Egypt faces an unprecedented wave of emigration by physicians, causing concern that the quality of health care in the country could deteriorate further.
Over the past three years, more than 10,000 doctors have left the country, according to the main association representing physicians, the Egyptian Medical Syndicate. The syndicate estimates that half the country’s doctors, or 110,000 out of 220,000 registered doctors, have left the country.
“Doctors’ emigration is worrying and threatens the collapse of the already neglected health system,” said Ehab el-Tahir, a member of the Medical Syndicate Council. He said an increasing number of doctors are resigning from public medical institutions, potentially emptying out some specialties of physicians.
“If this continues, Egyptian patients will soon find nobody to treat them,” he said.
The physician shortage was confirmed by Hala Zayed, the minister of health, in a speech before Egypt’s parliament in September, where she said that there are 103,000 doctors for 100 million citizens, or 10 doctors per 10,000 citizens. The global average is 32 doctors for every 10,000 citizens.
One Result, Many Causes
There are many reasons discouraging doctors from practicing in Egypt. These include low salaries and undesirable working conditions, including poor medical facilities and a lack of supplies in government hospitals. In addition, doctors say they need laws to protect them from patients and their families when they become belligerent if the doctors can’t successfully treat them or if the patients don’t like some aspect of their medical care.
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“We, as doctors, have many problems, starting with the poor salaries, frequent insults, abuse by patients and their families, the distortion of our image and continuous accusations of negligence,” said Khaled Samir, a professor of cardiothoracic surgery at Ain Shams University’s Faculty of Medicine. “All of this drives many of us to emigrate.”
Doctors say that if a patient’s condition gets worse or if a patient dies, even if the doctor is not at fault, patients and their families can refer them to public prosecutors and the doctors can be subjected to the provisions of the criminal code. Doctors get an injury allowance for such circumstances but it is only 19 Egyptian pounds ($1.13) a month.
A newly graduated doctor earns about 2,000 Egyptian pounds, or $120, a month, while a specialist who has an additional degree gets about 3,000 Egyptian pounds, or $180. The average monthly spending on all expenditures for an Egyptian family was about 3,058 pounds, or $183, in 2015, according to the latest figures available from the Central Agency for Public Mobilization and Statistics. (Those numbers were recorded before the devaluation of the Egyptian pound in 2016, and since then life has become much more costly for Egyptians paid in pounds.)
“I never regret my resignation from working in Egypt,” said Mustafa Abdel-Rahim, a pediatrician who now works in Kuwait. “The salaries are low, so the doctor works in clinics and private centers for 72 hours to meet his living and family needs, not to mention the lack of safety at work.”
Ahmed Refaat, a professor at Assiut University’s South Egypt Cancer Institute, agrees with Abdel-Rahim regarding the poor compensation for doctors and the lack of support for their role. “A professor at the Faculty of Medicine does not get more than 10,000 Egyptian pounds ($600), while a specialist in any Arab country earns ten times that salary,” he said. “And those who leave the country will never think of coming back.”
Those doctors who stay in Egypt often leave critical but stressful specialties such as general surgery, intensive care, anesthesia, emergency and heart surgery and move to specialties with easier hours and higher income, such as plastic surgery, gynecology or pediatrics.
This trend has resulted in a large deficit in certain specialties and surpluses of doctors in other fields. For example, the National Heart Institute recently announced it needed to appoint 50 doctors in anesthesia and 30 doctors in cardiac surgery. But only one doctor has applied for each of those departments.
“There is a severe shortage in the specialties of emergency medicine and intensive care, because doctors prefer to travel abroad, in addition to the lack of a law to evaluate medical errors, leaving doctors exposed to nonspecialized criminal trials,” said el-Tahir, the member of the Medical Syndicate Council.
Disagreement Over Solutions
Despite the agreement on the causes of doctors’ emigration, people disagree about the solutions.
Recently, the Egyptian government announced its intention to study the possibility of graduating an additional cohort from medical schools, as well as increasing the number of students admitted to medical schools. But many critics say these steps won’t solve the problem.
“It is not possible to provide suitable training if the number of admitted students increases,” said Mona Mina, a member of the Medical Syndicate Council. “The graduates will still need in-depth and detailed study to avoid further deterioration of health services.”
Samir, the cardiothoracic surgery professor at Ain Shams University’s Faculty of Medicine, also rejects the idea of increasing student numbers or medical colleges. “Our problem is not a shortage in medical graduates, but their emigration after graduation,” he said. “The working environment here is repellent to competent physicians and there must be a fair wage system and laws that protect doctors so they can improve their standard of living.”
Ahmed Said, an assistant professor of obstetrics and gynecology at Kasr Alainy School of Medicine, at Cairo University, does not seem optimistic about conditions improving for Egyptian doctors any time soon. He is preparing to take the second part of a British fellowship exam this year to get a chance to travel and work in England.
“Unfortunately, I was late to take this step,” he said, “I should have taken it six years ago. The situation is getting worse every day.”