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Program Number: B092
Session Name: Poster Session

Factors Influencing ENT Surgeon Migration Between Low- and Middle-Income Countries and Higher Income Settings: An Ongoing Exploratory Qualitative Study

Michelle H Zhang¹; Hudson Lin²; Emma Finnegan, BA³; Annabelle Fischer⁴; Nidanur Sinanoglu, MD⁵; Tarika Srinivasan, BSA, BA¹; Mary Jue Xu, MD²; Taseer Din, MBChB, MMed⁶; ¹Harvard Medical School, Boston, MA; ²University of California San Francisco, San Francisco, CA; ³Trinity College Dublin, Dublin, Ireland; ⁴Colby College, Waterville, ME; ⁵School of Medicine, Hacettepe University, Ankara, Turkey; ⁶Sidra Medicine, Doha, Qatar

Objectives: The shortage of ENT surgical care in low- and middle-income countries (LMICs) is exacerbated by the emigration of local physicians to higher-income countries (HICs). As a result, countries with the lowest density of surgical specialists also have the largest proportion of graduates practicing in HICs. The factors shaping these professional migrations are poorly understood. As part of the Global Otolaryngology-Head and Neck Surgery (OHNS) Initiative, this qualitative study sought to capture the authentic experiences of ENT surgeons from LMICs who have trained, or are training, in a HIC to understand the key factors driving decision-making approaches with regard to career trajectories. 

Methods: Focused, semi-structured Zoom interviews were conducted using a grounded theory approach. Participants were ENT surgeons who have moved to a country with a higher World Bank classification for training, where training was defined as at least one year of residency or fellowship in a non-origin country leading to the conferral of clinical credentials in an OHNS specialty. Of 17 interviewees thus far*, five are practicing in a HIC, eight are back in their home countries, two trainees plan to stay abroad, and two trainees intend to return home. Interviews were open-coded in Dedoose and analyzed to create a formal code book to assess emerging categories.

Results: The core categories that emerged from the interviews included (1) reasons for pursuing training in HIC, (2) barriers faced during training, (3) experiences of training in HIC, (4) differences between LMIC and HIC healthcare systems, (5) factors influencing post-training practice location, (6) applicability of HIC training to LMIC settings, and (7) processes for obtaining HIC training. 

Within each core category, sub-themes were identified. Among the various motivations for seeking training in HIC, unifying themes of academic and clinical career development, personal and financial considerations, and sociocultural influences were apparent. It was common for interviewees to experience administrative, financial, and opportunity barriers  in pursuit of training, in addition to experiencing challenges  during the training itself. These included institutional and structural barriers as well as social and cultural challenges that were complicated by the navigation of personal and emotional difficulties. 

Key differences noted between HIC and LMIC settings were the availability of resources, healthcare system practices, and training exposure. As a result of these stark differences, some trainees expressed difficulty in adequately transferring newly learned skills back to their home countries, even if the training was highly relevant. Despite these challenges, many interviewees expressed feelings of responsibility to bring new techniques back to their LMICs and establish new hospital programs. Other factors influencing post-training practice location were financial and career considerations, personal and family factors, and political instability or conflict. 

Conclusions: This study provides valuable insights into the experiences and challenges LMIC trainees face in HIC settings. These findings offer opportunities to improve collaborative global learning with the ultimate goals of enhancing trainee experiences, increasing LMIC trainee retention and bettering LMIC healthcare infrastructure.

 

 

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