International migration of surgeons, anaesthesiologists, and obstetricians.

www.thelancet.com/lancetgh Vol 3 (S2) April 2015 S11 The data provided by our study are relevant to both lower and higher income countries, and can help policy makers understand and predict the supply and demand of their future surgical workforce. For lower-income countries, addressing the shortage of surgical providers is fundamental to meeting the increasing need for surgical care. For higher-income countries that still depend on an influx of surgical professionals from lower-income countries, there should be much greater domestic capacity to meet the demand for surgeons, anaesthesiologists, and obstetricians. The internationally ratifi ed Global Code of Practice on the International Recruitment of Health Personnel aims to bring awareness in all countries to the importance of national workforce planning, resource allocation, and data collection. Although previous studies of international migration of physicians have used data from even fewer high-income countries, our study is limited by the inclusion of only 14 out of 75 high-income countries. This study is also limited by the fact that not all countries categorise specialists and subspecialists the same way, limiting comparisons between particular specialties. It is important to emphasise that the study results are based on the emigration of medical graduates, not necessarily fully trained specialists. Also, our study design did not address internal migration or the geographical maldistribution of the surgical workforce within countries due to migration into urban settings and to non-governmental organisations and administration, nor did we capture the surgical workforce migrating regionally between lowincome or middle-income countries. These limitations translate into a likely underestimation of the degree of migration out of the most severely affected settings, and we acknowledge that in analysing the surgical work force, one should also International migration of surgeons, anaesthesiologists, and obstetricians