International Migration of Doctors, and Its Impact on Availability of Psychiatrists in Low and Middle Income Countries

Background:Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. Methods: In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. Findings: We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149) , Nigeria (384) , Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100, 000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). Conclusions: Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/ population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health, and that there are public and fair agreements between countries within an internationally agreed framework. © 2010 Jenkins et al

Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design.

Frequent attendance to the emergency department (ED) is a growing public health concern. Designing services for frequent attenders poses challenges, given the heterogeneous nature of this group. This was a two-part observational study identifying frequent attenders from ED records. The first stage studied trends and developed personas with emphasis on differentiating moderate frequent attenders (attending between 5 and 20 times per year) and extreme frequent attenders (attending more than 20 times). Stage 2 included a case note review of 100 consecutive frequent attenders. Results showed an increase in frequent attendance from 2.59% to 4.12% over 8 years. Moderate frequent attenders accounted for 97%. Of the 100 frequent attenders studied, 45% had medically unexplained symptoms (MUS), associated with younger age (p0.05). In conclusion, the ED is a useful hub for identifying frequent attenders with MUS, particularly among moderate frequent attenders; service design for this group should consider a 'whole-systems approach' with integration between primary and secondary care, including specialist liaison psychiatry services where appropriate

The number of psychiatrists with specialist qualifications from each of the countries in the WHO Eastern Mediterranean Region who are now working in the UK, Australia, New Zealand and USA.

1<p>Data from The Royal College of Psychiatrists 2007</p>2<p>Data from RANZCP 2008</p>3<p>Data from 2006 Medical Council of New Zealand annual workforce survey</p>4<p>Data from the American Psychiatric Association 2008</p>5<p>Data from the WHO Atlas 2005</p

The number of psychiatrists with specialist qualifications from each of the countries in the WHO European Region who are now working in the UK, Australia, New Zealand and USA.

1<p>Data from The Royal College of Psychiatrists 2007</p>2<p>Data from RANZCP 2008</p>3<p>Data from 2006 Medical Council of New Zealand annual workforce survey</p>4<p>Data from the American Psychiatric Association 2008</p>5<p>Data from the WHO Atlas 2005</p

The number of psychiatrists with specialist qualifications from each of the countries in the WHO South-East Asia Region who are now working in the UK, Australia, New Zealand and USA.

1<p>Data from The Royal College of Psychiatrists 2007</p>2<p>Data from RANZCP 2008</p>3<p>Data from 2006 Medical Council of New Zealand annual workforce survey</p>4<p>Data from the American Psychiatric Association 2008</p>5<p>Data from the WHO Atlas 2005</p

The number of psychiatrists with specialist qualifications from each of the countries in the WHO Americas Region who are now working in the UK, Australia, New Zealand and USA.

<p>The number of psychiatrists with specialist qualifications from each of the countries in the WHO Americas Region who are now working in the UK, Australia, New Zealand and USA.</p

The number of psychiatrists with specialist qualifications from each of the countries in the WHO Western Pacific Region who are now working in the UK, Australia, New Zealand and USA.

1<p>Data from The Royal College of Psychiatrists 2007</p>2<p>Data from RANZCP 2008</p>3<p>Data from 2006 Medical Council of New Zealand annual workforce survey</p>4<p>Data from the American Psychiatric Association 2008</p>5<p>Data from the WHO Atlas 2005</p

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially