This is the first study that has looked in to the aspirations of migration of medical graduates in Sri Lanka. It shows that a significant proportion of the sample (23.8%) intend to migrate while a larger percentage (32.4%) are still not sure of their ultimate decision. As mentioned previously, though data is not available for all locally trained doctors, 11% of board certified consultants have either not returned from their foreign training or have left the country after coming back [1]. Therefore the risk of brain drain is real and still has the potential to amplify in the coming years with larger numbers of locally trained graduates intending to leave the country.
However, it is notable that of the socio-demographic and situational factors that were analyzed, none were significantly associated with an intention to migrate (table 3). This means that the subgroup that is intending to migrate cannot be differentiated from others based on any predictive traits. The decision to migrate therefore may be a highly individualized decision fuelled by unique and heterogenous contributory factors. However, when queried about why they intended to migrate most seemed to cite a better quality of life and better earnings as the prime cause for emigration. Even those not intending to migrate immediately seem to think along those lines. In the days of global connectivity, the salaries and life styles of peers abroad is easily visible to undergraduates in Sri Lanka and communication with them is always easier than ever before. Therefore, people do have ways and means of appreciating the cost of living, salaries and savings in a foreign country much better than before. It is also noted that most undergraduates responded that one reason they would like to stay behind is to be with their family. However, again in view of ease of communication, this may be less of a limiting factor now, as effective means of communication over the internet can maintain close connectivity across borders.
Local data on the topic of migration of medical professionals is limited. A single qualitative study from Sri Lanka on migration of medical specialists has revealed better quality of life, having to work in rural parts of Sri Lanka if they remain in the country, future career development, and social security as topmost reasons to migrate [1]. This data is from only 5 emigrated specialists as the study had a poor respondent rate. Hence the generalisability of this data is questionable. Our study is unique as we look at factors that influence a decision to migrate before the act of actual migration.
Conclusion
This cross-sectional survey from the largest medical faculty of Sri Lanka showed that out of a sample of 374 first year, fourth year students and newly passed out graduates, 23.8% have already decided to migrate while another 32.3% were unsure as to whether they would choose to migrate or not. The most cited reasons for migration were a perceived better quality of life, better earnings and more training opportunities in the host country. The most commonly cited reason against migration was the loss of family bonds. There were no socio-demographic characteristics that had a significant association with an intention to migrate in this sample indicating that it is a highly personal and an individualized decision without any group characteristics. The rates of intention to migrate are low when compared to international studies from Africa and South Asia but nevertheless significant. Observing the trends of migration, maintaining accurate databases of migrating medical professionals and having a multi sectoral policy plan to uplift the quality of life of medical professionals is a need of the hour to curb the “brain drain”.