The term Brain-drain is the migration of skillful intellectual and technical workers, in search of improved living standards, meaningful quality of life, higher remuneration, access to globalization. But in terms of Pakistan, the priority is to have a stable socio-political and professional environment, where one can survive with their family. The migration of health professionals all over the world is a growing concern, as it has a great impact on the community. There are various reasons for a healthcare person to migrate. "Push and pull" factors for migration are mainly, salary disparity in working conditions, long wait for promotion opportunities, enthusiasm for new experiences, change for professional development, family pressure and financial issues. Immigration of highly trained professional first became known as a major public health issue in the 1940's, when many European health professionals moved to UK and US and since then it has become an important and debatable aspect of the health industry. From the study of Talati & Pappas; "Statistics for migration of Pakistani Physician", provided by the Bureau of Emigration and Overseas Employment, about 1000 to 1500 physicians leave the country every year, of which 10-15% return, this amounts to a net migration of 900 - 1275 physicians per year. This figure can be affordable in the Medical Profession, but the Dental fraternity in Pakistan comprises of only a few thousand Dentists. Thus, if the current pace of Dentists migration remains the same, soon Pakistan will be in trouble due to the resulting shortage of Dentists in the country. After seeing, for many years, the trend of continuous migration of Dental Surgeons, towards the Middle East, Malaysia & Canada, Pakistan's already deprived community is facing an Oral healthcare worker migration crisis, which may eventually put the whole nation at risk. The question is; Why Dental surgeons are migrating from Pakistan? Who is accountable for this? PMDC, PDA or the Health Ministry? The answer is still awaited from Governing bodies. Whether the source country fulfills their physiological and psychological needs, including, security, prosperity, self esteem, and self actualization. The migration is caused by moral and physical deprivation due to the poor social, emotional and political circumstances. Despite becoming Dental Graduates after long years of expensive academic efforts, they still suffer due to; Low salaries, under-employment or unemployment. These factors force the citizens to leave their home country and their beloved family and seek greener pastures abroad. In the past, many Dentistry graduates have chosen to migrate to other countries for further studies and later return with post-graduate qualifications, mainly from UK , USA, Turkey or Malaysia. Many of those who went abroad for higher studies, have the devotion & obligation in their hearts & minds, inspiring them to come back & serve their country. This way, they want to repay their nation and their people. Generally, now the trend is changing, whereby the postgraduates do not prefer to come back to their homeland after acquiring foreign degrees. The apparent reasons are; lack of research opportunities in Pakistan, while facilities, funding and professional growth is generally limited. This causes lack of motivation, intensified by the poor law & order situation in the country. Other reasons for emigration include; Lack of quality education for children, especially with high competition for university admissions and the corruption found in educational institutions. Being optimistic, we may consider migration for Dental Surgeons as a promising move. It offers a brighter future with acquisition of expensive skills, which are not easily available within Pakistan. If we track the statistics and records, another negative aspect is unveiled; these foreign skills and knowledge never come back into Pakistan. The government, Dental Associations, PMDC & Dental societies need to adopt a strategic approach, within their limited resources, to regulate the out-flow of Dental fraternity from Pakistan. PMDC along with Ministry of Health, should introduce bonding system to decrease the high rate of migration from Pakistan. Concrete measures should be taken for implementation of certain rules by governing bodies, for Dental professionals to serve in their own country for a minimum period of one year, before they can leave for further education or employment abroad. Another way of long term retention of migrating Dental professionals, is to provide them with good teaching faculty posts with handsome remuneration, provident funds & pension plan, health facilities for their families, healthy working environment and equal growth opportunities for ensuring job satisfaction. Special study leaves and Training opportunities can also enhance their professional development. A crucial step has been taken by CPSP, by offering an executive consultant training program, which supports the Dental specialists to go to the Middle East for three months training. This approach provides better opportunities for Dental surgeons to experience working in a modern environment and interact with foreign professionals, learning newer approaches and technologies for advanced dentistry for higher grooming and enhanced dignity. Recruitment and retention of quality Dental surgeons, who can also serve as teaching faculty, is the responsibility of human resource professionals, University administration, and trainers by fostering an environment of growth and satisfaction for the faculty. There are many factors involved from governance, to funding, to designing the right selection tools, to the environment and systems, with opportunities for world class research, education training, mentorship, support systems, work life balance, provision of subsidized housing, health benefits and wide array of facilities along with recognition of individual talents and developing it to full potential. If a University is keen to excel, it is essential for the administration to identify all the weaknesses, find quick solutions and evaluate outcomes. This way, we can control further loss of Dental Faculty leaving the country. When one faculty member leaves, it is not just a person leaving; it incurs cost and impacts at various levels. It has an effect on students, departments, institute itself, research projects, patients and community as a whole. The attitude of the administration towards faculty migration has a great influence if they develop a framework with positive and negative implications and then take wiser decisions. Here, good governance at institutional and government level, plays a great role. University should foster a conducive environment, where faculty rather than thinking about feeding their children or struggling with educational expenses or disparity in rating faculty as well as, inequality which leads to unrest of minds. One cannot think innovatively and creatively if the mind is restless. When appointment and promotion processes are not transparent, when HR wants faculty to fill in complex forms with no account of extra working hours, when quantity not quality is recognized, faculty remains under constant stress with conflict on contradicting values on paper. In such cases, the ultimate choice left is job-switching or migration. Compensation & retention is indeed a very important issue, yet to be addressed for Dental Faculty. Research is needed to identify reasons for leaving the institution & country. Is it dissatisfaction with the growth, no mentor-ship or funding provisions, underpaid BDS, talent not recognized or lack of opportunities to working in their areas of expertise. There needs to be mechanisms in place to promptly identify all this and find remedies. Although we agreed that the immigration of healthcare providers is movement towards globalization and that cannot be avoided. Attention should be paid towards the reason for migration of dental surgeons, in order to prevent future shortage of Dental surgeons in Pakistan. There is no statistical data available on the number of Dental surgeons migrated so far, but as far as our observation is concerned, many of the reputable, highly educated and exceptionally skilled Dental surgeons have left the country for good. We can get a rough estimation for migrating Doctors from PMDC, by looking at the number of excellence certificates issued so far. Migration is affected by many factors, some of which are controllable through strategic interventions and thus may assist policy makers like PMDC, PDA, CPSP & other associations along with Health Ministry in planning strategies to recruit and retain Dentists in the home country. Although the choice to migrate is basically a personal one, the overall social and economic circumstances have a great impact on the decision to migrate. Consensus should be developed among countries, There must be negotiated agreements to build opportunities for Dental Surgeons to work overseas for limited periods of time, by granting temporary visas on rotational basis. This way, we can welcome & promote international investors for oral healthcare in our country, once our professionals become skillful enough through Faculty exchange training programs. Suggestion for the Health ministry is to conduct a pilot study on assessing the Brain Drain & to make certain policies to control further migration of Doctors from Pakistan. The writer is an Assistant Professor, Department of Maxillofacial Surgery, Liaquat College of Medicine & Dentistry, Karachi.
