Interviews were successfully done with 25 physicians. From these 25 physicians 9 physicians were consultant, while 7 were specialists, and 9 were residents or general practitioners. Most of the sample were males with only 3 females. Most physicians were working inside Egypt (17) with 9 physicians working abroad (3 in Gulf countries -Saudi Arabia and Kuwait- and 6 in Western countries-USA and UK). The interview was around 30 minutes duration ranging from 22 to 40 minutes.
It was evident that all the interviewees considered or thought of practicing medicine abroad at different stages in their careers. Most of them considered that early after graduation or after finalizing their training program. Several reasons for leaving the country were mentioned. Some mentioned low payment compared to other countries even the ones with financial struggles like Maldives, and Zambia where some Egyptian physicians started working there. Other people mentioned better training opportunity and exposure to more advanced technologies and seeking world class recognition in medicine. “Take a world class training and strong certificate that none can refuse, then the world is all yours” according to one physician taking about his reasons to practice medicine in the united stated. The sense of insecurity, “underestimation”, and loss of effort was the main reason why one physician in a relatively good training place in Egypt decided to leave to Germany. “I might be attacked by any relative or patient in the Emergency room in the hospital, if any complications happen to a patient. It is my responsibility to solve the equipment and medications shortage. People don’t understand that. They just believe doctors are monsters with no mercy” He stated.
“Medicine is a career that eats you up specially in Egypt. It takes several years to build a career. You need Masters, Philosophy of Doctorate (PhD), and different fellowships and thousands of courses in order to become a good doctor. And this might not happen. Your forties are your golden age while in any other profession you start to make good profits with a better lifestyle in 20s-30s”. Says Dr. Mohamed working in one of the brilliant institutes in Egypt. He believes that despite his work in Egypt and having a good private practice and good financial income compared to his peers, that he could make similar amount of money with better lifestyle if he left to one of the Gulf countries.
“I have attended a medical conference when I was a student, and since I landed in USA, I decided I want to be here” One physician working in USA describing that the reason why he left Egypt was not just related to medicine, but to the whole situation. He believed that he could have better lifestyle and experience in USA for himself and his family in the future. He compares the USA and Egypt in many aspects including income, health services, education opportunities, and others. The social aspect was his main motive to immigrate, and medicine provided him a prestigious job in the United States.
The challenging nature of work, and the stressful working environment dealing with sick people, watching them dying, or in pain make physicians depressed. This is exaggerated by the malfunctioning healthcare system- from their point of view-. Some physicians mentioned there were situations where they could provide help to their patients but couldn’t do due to several reasons. This was frustrating to them. “Working in healthcare systems where all the equipment is available and ready to use regardless of the cost is the goal of medicine. I would feel more accomplished then regardless of the outcomes”, one specialist said. That challenging working atmosphere and hard career pathway was the reason why many physicians would even totally drop medical practice or limit it and have side business to improve his income.
It could be easily detected that there are 2 main groups of physicians leaving the country. The first group representing majority of the interviewees who believed of leaving to Gulf countries. The options were Saudi Arabia, Kuwait, Oman. Few had opportunities in United Arab Emirates and Qatar. The major drive to leave was better payment, less workload, culturally and socially accepted communities to raise families. The major challenge was that most of the opportunities were service jobs not training jobs with less opportunity to find a career pathway and upgrade clinically except in limited cases and centers.
The other group was directed west. On the top of the list came UK. Other countries included USA and Germany and Australia in few cases. These countries provide better training opportunities specially for those starting early in their careers. Payment is very good in USA compared to the UK. The power of the training certification in these countries and their international accreditation overcome the high working load many physicians complain of. The social aspect and the ability to blend in the western communities specially with physicians who have families were the main concerns mentioned by the interviewees. Physicians working in western countries admitted several challenges regarding the social aspect and the variance in quality of the training programs in their centers too, yet they believed their current situation is better than what they witness from their colleagues working in Egypt.
All the physicians working in Egypt mentioned they do have private practice either a private clinic or part-time working in private hospitals and centers. They mentioned that this is not an option because it is the main bulk of income to their families. Some physicians in Egypt believe the Egyptian government is doing efforts to improve the situations of physicians with salary raise for house officers and medical practitioners, (11) but they believed it is not sufficient to retain the physicians. This is incomparable to the international incentives’ physicians get in other countries. They believe the main drive for the Egyptian physicians to stay in Egypt was the social aspect and the strong ties they have in Egypt. Suggestions by the interviewees to retain Egyptian physicians included increase in the total budget of healthcare. This should improve healthcare quality and raise physicians’ wages. Improvement of the medical education either in the undergraduate or the postgraduate levels. This will bring back the quality of the Egyptian physician and increase his credibility abroad as used to be. Reform of the private market with reduction of the payment inequalities between physicians at different centers and private practice. Other suggestions were increase in training grants either nationally for master’s or PhD or internationally for fellowships. Additionally, standardization of the physician training either in the residency pathway or the fellowship pathways of medical training. Finally, it was suggested to provide more security to physicians in their medical practice with effective legislative system and malpractice insurance.