Beyond Brain Drain: Understanding Physician Retention in Guyana's Emergency Medicine Program

In 2010, Vanderbilt University Medical Center partnered with Georgetown Public Hospital Corporation, the University of Guyana, and the Guyanese Ministry of Health to create an emergency medicine residency. Since then, 27 physicians have graduated; 100% of the Guyanese physicians and 91% of total graduates continue to practice in Guyana. This contrasts with global trends of high “brain drain” among medical professionals. A qualitative study was performed to identify key retention factors that could inform strategies to prevent brain drain.

An anonymous RedCap survey, informed by a literature of common factors affecting brain drain, was sent to all graduates of the GPHC EM Residency. The survey included Likert scale and open-ended questions. Likert scale data were averaged to identify the most significant factors. Thematic analysis of responses to open-ended questions was performed to identify common themes. Additionally, in-person, semi-structured interviews were performed with volunteers for insight into survey responses.

The factors participants rated the most likely to contribute to their continued medical practice in Guyana were family ties within Guyana, a desire to make a difference and serve the local community, and work-life balance. The lowest-ranked factors were salary and financial incentives, adequacy of healthcare infrastructure, and contractual obligations to practice within Guyana. Free-response questions corroborated these findings and highlighted the importance of personal fulfillment.

As global access to advanced medical education expands, retention of physicians in training countries remains a challenge. This survey indicates factors affecting Guyanese physicians’ desire to stay and practice in-country revolve around social relationships, philanthropy, and individual quality of life rather than financial or contractual factors. Insights from Guyana’s high retention rates can inform targeted education system and health system strategies in other low- and middle-income countries to mitigate brain drain.