International health worker migration: the case of GBregistered pharmacists

1
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

2
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
3
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

4
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

5
Number of GB registered pharmacists selected
years
6
Number of pharmacists 2002 to 2007
7
(No Transcript)
8
Age groups by gender (2007)
Data source 2007 register (n 47232)
9
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)

10
Distribution of pharmacists in selected EU
countries (2004 data)
Data source www.fip.org
11
Distribution of pharmacists elsewhere (2003/04
data)
Data source www.who.int/whosis/database
12
Immigration of pharmacistsStudents

• 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?

13
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

14
Number of foreign trained pharmacists domiciled
in GB, 2002 - 2004, by entry route
15
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

16
Pharmacist emigration
17
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
18
Pharmacist emigration
45110 (100) GB Register    
                       
40279 (89) Home status (current address is GB
based)
4831 (11) Overseas Status (current address is
overseas based)
37317 (82.7) GB
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
19
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 gt than movement in
• Dissatisfaction with their profession?
• Will they return to GB?

20
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 (JunDec 2003)
• 55 response rate (n1947)

21
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?

22
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

23
Why leave GB?
24
What are they doing?

• 18 is economically inactive
• includes retired, carer, travelling/education
• 8 of economically active work outside pharmacy
• 29 of pharmacy employed dont 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

25
Future intentions of those whove emigrated
26
Pharmacist emigrant a possible typology
Migration from GB GB-qualified exits from
Britain

Retired migrant
Travel/lifestyle migrant

Returning home migrant
Migrant partner
Spouse trailing/ tied movers
Overseas nationals who qualify in GB - funded by
their home government
Career migrant
Occupational achievement, career preferences, job
mobility, opportunities

27
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

28
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

29
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

30
Thank you