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Early career retention of Malawian medical graduates: a retrospective cohort study

OBJECTIVE: There have been longstanding concerns over Malawian doctors migrating to high‐income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. METHODS: We obtain...

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Autores principales: Mandeville, Kate L., Ulaya, Godwin, Lagarde, Mylene, Gwesele, Lyson, Dzowela, Titha, Hanson, Kara, Muula, Adamson S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737132/
https://www.ncbi.nlm.nih.gov/pubmed/25329519
http://dx.doi.org/10.1111/tmi.12408
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author Mandeville, Kate L.
Ulaya, Godwin
Lagarde, Mylene
Gwesele, Lyson
Dzowela, Titha
Hanson, Kara
Muula, Adamson S.
author_facet Mandeville, Kate L.
Ulaya, Godwin
Lagarde, Mylene
Gwesele, Lyson
Dzowela, Titha
Hanson, Kara
Muula, Adamson S.
author_sort Mandeville, Kate L.
collection PubMed
description OBJECTIVE: There have been longstanding concerns over Malawian doctors migrating to high‐income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. METHODS: We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi‐squared tests were employed to investigate relationships by graduation year and gender. RESULTS: We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54–2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61–0.86, P < 0.0001). CONCLUSIONS: While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work.
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spelling pubmed-47371322016-02-11 Early career retention of Malawian medical graduates: a retrospective cohort study Mandeville, Kate L. Ulaya, Godwin Lagarde, Mylene Gwesele, Lyson Dzowela, Titha Hanson, Kara Muula, Adamson S. Trop Med Int Health Brain Drain OBJECTIVE: There have been longstanding concerns over Malawian doctors migrating to high‐income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. METHODS: We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi‐squared tests were employed to investigate relationships by graduation year and gender. RESULTS: We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54–2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61–0.86, P < 0.0001). CONCLUSIONS: While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. John Wiley and Sons Inc. 2014-10-20 2015-01 /pmc/articles/PMC4737132/ /pubmed/25329519 http://dx.doi.org/10.1111/tmi.12408 Text en © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Brain Drain
Mandeville, Kate L.
Ulaya, Godwin
Lagarde, Mylene
Gwesele, Lyson
Dzowela, Titha
Hanson, Kara
Muula, Adamson S.
Early career retention of Malawian medical graduates: a retrospective cohort study
title Early career retention of Malawian medical graduates: a retrospective cohort study
title_full Early career retention of Malawian medical graduates: a retrospective cohort study
title_fullStr Early career retention of Malawian medical graduates: a retrospective cohort study
title_full_unstemmed Early career retention of Malawian medical graduates: a retrospective cohort study
title_short Early career retention of Malawian medical graduates: a retrospective cohort study
title_sort early career retention of malawian medical graduates: a retrospective cohort study
topic Brain Drain
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737132/
https://www.ncbi.nlm.nih.gov/pubmed/25329519
http://dx.doi.org/10.1111/tmi.12408
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