Career plans of Polish medical university students

Transcription

1 Jośko Artykuły J i wsp. oryginalne Career plans of Polish / original medical university papersstudents 199 Career plans of Polish medical university students Plany zawodowe studentów polskich uczelni medycznych Jadwiga Jośko 1/, Janusz Kasperczyk 1/, Andrzej Grzybowski 2/, Jan Ejsmont 3/, Dorota Karwat 4/, Marzena Zarzeczna-Baran 5/, Zbigniew Jethon 6/ 1/ Chair and Department of Medicine and Environmental Epidemiology, Medical University of Silesia, Zabrze, Poland 2/ Department of Hygiene and Epidemiology, Medical University of Lodz, Poland 3/ Department of Hygiene and Epidemiology, Medical University of Gdansk, Poland 4/ Chair and Department of Epidemiology, Medical University of Lublin, Poland 5/ Public Health and Social Medicine Department, Faculty of Health Sciences, Medical University of Gdańsk, Poland 6/ Chair of Medical Sciences, Wroclaw University College of Physiotherapy, Wroclaw, Poland Wprowadzenie. Migracja wysoko wykwalifikowanych fachowców, zwłaszcza lekarzy i stomatologów od dawna jest tematem licznych badań. W ostatnich latach temat ten stał się również bardzo aktualny w Polsce. Cel. Zbadanie planów zawodowych studentów wydziałów lekarskich i stomatologicznych polskich uczelni. Materiał i metody. Badanie przeprowadzono w 4 uniwersytetach medycznych w Polsce przy użyciu anonimowego, autorskiego kwestionariusza. Udział w badaniu był dobrowolny. Wyniki. Zebrano dane od 1650 osób. Prawie 41% studentów planuje emigrację po studiach w poszukiwaniu wiedzy, lepszych zarobków i prestiżu zawodu. Jako kraj docelowy wybierają głównie Wielką Brytanię, Szwecję, Norwegię, Hiszpanię, Niemcy i Irlandię. Większość studentów jest dobrze poinformowana o warunkach pracy w krajach docelowych (staże, praktyki wakacyjne, praca wakacyjna za granicą, opinie znajomych). Wnioski. Znaczny odsetek przyszłej kadry medycznej wiąże swoją przyszłość zawodową z pracą za granicą. Przyczyny emigracji są od lat takie same: niskie zarobki, trudny dostęp do wybranej specjalizacji i kształcenia, niski prestiż zawodu. Należy wdrożyć odpowiedni system motywacji dla przyszłych lekarzy i stomatologów aby uniknąć negatywnych doświadczeń wielu krajów rozwijających się związanych z drenażem mózgów. Słowa kluczowe: emigracja, plany zawodowe, studenci, drenaż mózgów Introduction. Migration of highly skilled professionals, especially doctors and dentists have long been the subject of numerous studies. In recent years the subject has become very topical in Poland. Aim. To examine professional future plans of medical and dental students of Polish universities. Materials and methods. The study was conducted in four medical universities in Poland, using an author s anonymous questionnaire. Participation in the survey was voluntary. Results. The data were collected from 1650 people. Almost 41% of students plan to emigrate after graduation in order to improve their knowledge, financial status and professional prestige. As a destination country mainly the UK, Sweden, Norway, Spain, Germany and Ireland were indicated. Most students are well informed about working conditions in the destination countries (placements, vacation, summer job abroad, opinions of friends). Conclusions. A significant proportion of future health professionals associated their future with professional work abroad. The reasons for emigration have been constant for years: low salary, difficult access to the chosen specialization and education, low prestige of the profession. An adequate system of incentives for future doctors and dentists should be introduced to avoid the negative effect of brain drainage experienced in many developing countries. Keywords: migration, career plans, student, brain drainage Probl Hig Epidemiol 2011, 92(2): Nadesłano: Zakwalifikowano do druku: Adres do korespondencji / Address for correspondence Janusz Kasperczyk Katedra i Zakład Medycyny i Epidemiologii Środowiskowej ul. Jordana 19, Zabrze, Poland fax , jkas@mp.pl Introduction The migration of medical staff has become very topical in recent years, especially in Poland. Many countries in the world have been grappling with this problem which is broadly described in numerous publications [1-6]. Some percentage of doctors and dentists has always left Poland and we could observe this phenomenon every year; however, after our country s accession to the European Union which enabled us to work in other European countries, this phenomenon has intensified [5]. The subject literature often describes the problem of migration of medical specialists in terms of brain drainage and negative effects for exporting countries [5,7] resulting from

2 200 Probl Hig Epidemiol 2011, 92(2): this phenomenon. Similar problems, increasingly intensifying, can also be observed in Poland. The available data on the number of people planning to emigrate refer almost exclusively to practicing doctors who have taken documents certifying their qualifications from chambers of physicians and dentists, however, we lack detailed information concerning the number of doctors who have actually emigrated and the number of those who have emigrated without the above-mentioned documents. According to the incomplete data from chambers of physicians and dentists (of 2009) over 7 thousand doctors have already left Poland (there are 1800 doctors working in Great Britain only), which constitutes approximately 7% of all practicing doctors. However, in the case of some specializations this percentage has increased to 14%, e.g. in anaesthesiology or surgery. Polycentric studies on student career plans are scarce. The available, although limited literature shows that 40 80% of students think about emigration in search of better living conditions, higher salary or better perspectives for professional development [9,10]. For a country such as Poland it is slowly becoming a significant problem a financial one the cost of educating one student of medicine amounts to approximately 1 million PLN (approx Euro) which is irretrievably lost when a graduate emigrates and a social one the emigration of young doctors creates a generation gap resulting in a real threat for the health safety of the Polish population. We already lack doctors in Poland e.g. in Poland there is 1 GP for 2500 patients, while the EU average is one GP for patients. The data collected by Polish chambers of physicians and dentists show that the deficiency in some less profitable or more difficult specializations (e.g. paediatrics) is becoming increasingly more visible. Aim of the study 1. To learn about the plans of medical university students concerning the country they are planning to work in after graduation. 2. To specify the reasons behind students decisions to emigrate or to stay in Poland. Methods The research was conducted between in 4 medical education centers in Poland: Medical University of Gdansk, Medical University of Lublin, Medical University of Silesia and Medical University of Lodz. The research was conducted with the use of an author s anonymous questionnaire, filled in by each respondent individually without any time limits. The questionnaire included numerous open and closed questions concerning medical studies (a grade point average, a scholarship), students opinions concerning the curriculum, education, possibilities which the studies offer, career plans, students families and their attitudes towards emigration. There were 1650 students of medicine and dentistry, from the second to the sixth year, examined in total (Table I). Table I. The number of examined students at each university and faculty. Tabela I. Liczba przebadanych studentów na poszczególnych uczelniach i kierunkach University /Uczelnia Medical University of Gdansk /Uniwersytet Medyczny w Gdańsku Medical University of Lublin /Uniwersytet Medyczny w Lublinie Medical University of Silesia /Śląski Uniwersytet Medyczny Medical University of Lodz /Uniwersytet Medyczny w Łodzi Total /Razem Faculty of Medicine /Wydziały lekarskie Faculty of Dentistry /Wydziały dentystyczne Total /Razem ,3% ,7% 1650 The average age of examined students was 22.6±1.98 years and there were no significant differences between the universities. Women predominated at all universities 67%; with 33% of men. Statistical analysis The data were analyzed with the use of Statistica 8.0 program. Intergroup comparisons were made with the use of a Chi-square test, for quantitative variables t-tests or analysis of variance. Results As many as 40.8% of the examined students of all the universities are planning to work abroad after graduation. Characteristic is the fact that more men than women are planning to emigrate (44.8% vs. 38.8%). No significant differences among faculties were detected: 40.6% of future doctors and 41.5% of future dentists are planning to work abroad (p>0.05). The university itself (p=0.48) and the year of studies (p=0.11) do not have a significant impact on the decision to emigrate. Although more secondyear students are planning to emigrate (46.8%) in comparison with the fifth-year students (42.2%) or the sixth-year students (36.8%), the differences are insignificant. The decision to emigrate is not influenced by such factors as the number of times students took their entrance exam, by a scholarship or the grade point average (Table II).

3 Jośko J i wsp. Career plans of Polish medical university students Table II. Students planning to emigrate vs. those planning to work in Poland Tabela II. Porównanie studentów planujących emigrację do zamierzających pracować w Polsce Gender /Płeć Faculty /Wydział Scholarship /Stypendium Rightness of the decision /Słuszność decyzji Emigration /Emigracja Work in Poland /Praca w Polsce p value /współczynnik p men /mężczyźni 44,8% 55,2% p=0,03 women /kobiety 38,8% 61,2% Medicine /Medycyna 40,6% 59,4% p=0,11 Dentistry /Stomatologia 41,5% 58,5% yes /tak 40,2% 59,8% p=0,69 no /nie 41,3% 58,7% satisfied /zadowolony 39,4% 60,6% p=0,006 dissatisfied /rozczarowany Number of entrance exams taken /Za którym razem dostał się na studia Grade average /Średnia ocen 50,0% 50,0% 1,17±0,407 1,17±0,444 p=0,41 3,75±0,481 3,79±0,451 p=0,27 The analysis of the rightness of the decision made by students regarding their course of study shows interesting results. Almost 60% of all students were satisfied with their decision. Among the students who were satisfied with their choice regarding their future profession as many as 60.6% declared willingness to stay in Poland, while in the group of students disappointed with their choice only 50.0% (p=0.006). Among the reasons why students were disappointed with their choice of studies the respondents enumerated such elements as lack of professional perspectives, low salary, too much effort to get a diploma in comparison with opportunities that it provides, as well as long professional career training. Students want to go abroad as they expect greater prestige (38.8% of the students planning to emigrate), higher salary (74.1%), better career perspectives (55.6%), better work organization (45.1%), while 18.2% of the students declared planning to emigrate to join their family/friends already working abroad (possibility of multiple answers). No significant differences between the answers given by students of dentistry and medicine (p>0.05) were detected. Apart from the above-mentioned factors, the decision to emigrate from Poland was influenced by opinions of friends, family, professors and doctors. It has been found that 39.4% of the students declaring their willingness to leave Poland were much more often encouraged to stay (p=0.005) in comparison with the students who were not planning to emigrate 31.2%. It is not surprising a person who is not planning to go abroad will not be discouraged from emigrating. A situation was slightly different when students were asked whether they were encouraged to emigrate the research has shown that individuals planning to 201 emigrate are much more often (p<0.0001) encouraged to leave Poland (64.1%) than persons who are willing to stay (32.7%). These are mainly parents, close family and friends (usually living in Poland) who encourage students to stay, while students are encouraged to emigrate mainly by their friends, parents (usually those who worked abroad, work abroad and who work in a medical sector), doctors and professors. The answers to the question concerning the country of destination were quite diversified the great majority of students mentioned Great Britain (24.8%), Sweden (11.4%), as well as Norway, Spain, Germany, Ireland (5-8%) and other countries 26.7%; 19.2% of the students have not decided which country they want to go to, although they are planning to emigrate. The majority of students mentioned 1 country of destination, some of them mentioned 2 or 3 countries, usually connected with one another because of a certain type of similarity, e.g. language, a geographical location. 26.5% of the students planning to emigrate decide on a permanent stay abroad, 39.9% do not specify how long they want to stay abroad using such expressions as for some time a few years, 16.0% of the students intend to complete an internship and specialization abroad and return to Poland, while 17.6% are planning to stay abroad until they manage to earn enough money to start their independent lives in Poland (a slight prevalence of dentistry students). The majority of students are planning to work exclusively in their profession (77.4%), 11.2% would prefer to work in their profession but they do not exclude the possibility of working in other medical professions, 10.3% would prefer to work in their profession, but do not exclude any other job, even one outside their course of studies and as few as 1.1% of the students do not mind what they will do as long as their salary is satisfactory. No significant differences between the answers given by students of medicine and dentistry were found. The comparison of students planning to emigrate with those wanting to work in Poland is not uniform as far as experiences of the work abroad by their family members are concerned. While the percentage of parents who worked, work or are planning to work abroad is comparable in both cases, with a slight though significant (p>0.05) prevalence among the students planning to emigrate, it can be observed that students planning to emigrate usually have siblings (p<0.0001) or friends (p=0.001) who have some experience with work abroad, in comparison with students who are planning their professional career in Poland (Figure 1).

4 202 Probl Hig Epidemiol 2011, 92(2): % p<0.06 p< p<0.001 Parents A Parents B Siblings A Siblings B Friends A Friends B Intends to work abroad /Zamiar pracy za granicą Worked abroad /Pracował za granicą Working abroad /Pracuje za granicą Working in Poland /Pracuje w Polsce A - students planning to work in Poland /studenci planujący pracę w Polsce B - students planning to emigrate /studenci planujący emigrację Fig. 1. Work abroad of family members and friends of students planning to emigrate or to stay in Poland Ryc. 1. Praca za granicą rodziny i znajomych studentów planujących wyjazd lub pozostanie w Polsce Students planning to emigrate are more often those who have already had some experience in working abroad than their colleagues who are planning to stay and work in Poland (34.7% vs. 24.8%; p= ), and they completed hospital internships abroad more often than their colleagues (14.7% vs. 7.4%; p= ), which suggests a conscious choice of their professional career. Discussion There are not many objective studies showing the scale and reasons why doctors emigrate [3,4,8]. Even less in known about professional plans of medical students. The available studies usually concentrate exclusively on one medical education center and cover a relatively small population [9,10]. Presented results come from 4 medical universities in Poland and include opinions of 1650 future doctors and dentists. The results of our studies have confirmed a widely known fact that it is not particularly attractive to be a doctor in Poland. The results of our studies have shown that over 40% of students are planning to work abroad after graduation, which is slightly less in comparison with our earlier studies conducted among students at the Faculty of Medicine in Zabrze (almost 43%) 7, but the difference was insignificant. Our study was conducted before the crisis, but it concerned the countries that had experienced very similar effects. There was no significant change in the intensity of professionals emigration from Poland between 2007 and 2010 (data from chambers of physicians and dentists) perhaps because the problems that cause emigration, as described in this publication, have not changed over that time. The results of other studies conducted in Silesia show that 85% of the students are considering the possibility of working abroad [10]. A considerable difference probably resulted from a different type of a question asked it was not a declaration of emigration, but only general plans to work abroad. The results of conducted studies show that career plans are not influenced by the course of studies, faculty or the year of studies. The reasons why students emigrate have been found common for all students. These are mainly finances and better working conditions [2]. Similar factors are mentioned as reasons why doctors emigrate in similar reports worldwide [1,4,5]. Low prestige of a doctor s profession, as well as difficulties in completing postgraduate studies (difficult access to a chosen specialization, high financial and personal costs, difficult final specialization exam) are Polish specificities, which can be observed both in described studies and in the available literature [3,7,8,10]. All these factors result in the fact that gaining similar qualifications abroad proves to be simpler, in spite of linguistic difficulties. The decision to emigrate is difficult and that is why the great majority of students ask their family members for advice, mentioning them as their source of information regarding working abroad. The majority planning to emigrate are well informed about working conditions abroad. On the one hand, there are opinions of family members and friends, but on the other hand, students have their own experiences gained while they worked abroad during holidays or during their hospital internships. These experiences provide future emigrants with the picture of what to expect when working abroad. Students know what country they want to go to, however, in the questionnaire there was no question about the reasons behind their choice. However, when analyzing other questions, it can be concluded that criteria influencing students choice include such elements as linguistic skills, cultural similarity or willingness to join their family or friends who already work abroad. Therefore, the decision about emigration should be well-considered and made after collecting relevant information and own experiences (internships completed abroad) or experiences of friends/family members working abroad. Emigration of future doctors will lead to an increase in the deficiency of medical staff, which is already visible in Poland, especially in unprofitable

5 Jośko J i wsp. Career plans of Polish medical university students and demanding specializations [6]. Other countries [5,7,11] faced similar problems, which resulted in simplifications for persons planning their career in a medical sector. Poland cannot afford to import specialists from other countries, mainly because of financial reasons, as the salary is not satisfactory not only for Polish doctors but also for potential immigrants who may treat our country as a stop on their way to Western Europe. The data collected by chambers of physicians and dentists show that for over 7000 Polish doctors who emigrated there are about 300, mainly from Eastern Europe, who want to work in Poland. However, it is difficult to raise salaries in the current Polish system. Nevertheless, there are several ways of improving the attractiveness of a doctor s profession by: simplifying access to specializations and education too many students leave Poland because they are afraid that they would not have the chance to start the specialization they dream of. s p e c i f y i n g d o c t o r s c om p e t en c e s a n d responsibilities so that it is clear who is responsible for the situation in the health care sector. Doctors are usually blamed for all difficulties, 203 while restrictions of medical procedures, queues, problems with access to specialists actually result from restrictions on which doctors have no influence. Such activities might prevent at least some potential emigrants from leaving Poland, at least until they complete their specialization. It would give us some time for the implementation of greater reforms, expected especially by the medical environment namely a guaranteed health service offer and an increase of health insurance premium. Conclusions 1. A significant percentage of future medical staff see their professional future abroad. 2. The reasons behind emigration remain the same: low salary, difficult access to a chosen specialization and training, low prestige of the profession. 3. We should implement an appropriate motivational system for future doctors and dentists in order to avoid the negative effect of brain drainage experienced in many developing countries. Piśmiennictwo / References 1 Astor A, Akhtar T, Matallana MA, et al. Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Soc Sci Med 2005, 61(12): Garcia-Perez MA, Amaya C, Otero A. Physicians migration in Europe: An overview of the current situation. Health Serv Res 2007, 7: Article Number: Sapilak BJ, Siankowska H, Siankowski M, et al. An evaluation of problem of proffessional burnout and the impact of professional burnout on decisions about labourrelatedmigration among middle and senior healthcare professionals. Fam Med Prim Care Rev 2009,11(3): Kingma M. Les migrations des professionnels de la sante. Cah Sociol Demogr Med 2005, 45(2-3): Gerlinger T, Schmucker R. Transnational migration of health professionals in the European Union. Cadernos de Saude Publica, 2007, 23(2): Edbom-Kolarz A, Marcinkowski JT. Emigracja lekarska z Polski do Szwecji i jej uwarunkowania. Cz. I. Wprowadzenie. Hygeia Public Health 2010, 45(1): Watkins S. Migration of healthcare proffesionals: practical and ethical consideations. Clin Med 2005, 5(3): Edbom-Kolarz A, Marcinkowski JT. Emigracja lekarska z Polski do Szwecji i jej uwarunkowania. Cz. II. Wyniki badań wstępnych. Hygeia Public Health 2010, 45(1): Jośko J, Kostkiewicz M, Mazurek Ł, Wojcieszek P. Ojczyzna czy obczyzna? plany zawodowe studentów Śląskiej Akademii Medycznej. Probl Hig Epidemiol 2007, 88(1): Krajewski-Siuda K, Romaniuk P, Madaj B, et al. Brain drain threat Polish students are not satisfied with labor market options for health professionals in Poland. J Public Health 2008, 6(5), Oman KM, Moulds R, Usher K. Professional satisfaction and dissatisfaction among Fiji specialist trainees: What are the implications for preventing migration? Quantitive Health Research 2009, 19(9):