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The impact of physician migration on mortality in low and middle-income countries: an economic modelling study
  1. Saurabh Saluja1,2,
  2. Niclas Rudolfson2,3,
  3. Benjamin Ballard Massenburg2,4,
  4. John G Meara2,5,
  5. Mark G Shrime2,6
  1. 1Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Department of Clinical Sciences, World Health Organization Collaborating Center for Surgery and Public Health, Lund University, Lund, Sweden
  4. 4Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington, USA
  5. 5Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
  6. 6Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  1. Correspondence to Dr Saurabh Saluja; sausaluja{at}


Background The WHO estimates a global shortage of 2.8 million physicians, with severe deficiencies especially in low and middle-income countries (LMIC). The unequitable distribution of physicians worldwide is further exacerbated by the migration of physicians from LMICs to high-income countries (HIC). This large-scale migration has numerous economic consequences which include increased mortality associated with inadequate physician supply in LMICs.

Methods We estimate the economic cost for LMICs due to excess mortality associated with physician migration. To do so, we use the concept of a value of statistical life and marginal mortality benefit provided by physicians. Uncertainty of our estimates is evaluated with Monte Carlo analysis.

Results We estimate that LMICs lose US$15.86 billion (95% CI $3.4 to $38.2) annually due to physician migration to HICs. The greatest total costs are incurred by India, Nigeria, Pakistan and South Africa. When these costs are considered as a per cent of gross national income, the cost is greatest in the WHO African region and in low-income countries.

Conclusion The movement of physicians from lower to higher income settings has substantial economic consequences. These are not simply the result of the movement of human capital, but also due to excess mortality associated with loss of physicians. Valuing these costs can inform international and domestic policy discussions that are meant to address this issue.

  • health economics
  • epidemiology
  • health policies and all other topics
  • medical demography

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  • SS and NR are joint first authors.

  • Handling editor Sanni Yaya

  • SS and NR contributed equally.

  • Correction notice This article has been corrected since it was published. The article type has been updated.

  • Contributors SS, BBM and MGS conceived the study. SS, NR and BBM developed the methodology. NR performed the statistical analysis. SS, NR and BBM wrote the initial draft of the paper. SS, NR, BBM, JM and MGS revised the paper for critical intellectual content. JM and MGS supervised the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data and code used to produce the results are available upon reasonable request.