1. Health Professional Migration in an Interconnected World The case of Lebanon Jinan Usta

2. University (Founded) Faculty of Medicine Established Student Number MDs/year American University of Beirut (AUB) (1866) 18677,00090 Université St. Joseph (1875) 188310,00065 Beirut Arab University (BAU) (1960) (Affil. of Alexandria University) 196611,00050-60 Lebanese University (LU) (1953) 198380,00085-88 Balamand University (1988) 20003,10040-45 Université St. Esprit de Kaslik (1961) 20027,00024- Lebanese American University (LAU) (1835) 20067,50064 Average MDs/ Year ~ 500 LEBANESE MEDICAL SCHOOLS

3. LEBANON: ~ 75% of MDs pursue PGME abroad (PGME)

4. Akl et al. BMC Public Health 2008, 8:191 Lebanese medical students and emigration: Why do they go?

5. Time trends (1978-2004) of the number of Lebanese medical graduates in the US (number of residents, of practicing physicians and total number). Data for 1984 and 1990 are missing; we used straight interpolation in drawing the trends. RESIDENTS PRACTICING PHYSICIANS TOTAL

6. Emigration Factor: What is it?

8. LMG and emigration Lebanon has the highest emigration factor (EF) in the Middle East and North Africa and the 7th highest in the World Mullan F. NEJM. 2005; 353:1810 Emigration Factor: approximate percentage of medical school graduates from a source country working in one of four major recipient countries

9. LMG and emigration Numbers 2010: 3000 LMG in the US – 0.3% of all active physicians (n=910,755) – 1.3% of IMG (n=215,928) 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US Akl EA. BMC Health Serv Res. 2007; 7:49

10. Profession Group Practice93 (33%) Self-employed solo practice58 (20%) Government Facility29 (10%) Medical School15 (5%) Other26 (9%) No Classification62 (22%)

11. The willingness of Lebanese medical graduates in the United States to relocate to Lebanon and the Arabic Gulf region: a survey study Badr KF and Akl, EA. Regionalizing healthcare: a vision for transforming Lebanon into a regional academic hub. BMC Health Services Research. BMC Health Services Research, 10:167-170. 2010.

12. Findings: - 286 physicians participated in the survey (57% response rate) -A majority (61%) were willing to relocate to Lebanon -A third (33%) were willing to relocate to Arab Gulf region -About half (54%) were willing to relocate to Lebanon as a base for clinical missions to the Arab Gulf region

13. Why would they leave Career Citizenship Lack of support Political situation Economic Financial Phoenician genes?

14. Why would they go back Family Wife origin Social life Less competition ? Citizenship/change of contract

15. Advantages Knowledge and expertise (Lebanon) Change (Lebanon) Variety (Lebanon) Economic (Lebanon) Manpower redistribution (USA) Serving the underserved (USA)

16. Disadvantages Manpower mal distribution Loss of brain power Financial Family medicine vs Primary care

17. Role of AFP Encourage/assist in development of accredited programs- not copy paste Platform to share: –Best practices –Exchange of experiences –Develop algorithms/guidelines