Medical students’ migration intentions: Risk factor and challenge for the healthcare system in Kyrgyzstan

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UDC: 
614.23
Authors: 

N.K. Kasiev1, D.V. Vishniakov2

Organization: 

1Kyrgyz-Russian Slavic University named after the First President of Russian Federation B.N. Yeltsin, 44 Kievskaya St., Bishkek, 720021, Kyrgyz Republic
2International Higher School of Medicine (IHSM), 1F Intergel’po St., Bishkek, 720054, Kyrgyz Republic

Abstract: 

Physician migration challenges healthcare systems in developing countries. The “Irish paradox” phenomenon, where doctor shortages persist despite numerous medical graduates, is emerging in Kyrgyzstan (KR). Limited research on this exists in Central Asia. The study explores medical students' migration intentions, offering insights for regional and global health authorities.
A cross-sectional study surveyed 526 final-year medical students in KR. We analyzed demographic characteristics, intentions to work abroad, future professional preferences, and “Pull and Push” factors for migrations that might influence students’ decision to migrate.

86.1 % expressed willingness to emigrate. Intention to migrate was categorized by certainty of migration: 12.5 % “leave KR”, 14.5 % “highly likely to leave KR”, and 59.1 % “might leave KR”. 13.9 % decided to stay in KR. The significant predictors of migration were marriage and rural living; the main migration destinations were Russia (41.5 %), Kazakhstan (18.8 %), and the EU (11.5 %). Pull and push factors significantly differed among groups. The main limitations of the study arose from the nature of the observational study.

The study results are alarming, uncovering the potential scale of physican migration in Central Asia. The majority of medical graduates in KR plan to migrate, posing a threat to healthcare sustainability. The presence of the "Irish paradox" amplifies the pressure on these processes in the country and should be considered in the development of migration policy. Monitoring students' intentions provides timely information for adjusting migration programs promptly, and the combined score of Pull and Push factors might serve as an express test to address the challenge more effectively. Migration programs should be developed jointly with the Russian Federation, as the main destination and give priority to professional development in the group with low migration intentions.

Keywords: 
healthcare workers, physician migration, risk factor, brain drain, medical students’ intention to migrate, pull and push factors, Kyrgyzstan, Central Asia
Kasiev N.K., Vishniakov D.V. Medical students’ migration intentions: risk factor and challenge for the healthcare system in Kyrgyzstan. Health Risk Analysis, 2024, no. 1, pp. 128–140. DOI: 10.21668/health.risk/2024.1.13.eng
References: 
  1. Boniol M., Kunjumen T., Nair T.S., Siyam A., Campbell J., Diallo K. The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage? BMJ Glob. Health, 2022, vol. 7, no. 6, pp. e009316. DOI: 10.1136/bmjgh-2022-009316
  2. Campbell J., Dussault G., Buchan J.M., Pozo-Martin F., Guerra-Arias M., Leone C., Siyam A., Cometto G. A Universal Truth: No Health without a Workforce. Global Health Workforce Alliance and World Health Organization. Available at: https://www.who.int/publications/m/item/hrh_universal_truth (December 05, 2023).
  3. D’Aiglepierre R., David A., Levionnois C., Spielvogel G., Tuccio M., Vickstrom E. A Global Profile of Emigrants to OECD Countries: Younger and More Skilled Migrants from More Diverse Countries. OECD social, employment and migration working papers, 2020, no. 239. Available at: https://bit.ly/3BHsC99 (November 22, 2023).
  4. Kerr S.P., Kerr W., Özden Ç., Parsons C. High-Skilled Migration and Agglomeration. Annu. Rev. Econom., 2017, vol. 9, no. 1, pp. 201–234. DOI: 10.1146/annurev-economics-063016-103705
  5. Becker R., Teney C. Understanding high-skilled intra-European migration patterns: the case of European physicians in Germany. J. Ethn. Migr. Stud., 2020, vol. 46, no. 9, pp. 1737–1755. DOI: 10.1080/1369183X.2018.1561249
  6. Teney C. Immigration of highly skilled European professionals to Germany: intra-EU brain gain or brain circulation? Innov. Eur. J. Soc. Sci. Res., 2021, vol. 34, no. 1, pp. 69–92. DOI: 10.1080/13511610.2019.1578197
  7. Andersson D.E. Brain Drain and Brain Gain: The Global Competition to Attract High-Skilled Migrants, edited by Tito Boeri, Herbert Brücker, Frédéric Docquier, and Hillel Rapoport. J. Reg. Sci., 2013, vol. 53, no. 2, pp. 351–353. DOI: 10.1111/jors.12024_2
  8. Adeniyi M.A., Efuntoye O., Popoola G., Adebayo O., Ekundayo O., Ibiyo M., Igbokwe M.C., Ogunsuji O. [et al.]. Profile and determinants of intention to migrate by early career doctors in Nigeria: A report from CHARTING study. Int. J. Health Plann. Manage., 2022, vol. 37, no. 3, pp. 1512–1525. DOI: 10.1002/hpm.3422
  9. Ryazantsev S.V., Ochirova G.N. The impact of Labour Migration on the Sustainable Development of Central Asia. PONTE, 2019, vol. 75, no. 7, pp. 86–99. DOI: 10.21506/j.ponte.2019.7.9
  10. Dzushupov K., Lucero-Prisno D.E., Vishnyakov D., Lin X., Ahmadi A. COVID-19 in Kyrgyzstan: Navigating a way out. J. Glob. Health, 2021, vol. 11, pp. 03020. DOI: 10.7189/jogh.11.03020
  11. Vishniakov D., Kasiev N., Abdrasulova F. Healthcare system efficiency and its drivers in pre- and COVID-19 pandemic settings. Business, Manag. Econ. Eng., 2023, vol. 21, no. 2, pp. 293–310. DOI: 10.3846/bmee.2023.20409
  12. OECD. Recent Trends in International Migration of Doctors, Nurses and Medical Students. Paris, OECD Publishing, 2019. DOI: 10.1787/5571ef48-en
  13. van Dalen H.P., Henkens K. Emigration Intentions: Mere Words or True Plans? Explaining International Migration Intentions and Behavior. SSRN, 2008. DOI: 10.2139/ssrn.1153985
  14. Cairns D., Growiec K., Smyth J. Spatial reflexivity and undergraduate transitions in the Republic of Ireland after the Celtic Tiger. J. Youth Stud., 2012, vol. 15, no. 7, pp. 841–857. DOI: 10.1080/13676261.2012.683404
  15. Plopeanu A.-P., Homocianu D., Mihăilă A., Crișan E., Bodea G., Bratu R.-D., Airinei D. Exploring the Influence of Personal Motivations, Beliefs and Attitudes on Students’ Post-Graduation Migration Intentions: Evidence from Three Major Romanian Universities. Appl. Sci., 2018, vol. 8, no. 11, pp. 2121. DOI: 10.3390/app8112121
  16. Ivlevs A., King R.M. Family Migration Capital and Migration Intentions. J. Fam. Econ. Iss., 2012, vol. 33, pp. 118–129. DOI: 10.1007/s10834-011-9269-9
  17. Suciu Ş.M., Popescu C.A., Ciumageanu M.D., Buzoianu A.D. Physician migration at its roots: a study on the emigration preferences and plans among medical students in Romania. Hum. Resour. Health, 2017, vol. 15, pp. 6. DOI: 10.1186/s12960-017-0181-8
  18. Kabbash I., El-Sallamy R., Zayed H., Alkhyate I., Omar A., Abdo S. The brain drain: why medical students and young physicians want to leave Egypt. EMHJ, 2021, vol. 27, no. 11, pp. 1102–1108. DOI: 10.26719/emhj.19.049
  19. Hossain N., Shah N., Shah T., Lateef S.B. Physicians’ Migration: Perceptions of Pakistani Medical Students. J. Coll. Physicians Surg. Pak., 2016, vol. 26, no. 8, pp. 696–701.
  20. Goštautaitė B., Bučiūnienė I., Milašauskienė Ž., Bareikis K., Bertašiūtė E., Mikelionienė G. Migration intentions of Lithuanian physicians, nurses, residents and medical students. Health Policy, 2018, vol. 122, no. 10, pp. 1126–1131. DOI: 10.1016/j.healthpol.2018.07.001
  21. Gouda P., Kitt K., Evans D.S., Goggin D., McGrath D., Last J., Hennessy M., Arnett R. [et al.]. Ireland’s medical brain drain: migration intentions of Irish medical students. Hum. Resour. Health, 2015, vol. 13, pp. 11. DOI: 10.1186/s12960-015-0003-9
  22. Miller I. Review of “Doctors for Export”: Medical Migration from Ireland, c.1860–1960, by Greta Jones. Bull. Hist. Med., 2023, vol. 97, no. 1, pp. 163–165. DOI: 10.1353/bhm.2023.0014
  23. Dohlman L., DiMeglio M., Hajj J., Laudanski K. Global Brain Drain: How Can the Maslow Theory of Motivation Improve Our Understanding of Physician Migration? Int. J. Environ. Res. Public Health, 2019, vol. 16, no. 7, pp. 1182. DOI: 10.3390/ijerph16071182
  24. Krajewski-Siuda K., Szromek A., Romaniuk P., Gericke C.A., Szpak A., Kaczmarek K. Emig¬ration preferences and plans among medical students in Poland. Hum. Resour. Health, 2012, vol. 10, pp. 8. DOI: 10.1186/1478-4491-10-8
  25. Stankūnas M., Lovkytė L., Padaiga Ž. Lietuvos gydytojų ir rezidentų ketinimų dirbti Europos Sąjungos šalyse tyrimas [The survey of Lithuanian physicians and medical residents regarding possible migration to the European Union]. Medicina (Kaunas), 2004, vol. 40, no. 1, pp. 68–74 (in Lithuanian).
  26. Sancak B., Selek S.N., Sarı E. Depression, anxiety, stress levels and five‐factor personality traits as predictors of clinical medical students’ migration intention: A cross‐sectional study of brain drain. Int. J. Health Plann. Manage., 2023, vol. 38, no. 4, pp. 1015–1031. DOI: 10.1002/hpm.3646
  27. Nadir F., Sardar H., Ahmad H. Perceptions of medical students regarding brain drain and its effects on Pakistan’s socio-medical conditions: A cross-sectional study. Pak. J. Med. Sci., 2023, vol. 39, no. 2, pp. 401–403. DOI: 10.12669/pjms.39.2.7139
  28. Avdeev A.A., Troitskaya I.A. Features and factors of demographic dynamics in the Kyrgyz Republic. Popul. Econ., 2021, vol. 5, no. 2, pp. 29–54. DOI: 10.3897/popecon.5.e67183
Received: 
20.01.2024
Approved: 
31.03.2024
Accepted for publication: 
31.03.2024

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