Migration of Doctors – Where To: The Realities

Given the high number of registered medical graduates in the country, that was further highlighted recently when only 60 out of about 450 medical practitioners had been recruited by the Ministry of Health and Quality of Life (MOH), there has been talk about the migration of our doctors. While this may seem an obvious and practical proposal, it is nevertheless not an easy one to implement. The issue of migration is highly complex, as we are seeing in the current ‘migration crisis’ in the European Union. And ‘medical’ migration is attended by a number of constraints related to the specificities of the medical profession and the complexities of medical practice, which makes it even more difficult.

Currently there are approximately 2500 registered medical practitioners in the country, of whom about 800 are specialists. On an average between 200 – 250 have been registered annually for several years now, and this trend is likely to continue for 4-5 years more. MOH employs a total of less than 1000 doctors on a substantive basis, and this number has not increased significantly for many years. For this to happen, new posts have to be created, which means increasing the budget of MOH, and this is a larger national policy issue that has to be considered within the overall economic landscape of country, besides negotiations at the level of the Ministries of Finance and Civil Service Affairs.

But a look at the medical manpower situation from a longer historical perspective will help us to place this issue of migration in context. In the colonial times, Mauritian citizens went mainly to the UK and France for their medical studies, for obvious reasons. It was only after India obtained Independence and relations with the USSR and other Iron Curtain countries (e.g. Poland, Rumania) were established that the possibility of studying in those countries opened up for our citizens. Many Mauritians went to India and Pakistan either on scholarship or on self-finance basis, while those going to the communist countries did so mostly on scholarships awarded by those countries, with all of them returning to practise in Mauritius.

As for those who went to France and the UK, many stayed back because the employment laws as well as medical manpower needs there gave this possibility to them. There were also possibly other more attractive opportunities that existed, such as medical research or academic positions that were not available locally. Besides, Mauritians were also going to some other countries although in lesser numbers, such as Tunisia, Algeria, Egypt but again, would return to the country.

In the wake of the breakup of the USSR in the late 1990s, and the subsequent emergence of a new ‘commonwealth’ of countries in that vast region, many of the latter, such as the Ukraine, started to offer medical education in English at more affordable rates than UK or France. This was an opportunity for many more Mauritians to go and study in those new destinations, to which in the past fifteen years or so has been added China, with a large number of universities and medical colleges at similarly affordable rates, and also in English language. After graduating in these countries, all the doctors come back to Mauritius. Together with the hundred or so that have been passing out annually from the SSR Medical College at Belle Rive since 2005, it is therefore no surprise that the number of doctors in the country has known a massive increase, keeping in mind the size of our population.

On the other hand, comparatively there are only a handful of Mauritians who have studied in North America (USA and Canada) and who mostly have settled there. A few have also studied in South Africa and Kenya, and have returned to the country. As can be seen, therefore, it is mainly UK and France that have been possible ‘migration’ destinations for Mauritians, and that too in the years before the 1990s, after which things have become more difficult if not impossible because of the barriers to entry and the employment situation of native medical graduates there.

The new rules of the European Union give priority of employment to EU nationals across EU countries, which from our point of view means UK and France. Even the fewer Mauritians who are graduating in those two countries are at pains to secure jobs there, what with the EU rules and the country-specific constraints and dwindling opportunities. Anyone who wishes to practise in the UK must pass the PLAB (Professional and Linguistic Ability Test), which is both costly and difficult, even for those who have studied in English medium elsewhere (China, India, ex-USSR countries). But even if one crosses this barrier, there is then the question of finding a suitable position, and this is only for pursuing post-graduate studies, for which there is a limitation on the number of years allowed, which I think is five years. There are equivalent constraints in France.

As far as the USA and Canada are concerned, there too there are costly and quite tough entrance requirements, such as the USMLE in the USA which is in three steps. After spending a fortune in acquiring a first medical degree, often with the parents taking a loan, hardly anyone can afford to seek employment in these two countries.

This leaves us with the Arab countries and Africa. The one time that there was a relatively large number of Mauritians who ‘migrated’ was in the early 1980s, to a few Gulf countries. But that was temporary, and they were all back after a few years. Not all of them were enamoured with their experience, though their financial situation was better on the whole. In Africa there are even fewer opportunities for our citizens.

These are only some of the realities and difficulties that stare us when we talk of the migration of doctors, and doctors themselves are aware of the extremely limited possibilities and opportunities that exist, especially in the developed countries. Any decision that has to be taken in relation to individual aspiration to become a doctor or at the national level has to factor in these hard but unavoidable realities and constraints.

• Published in print edition on 13 November 2015