International health worker migration: the case of GB-registered pharmacists
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Transcript of International health worker migration: the case of GB-registered pharmacists
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International health worker migration: the case of
GB-registeredpharmacists
Professor Karen Hassell
Global health, Justice and the ‘Brain Drain’ Conference, Keele University
17th September 2007
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Acknowledgements
• Liza Nichols – PhD Student• Peter Noyce – other supervisor• RPSGB – funding• The pharmacists themselves
For more information about our research please visit:
www.manchester.ac.uk/cpws
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Presentation outline
• Some background about the pharmacy profession
• Data on the current stock of pharmacists
• Migration in and out of the profession
• Who emigrates and why
• Implications
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Some facts about pharmacy
• Degree entry profession from 1967
• Now a 4-year (MPharm) degree programme
• 1 year pre-registration training before qualifying
• 16 ‘established’ Schools of Pharmacy
• Majority of pharmacists work outside the NHS
• Large chains now dominate private sector
• Changing professional role• The RPSGB (and PSNI) is currently the professional
and regulatory body for the profession
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Number of GB registered pharmacists:
selected years
26,6295064
268106800
28,6179432
3291314259
39,46720325
4796226932
0 10,000 20,000 30,000 40,000 50,000
1964
1972
1981
1991
2001
2007
All pharmacists Females
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Number of pharmacists: 2002 to 2007
Total number on regsiter by gender
20000
21000
22000
23000
24000
25000
26000
27000
28000
Male 21912 22152 22396 21193 20949 21030
Female 23355 24233 25182 25203 26119 26932
2002 2003 2004 2005 2006 2007
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Demographic profile of all pharmacists on GB register (2007)
12.9
16.1
23.0
27.1
21.0
3.4
5.6
19.1
71.9
43.8
56.2
0 10 20 30 40 50 60 70 80 90
60 yrs and over
50 - 59 yrs
40-49 yrs
30 - 39 yrs
29 yrs and under
Black
Other EG
Asian
White
Male
Female
%
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Age groups by gender (2007)
24.8
16
30.4
22.9 23.921.8
13.8
18.9
7
20.4
0
5
10
15
20
25
30
35
%
29 yrs and under 30 to 39 yrs 40 to 49 yrs 50-59 60 and over
Female Male
Data source: 2007 register (n = 47232)
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The pharmacy workforce in context
• Not largest health care workforce in GB:• Smaller than nurses and doctors
• But larger than dentists and physios
• Size in comparison with other countries:• 249,642 (88/100k pop) in USA (2000 data)
• 13,956 (72/100k pop) in Australia (2001 data)
• 20,765 (67/100k pop) in Canada (2003 data)
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Distribution of pharmacists in selected EU countries (2004 data)
Data source: www.fip.org0 50 100 150 200 250
per 100,000 population
NetherlandsTurkeyNorway
GermanyPoland
DenmarkSwitzerland
GBEU Average
SpainFrance
ItalyFinland
Malta
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Distribution of pharmacists elsewhere (2003/04 data)
Data source: www.who.int/whosis/database
0 10 20 30 40 50 60 70 80
per 100,000 population
Kenya
Bangladesh
Nigeria
Cameroon
Gambia
Uganda
Ethiopia
GB
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Immigration of pharmacists:Students
• How many?• UCAS data: 1741 (1996); 2237 (in 2001)• 19% & 16% respectively were from ‘overseas’• In 2001 majority (53%) were non-EU
• Trends?• Why study in the UK?• What happens after studying?
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Immigration of pharmacists: Practitioners
• There were three (but now two) routes for overseas pharmacists to enter the register of pharmaceutical chemists:• ‘European’
• ‘Adjudicating’
• Reciprocity route abolished
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0
200
400
600
800
1000
1200
Recip. 961 968 1059
Euro. 481 864 989
Adjud. 975 1130 1244
total 2417 2962 3292
2002 2003 2004
Number of foreign trained pharmacists domiciled in GB, 2002 - 2004, by entry route
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Immigration of pharmacists: Practitioners
• Not a large number/proportion, but growing
• Registration requirements vary
• Source countries
• Practitioner experience of working in GB?• Exploitation?
• Work conditions?
• Language problems?
• Financial burden?
• Pre-registration difficulties
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Pharmacist emigration
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Pharmacist emigration
45110 (100%)GB Register
40279 (89%)Home status
(current address is GB based)
37317(82.7%)
GB
968(2.1%)RECIP
1130(2.5%)
ADJ
864(1.9%)
EU
Movement into Britain All overseas qualified = 6.5%
2003 data
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Pharmacist emigration
45110 (100%)GB Register
40279 (89%)Home status
(current address is GB based)
37317(82.7%)
GB
4831 (11%)Overseas Status
(current address is overseas based)
968(2.1%)RECIP
1130(2.5%)
ADJ
864(1.9%)
EU
3562(7.9%)
GB
1008(2.2%)RECIP
112(0.3%)
ADJ
149(0.3%)
EU
Movement into Britain All overseas qualified = 6.5%
Movement out of Britain All =11%; GB qualified = 8%
2003 data
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Pharmacist emigration: why study it?
• Emigration thought to be exacerbating workforce shortages:• Demand for services increasing• More chain-store pharmacies• More elderly people• Higher levels of prescribing and use of OTCs
• Movement out > than movement in• Dissatisfaction with their profession?• Will they return to GB?
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Pharmacist emigration: a research study
• Literature review• Secondary analysis of existing data:
• UCAS data on students• RPSGB pharmaceutical register data on pharmacists
leaving and joining
• Primary research about GB-trained pharmacists who reside overseas:• email ‘interviews’• postal and email survey (Jun–Dec 2003)• 55% response rate (n=1947)
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Research questions
• Who is leaving?
• GB nationals?
• Why are they going?
• Where are they moving to?
• What are they doing?
• Will they return to GB practice?
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So who are they?
• Men are over represented• Most (82%) are working• ‘Top’ destination countries:
• USA, Australia, Ireland, Canada, Hong Kong, elsewhere in the UK; (Malaysia, New Zealand, Kenya).
• Over a quarter (27%) are non-GB nationals
• Reasons for leaving vary: push and pull factors feature, but ‘pull’ more prominent
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Why leave GB?
6.7
13.3
11.8
15.6
13.8
12.2
2.1
14.7
1.1
34.8
15.1
31.4
0 10 20 30 40 50
Economically inactive
Hong Kong
All overseas
Top 4 reasons: % of respondents
Partner's job Career opportunity Lifestyle Return home
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What are they doing?
• 18% is economically inactive:• includes retired, carer, travelling/education
• 8% of ‘economically active’ work outside pharmacy
• 29% of ‘pharmacy’ employed don’t work in a health care setting:• Over half (52%) of these work in industry, 12% in
academia, and 10% in marketing• Industry work is more prominent among the emigrating
pharmacists (14% cf 4%)
• Most (49%) work in community (retail) pharmacy
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Future intentions of those who’ve emigrated
33.8
22.6
25.2
44.5
46.5
21.3
53.6
37.9
27.9
11.2
14.1
59.7
0 10 20 30 40 50 60 70 80
Stay permanently
Depends on personalcircumstances
Stay long term (2 yrs +)
Eventually want to returnto GB
% of respondents
Not working Hong Kong All overseas
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Pharmacist emigrant: a possible typology
Travel/lifestyle migrant
Occupational achievement, career preferences, job mobility, opportunities
Retired migrant
Spouse trailing/ tied movers
Migrant partnerOverseas nationals who qualify in GB - funded by their ‘home’ government
Career migrant
Migration from GB:
GB-qualified exits from Britain
Returning home migrant
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Summary
• Number of foreign-trained pharmacists in GB is not large, but it is increasing
• A sizeable proportion of GB-trained pharmacists emigrating are non-GB nationals
• Over half intend staying overseas permanently
• Pull factors more prominent than push for emigrating pharmacists as drivers to leave
• Emigration mainly driven by social & career factors
• Most work in commercial healthcare setting
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What next? (1)
• For policy? • System of recording and monitoring movement for
workforce planning purposes and research
• Should professional body assist developing countries to expand their capacity to train and retain staff?
• Should the RPSGB consider not taking pharmacists from under served countries?
• Liaise and learn from other health care regulators and professional bodies
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What next? (2)
• For research?• Describe and understand migration into GB• Consider impact of movements on receiving
countries and countries ‘losing’ pharmacists
• For employers in GB?• Employer responsibilities?• Consider their role in inducing talent exit?• Retention or return to (GB) practice initiatives
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Thank you