stay in Africa. BMJ 2005;331(7519):780.

Oman KM, Moulds R, Usher K. Specialist training in Fiji: why do graduates migrate, and why do they remain? A qualitative study. Hum Resour Health. 2009;7:9.

De Silva AP, Liyanage IK, De Silva STGR, Jayawardana MB, Liyanage CK, Karunathilake IM. Migration of Sri Lankan medical specialists. Hum Resour Health 2013;11:12.

Fisher K, Fraser J. Rural health career pathways: research themes in recruitment and retention. Aust Health Rev 2010;34(3):292–6.

Tolhurst H. Landscape of fulfilment: a model for understanding rural medical recruitment and retention [PhD thesis]. Newcastle (NSW): University of Newcastle, Australia; 2008.

Gadit AAM. Migration of doctors: should we apply the index of happiness? J Pak Med Assoc 2008;58(6):342–4.

Taj F, Aly Z. Will discouraging migration really make doctors happier? J Pak Med Assoc 2008;58(8):474.

Akl EA, Maroun N, El-Asmar K, Abou Jaoude E, Irani J, Badr K. Willingness of the Lebanese physicians in the United States to relocate Lebanon. Hum Resour Health 2012;10:15.

Konstantinou K. Factors that Affect the Decisions Made by Skilled Professionals to Migrate to the UK: A Qualitative Study of Cypriot Migrant and Returning Physicians. [Doctoral thesis]. UK: Keele University; 2019.

Moore RA, Rhodenbaugh E. The unkindest cut of all: are international medical school graduates subjected to discrimination by general surgery residency programs? J Surg Educ 2002;59(2):228–36.

Woods SE, Harju A, Rao S, Koo J, Kini D. Perceived biases and prejudices experienced by international medical graduates in the US Post-Graduate Medical Education System. Med Educ Online 2006;11(1):4595.

Nasir LS. Evidence of discrimination against international medical graduates applying for family practice residency programs. Fam Med 1994;26(10):625–9.

Miller RS, Dunn MR, Richter TH, Whitcomb ME. Employment-seeking experiences of resident physicians completing training during 1996. J Am Med Assoc 1998;280(9):777–83.

Shafqat S, Zaidi AKM. Pakistani physicians and the repatriation equation. N Engl J Med. 2007;356(5):442–3.

Nagai M, Fujita N, Diouf IS, Salla M. Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study. Rural Remote Health 2017;17(3):4149.

Alameddine M, Saleh S, El‐Jardali F, Dimassi H, Mourad Y. The retention of health human resources in primary healthcare centers in Lebanon: a national survey. BMC Health Serv Res 2012;12(1):419.

Published

2022-06-24

Issue

Vol. 34 No. 3 (SUPPL 1) (2022): JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.