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

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

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

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

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

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

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

%

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)

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)

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

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

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?

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

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

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

Pharmacist emigration

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

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

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?

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)

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?

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

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

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

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

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

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

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

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

Thank you