The Brain Drain of Egyptian Physicians and Its Driving Factors: A Cross-Sectional Study

Abstract

Background: During the past years, brain drain has become an international problem. A shortage of human resources in the medical field revealed its challenges during the COVID-19 pandemic. Despite the large number of medical school graduates in Egypt, the reports of the World Health Organization and the Egyptian Medical Syndicate indicate a yearly decline in the number of physicians in Egypt. The aim of this study is to determine the factors affecting Egyptian physicians’ intention to leave Egypt to work in another country. Methods: This is a cross-sectional study with a self-administered questionnaire via the snowball sampling technique that focused on Egyptian physicians who graduated from Egyptian universities and were working in Egypt. The outcome measures include the migration intentions of physicians and their satisfaction with different aspects of work, their family and housing conditions, and their demographic characteristics. Results: The questionnaire was answered by 249 Egyptian physicians, 140 of whom were living in Egypt. The findings revealed that 66.4% of the sample in Egypt were considering working abroad. Work satisfaction was the main factor affecting the decisions of physicians in Egypt; the physicians with a lower satisfaction score were 20 times more likely to leave their country. Additionally, physicians who classified themselves as having a low economic status, being younger, or who were male were more likely to leave. Conclusion: Egypt may suffer major resource losses as a result of the high degree of dissatisfaction among physicians regarding their working conditions. To realize Egypt’s Vision 2030 for health and economic progress, policymakers need to address the driving factors and take probable intervention measures to reduce the drain of our physicians.

1. Introduction

The emigration of healthcare professionals, especially physicians, has been a global concern in recent years. During the COVID-19 pandemic, there was a spotlight on the issue of physician shortage as one of the significant resources needed to fight the pandemic. As a result, many nations aimed to attract highly skilled medical workers which increased the emigration of physicians (Adovor et al. 2021). This phenomenon is called brain drain, where well-educated and talented workers leave their countries to work in another (Beine et al. 2001). This ongoing flow raised concerns on the consequences of the brain drain of physicians. The consequences could range from a decline in the quality of healthcare services and hindering the achievement of universal health coverage to a complete breakdown in the healthcare system (Jin et al. 2017; Naicker et al. 2009; Miseda et al. 2017; Abdo et al. 2016).

Multiple studies have explored the increase in physician brain drain. A study in Poland showed that the primary motivations for their physicians to migrate were searching for better and less stressful working conditions, enhanced work–life balance, higher wages, and access to better training opportunities (Dubas-Jakóbczyk et al. 2020). Similarly, in Pakistan, a study revealed that the most reported reasons for migration cited by medical students were higher earnings, training quality, job satisfaction, and better quality of life (Sheikh et al. 2012). Being female, receiving part of their education abroad, and searching for better income and research opportunities were some of the reasons for junior physicians in Portugal to seek work abroad, showing that brain drain can affect developed countries as well (Ramos and Alves 2017). Likewise, previous Egyptian studies reported that medical students and junior physicians stated that finding better working conditions and training opportunities were the main factors to work abroad (Kabbash et al. 2021; Fouad et al. 2015; Schumann et al. 2019).

On the ground, the number of physicians in Egypt, especially those working in the government sector, is decreasing every year. In just two years, 2018 and 2019, over 3000 physicians under the age of 35 left the Egyptian Ministry of Health, according to an announcement by the Egyptian Medical Syndicate (Debs 2020). This indicates that Egypt loses its workforce when it is young and in its most productive age. Furthermore, it was revealed in 2020 that of the 120,000 registered physicians in the syndicate, half are now employed outside of Egypt (Elshobky 2020). Moreover, the syndicate announced at the end of 2022 that this year had the highest rate of physician resignation from the government sector, with a rate of 12 physicians per day (Egyptian Medical Syndicate 2022). Despite Egypt having ten thousand medical school graduates each year, the number of physicians per 10,000 people declined from 7.8 in 2016 to 6.8 in 2020 (Abdelaziz et al. 2018; World Health Organization 2024). Egypt is the country with the second-highest number of emigrant physicians in the Eastern Mediterranean Region of the World Health Organization, according to a study comparing the number of psychiatrists who departed their respective nations (Jenkins et al. 2010). Keeping the healthcare workforce in Egypt is essential for achieving the 2030 targets for universal healthcare, particularly for the public sector (Egypt 2030 n.d.; United Nations Development Programme 2018; World Health Organization 2022).

Previous studies on physician migration in Egypt focused on quantitative analyses of medical students and junior physicians, or qualitative research involving older physicians (Kabbash et al. 2021; Fouad et al. 2015; Schumann et al. 2019). While these studies have provided valuable insights into the motivations behind migration intentions, they have largely relied on self-reported perspectives, without examining actual data such as income and working hours. To our knowledge, this is the first study to compare income, working hours, and other actual data to migration intentions and to include senior physicians. By including these critical variables, our study aims to provide a clearer understating of the factors influencing physician migration in Egypt and to add to the existing literature in a way that can help inform future decision making in Egypt.

The objectives of this study were to determine the intention of Egyptian physicians to work abroad and identify the variables influencing their decision. As such, our research questions are as follows: (1) how do sociodemographic factors such as age, sex, education, and economic level influence the migration intentions of Egyptian physicians? and (2) how do satisfaction levels with working conditions, family, and housing conditions affect the migration intentions of Egyptian physicians? We examined the relationships between the migration intentions of individuals and sociodemographic factors such as age, sex, education, economic status, income, working hours, and more. In addition, we assessed the satisfaction of physicians with their work environment, as well as their family and living circumstances, to their migration intention. This study included Egyptians who are living in Egypt and who graduated from Egyptian civilian medical schools, assuming that the graduates of non-Egyptian medical schools will mostly work abroad from the outset. We aimed to gather insights from physicians who are currently practicing and have a comprehensive understanding of the living and working environment, so we excluded students.

2. Materials and Methods

2.1. Research Design and Target Population

This is a cross-sectional study in which an online self-administered questionnaire was used. The target population consisted of Egyptian medical graduates from Egyptian universities, both junior and senior, to assess which group had a greater intention to migrate. Non-Egyptians, graduates of Egyptian military medical institutions, graduates of non-Egyptian medical schools, and current medical students were excluded. Non-Egyptian medical school graduates were excluded as they are likely to plan to work abroad from the outset and may not share the same local work and living experiences. Additionally, current medical students were excluded to focus on individuals who are already practicing the profession and possess on-the-ground experience.

2.2. Data Collection and Survey Method

After reviewing previous migration studies and theories, we designed a novel questionnaire for our study. The questionnaire was divided into four sections: sociodemographic, work satisfaction, housing and family life satisfaction, and the reasons behind the decision to work in Egypt or elsewhere. In the first section, sociodemographics were taken into account when looking for aspirations for leaving their country to work abroad (Brugha et al. 2021; de Haas 2021; Gouda et al. 2015; Kabbash et al. 2021; Ramos and Alves 2017; Schumann et al. 2019). Another crucial element that can lead to a desire to migrate is work satisfaction (Dubas-Jakóbczyk et al. 2020; Jewell and Kazakis 2021). Thus, the satisfaction of physicians with their work and the actual working hours and income of the participants were collected. Participants in earlier Egyptian studies were questioned about their perceptions of these issues (Fouad et al. 2015; Kabbash et al. 2021; Schumann et al. 2019). In this study, we divided work satisfaction into three categories: working conditions, work staff, and job benefits. Working conditions consisted of income, cleanliness of the workplace, working tools, working hours, and workload. Work staff consisted of work staff sufficiency, relationships with colleagues, relationships with supervisor, work arrangements, decision making, and sharing suggestions. Job benefits consisted of social insurance, health insurance, career development, chances for postgraduate studies, and personal protective equipment availability. The intention to migrate may also be influenced by one’s economic situation (Suciu et al. 2017). Furthermore, the urge to migrate may be influenced by one’s family and the surrounding environment (de Haas 2021). Since there is a high rate of violence against health workers in Egypt, this issue was included in the questionnaire and influences the decision to migrate (Abdel-Salam 2014; Bakr et al. 2019; Chakraborty et al. 2022). The questions were on a 5-point Likert scale and included free text space to allow the respondents to express all of their thoughts. Every participant responded to questions one through seven and twenty-eight through sixty. Physicians living in Egypt responded to questions 8 through 15, whereas physicians living overseas responded to questions 16 through 27. Permission from the Institutional Review Board was given on 26 January 2023.

In this study, we used convenience sampling, supplemented by the snowball sampling method due to its effectiveness in reaching a specific and hard-to-access group (Kirchherr and Charles 2018). This approach was particularly valuable for targeting both junior and senior medical graduates from diverse specialties and positions. However, snowball sampling can introduce potential biases, as participants may refer others who share similar characteristics or experiences, limiting the diversity of perspectives in the sample. To mitigate this risk, we made an effort to reach a broad range of medical graduates from various institutions, regions, and backgrounds by encouraging diverse referrals and limiting the influence of any single network on the final sample. Despite these limitations, snowball sampling was considered the most appropriate approach for this study’s objectives.

Data were collected using an online questionnaire which was an appropriate option given the study’s objectives, which included determining the migration plans of Egyptian physicians and the factors influencing such intentions. The use of an online platform instead of in-person meetings allowed for faster and less expensive access to the required participants, as participation from different institutions was needed. The survey was distributed online via social media depending on whether the respondents encouraged their networks to take the survey. The information was gathered via email, Facebook, Messenger, and WhatsApp. All of the anonymous responses were submitted via the SurveyMonkey shared link. The questionnaire started with a consent form that informed participants of the study’s purpose and guaranteed the confidentiality and anonymity of all the data. Two and half months of data collection occurred from 13 February 2023 to 21 April 2023.

2.3. Data Analysis

The data were analyzed at multiple stages after several trials. Initially, the characteristics of the participants were presented using descriptive analysis, including frequencies and percentages. The participant satisfaction was then compared via the independent t-test. The individuals’ demographics, which are discrete values, were then compared to their intentions to migrate using the chi-square test once more, while the continuous values were tested using the independent t-test. The independent t-test was then used to compare satisfaction with the desire to migrate. Satisfaction was measured using a 5-point Likert scale, where 5 = very satisfied, 4 = satisfied, 3 = neutral, 1 = dissatisfied, and 0 = very dissatisfied. For each type of satisfaction (work conditions, work staff, job benefits, and family and housing), responses were summed and averaged to obtain a composite score. This allowed the use of the t-test to compare mean satisfaction levels and migration intention.

Finally, the association between all study parameters and the participants’ intentions to migrate were tested using univariate and multivariate binary logistic regression. Fourteen independent variables were used in the binary logistic regression, and each variable was categorized based on meaningful cut-off points. The cut-off points of continuous variables were determined as the following: working hours per week were categorized as ≤48 h (reference) and ≥49 h because working hours in Egyptian labor law are limited to 48 h per week, so higher working hours may have a higher tendency to migrate. The income was divided into ≥261 (reference) and ≤260 based on the mean income of the sample. Age was categorized as ≥32 (reference) and ≤31 based on the average age where physicians complete their residency program and their master’s degree and became specialized, so they became more settled. A residency program is a period of advanced and hands-on medical training that takes place after medical school, where graduates specialize in a specific field of medicine under the supervision of experienced physicians. Polytomous Variables are dichotomized as the following: high economic status includes those who can afford anything for normal life/without restriction (reference) and low economic status includes those who cannot afford basic needs or can only afford basic needs. Current position was grouped into specialist, consultant, and others as a group (reference) and house officer and resident as a second group. A resident is a physician who is undergoing specialized training in a specific field of medicine as part of a residency program. Similarly, specialty was grouped into specialized (reference) and not specialized, assuming physicians who are still in training or their residency period are more willing to search for opportunities abroad. Satisfaction was categorized into “satisfied” (reference) and “unsatisfied”. A score of ≥3 on a 5-point Likert scale was classified as “satisfied”, while a score of <3 was classified as “unsatisfied”. This classification was based on the assumption that respondents choosing a neutral option (score = 3) lack strong dissatisfaction and are more aligned with satisfaction. Sex was categorized as female (reference) and male, as previous research suggests that male physicians are more likely to have migration intentions. Marital status was categorized as married (reference) and single, suggesting married individuals are generally more likely to be settled and less likely to migrate. Being financially responsible was categorized as “yes” and “no” (reference), as individuals with financial obligations may have different migration considerations compared to those without.

3. Results

3.1. Characteristics of the Respondents

There were 255 respondents who finished the survey in total and it took 17.5 min on average to finish the survey. Six of them were eliminated because they did not fit the requirements for inclusion. As a result, there were 249 people in the sample, 146 (58.6%) of whom lived in Egypt and 103 (41.4%) elsewhere. In this paper, we will focus on the 146 Egyptian physicians who were living in Egypt. The bulk of the sample (58.9%) was made up of people between the ages of 30 and 39, and the majority were female (71.2%). Among the sample, only 32.9% were unmarried, while the majority (67.1%) were married (

Table 1. Characteristics of the respondents in Egypt.

Characteristics		Respondents (146)
		N (%)
Gender	Male	42 (28.8)
	Female	104 (71.2)
Age	Less than 30	34 (23.3)
	30–39	86 (58.9)
	40–49	20 (13.7)
	50 and over	6 (4.1)
Marital status	Single	48 (32.9)
	Married	98 (67.1)
Education	Bachelor degree (MBBS)	49 (33.6)
	Master’s degree	56 (38.4)
	Doctor of Medicine (MD)	16 (11.0)
	Other postgraduate degrees	25 (17.1)
Current position	House officer	10 (6.8)
	Resident	47 (32.2)
	Specialist	49 (33.6)
	Consultant	24 (16.4)
	Others 1	16 (11.0)
Specialties	Surgery	44 (30.1)
	Internal medicine	64 (43.8)
	General practitioner/not specialized	16 (11.0)
	Others 2	22 (15.1)
Financially responsible 3	Yes	57 (39.0)
	No	89 (61.0)
Economic status	Cannot afford basic needs	16 (11.0)
	Can afford basic needs	94 (64.4)
	Can afford anything for normal life/without restriction	36 (24.7)
Faced violence	Yes	45 (30.8)
	No	101 (69.2)
Unsafe workplace	Yes	75 (51.4)
	No	71 (48.6)
Working hours 4	≤29	39 (27.7)
	30–48	67 (47.5)
	≥49	35 (24.8)
Minutes to work 5	≤30	75 (52.4)
	31–60	37 (25.9)
	≥61	31 (21.7)

¹ Academia, healthcare management, and insurance; ² academia, healthcare management, insurance, anesthesia, emergency, and intensive care; ³ financially responsible means providing money or financial support to help cover the living expenses of any of your family members; ⁴ total participants = 141, some of the participants unclear answers or were not currently working; ⁵ total participants = 143, 3 gave unclear answers such as “it depends” or were not currently working.

). Over half of the individuals in the study were not financially responsible for their families. The degrees that were more predominant in our sample were bachelor’s degrees and master’s degrees. After grouping the physicians’ specialties, internal medicine physicians made up the highest percentage of the participants (43.8%), with surgeons coming in second (30.1%). Nearly one-third of the respondents (30.8%) said they had experienced physical or verbal abuse at work when questioned about violence in the workplace.

3.2. Satisfaction

There are two main groups of satisfaction in this study: family and housing satisfaction, and work satisfaction; work satisfaction has subgroups as shown in

Table 2. Intention of migration and satisfaction scores of respondents in Egypt.

Category/Factor		Respondents (146)
		Frequency (%)/Mean (SD)
Intention	Yes	97 (66.4)
	Maybe	33 (22.6)
	No	16 (11.0)
Working conditions	Income	2.20 (0.980)
	Cleanliness of workplace	2.89 (1.102)
	Working tools	2.51 (0.984)
	Working hours	2.72 (1.042)
	Workload	2.62 (0.991)
	Total	2.59 (0.725)
Work staff	Work staff sufficiency	2.75 (1.111)
	Relationships with colleagues	3.74 (0.918)
	Relationships with supervisor	3.40 (1.093)
	Work arrangements	3.30 (0.890)
	Decision making	3.14 (0.902)
	Sharing suggestions	2.98 (1.054)
	Total	3.22 (0.7036)
Job benefits	Social insurance	2.20 (0.973)
	Health insurance	2.17 (1.006)
	Career development	2.50 (0.998)
	Chance for postgraduate studies	3.05 (1.029)
	PPE availability	2.36 (1.030)
	Total	2.46 (0.7216)
Total work satisfaction		2.78 (0.5934)
Family and housing	Current housing condition	3.50 (1.019)
	Time spent with family	3.02 (1.142)
	Total	3.26 (0.8371)
Total satisfaction		2.84 (0.5636)

PPE: personal protective equipment; SD: Standard Deviation.

. Working conditions received the lowest satisfaction rating from the participants (2.59), whereas family and housing received the best rating (3.26) (Table 2).

3.3. Migration Intention

For migration intentions, the highest percentage said yes to work abroad with 66.4%, then 22.6% said maybe, and only 11% said no, as shown in Table 2. The maybe group and no group were combined during the data analysis. The migration intentions of the participants were tested to their sociodemographic discrete variables by a chi-square test and to the continuous variables by an independent t-test. Four factors had effects on the physicians’ intentions: gender, economic status, financial responsibility, and working hours. Gender played a part, whereby the percentage of males who wanted to work abroad was greater than females (p < 0.05). People with higher economic levels had less desire to leave (p < 0.05). Additionally, being financially responsible for their families increased their willingness to leave (p < 0.05). In addition, participants who were willing to leave were working for longer hours, with a mean of 46 h per week, than participants who did not want to leave or were still thinking about it, with a mean of 35 h per week.

3.4. Satisfaction and Migration Intention

We analyzed the satisfaction of the participants with their migration intentions via an independent-t test. For all groups and subgroups of satisfaction, the participants in Egypt who intended to migrate to work abroad had lower satisfaction scores than the participants who had not (

Table 3. Satisfaction of respondents in Egypt with their consideration of working abroad.

Factor	Working Abroad Consideration	Mean (SD)	t (p-Value)
Working conditions	Yes (97)	2.3711 (0.63113)	−5.538 (0.000)
	Maybe/No (49)	3.0122 (0.71578)
Work staff	Yes (97)	3.1151 (0.72623)	−2.742 (0.007)
	Maybe/No (49)	3.4286 (0.61143)
Job benefits	Yes (97)	2.3402 (0.66468)	−2.830 (0.005)
	Maybe/No (49)	2.6898 (0.77895)
Total work satisfaction	Yes (97)	2.6405 (0.55989)	−4.353 (0.000)
	Maybe/No (49)	3.0676 (0.55972)
Family and housing	Yes (97)	3.1289 (0.81099)	−2.727 (0.007)
	Maybe/No (49)	3.5204 (0.83516)
Total satisfaction	Yes (97)	2.6947 (0.52736)	−4.568 (0.000)
	Maybe/No (49)	3.1179 (0.53101)

SD: Standard Deviation.

).

3.5. Variables Associated with Working Abroad Consideration

By examining all the variables related to the migration intentions of the participants, univariate binary logistic regression revealed that working for longer hours, being financially responsible, having lower economic status, being younger than 32 years, and being dissatisfied with work were associated with the intention to leave the country and work abroad (

Table 4. Univariate and multivariate binary logistic regression: factors associated with working abroad consideration of respondents ¹.

Indicator (Reference Category)		Univariate/Unadjusted		Multivariate/Adjusted
		OR	95% C.I.	OR	95% C.I.
Gender (female)	Male	2.292	(0.993–5.288)	2.601	(0.198–34.124)
Marital (married)	Single	1.563	(0.733–3.335)	1.478	(0.192–11.393)
Working hours (≤48)	≥49	2.523 *	(1.010–6.305)	0.847	(0.131–5.493)
Financial responsible (No)	Yes	2.299 *	(1.086–4.865)	5.510	(0.821–36.957)
Income (≥261)	≤260	1.150	(0.442–2.994)	1.292	(0.131–12.760)
Economic status (can afford normal or higher)	(Difficult or can only afford basic needs)	2.980 **	(1.370–6.484)	9.877 *	(1.571–62.116)
Age (≥32)	≤31	2.220 *	(1.074–4.591)	12.110 *	(1.376–106.563)
Position (specialist/consultant/others)	House officer/Resident	1.158	(0.570–2.352)	0.439	(0.045–4.286)
Education (postgrad)	Bachelor	1.063	(0.512–2.207)	1.178	(0.135–10.286)
Specialty (specialized)	Not specialized	1.588	(0.484–5.210)	0.919	(0.024–35.698)
Working conditions (satisfied)	Unsatisfied	8.858 ***	(4.031–19.467)	24.414 **	(3.346–178.122)
Working staff (satisfied)	Unsatisfied	3.541 **	(1.440–8.709)	21.222 *	(1.656–271.934)
Job benefits (satisfied)	Unsatisfied	2.438 *	(1.144–5.195)	0.102 *	(0.011–0.946)
Family and housing (satisfied)	Unsatisfied	1.504	(0.660–3.431)	1.659	(0.235–11.732)

¹ OR: odds ratio. C.I.: confidence interval. Note: ORs with p-values (p ≤ 0.05) are flagged with star symbols (*), ORs with p-values (p ≤ 0.01) are flagged with double star symbols (**), and ORs with p-values (p ≤ 0.001) are flagged with triple star symbols (***).

). After controlling all variables using multivariate analysis, only age, economic status, and work satisfaction were associated with migration intention. Physicians who were 31 years of age or older were 12 times more likely to work abroad. In addition, the intention of migration was 10 times greater among physicians with lower economic status. Furthermore, physicians who were less satisfied with their work conditions and work staff were 24 times and 21 times more likely to consider going abroad. In contrast, being less satisfied with job benefits was inversely associated with migration intention.

4. Discussion

The purpose of this study was to determine how common it is for Egyptian physicians to want to work overseas and what influences their choices. A significant finding of this research was that 66.4% of the respondents in Egypt desired to depart. The findings also demonstrated the significance of the working environment in influencing the decisions of physicians. Furthermore, there is a correlation between one’s financial standing and their will to depart, in addition to the economic status, age, and financial responsibility of the physician.

According to this study, 66.4% of the sample wanted to leave Egypt to work in another country, 22.6% might depart, and only 11% did not consider working abroad. In a similar vein, an Egyptian study showed that 89.4% of Egyptian medical students and young physicians intended to emigrate (Kabbash et al. 2021). According to a different Egyptian study, 85.7% of Egyptian medical students desired to travel overseas after completing their education (Fouad et al. 2015). Furthermore, a study that was conducted in Europe revealed that a comparable proportion of medical students desired to depart upon graduation (Gouda et al. 2015; Santric-Milicevic et al. 2014). Moreover, 60% of Pakistani medical students wished to pursue their studies overseas (Sheikh et al. 2012). Portuguese and Irish surveys reported that 52% to 55% of junior physicians pondered leaving their country and working overseas (Brugha et al. 2021; Ramos and Alves 2017). A shift in perspective and priorities following graduation and entry into the workforce is implied by the increased percentage of migration intentions found in the majority of research aimed at students. While there was a “maybe” choice for the migration intention question in this study, the most common response was “yes”, indicating that the participants had already made up their minds to work abroad. This serves as a warning that there will be more physician losses in the near future.

One of the main conclusions of this study was that the intention of physicians to work abroad was influenced mostly by their level of work satisfaction. This finding pointed out that the physicians with low satisfaction scores in the work conditions and work staff categories outlined in Table 2 were 24.4 and 21.2 times more likely, respectively, to consider working abroad (p < 0.01). Similarly, another study identified a correlation between work satisfaction and the decision to work abroad, where physicians who were less satisfied with their careers wanted to work abroad (Dubas-Jakóbczyk et al. 2020). Additionally, the link between physicians’ desire to return to their country of origin and their level of job satisfaction was confirmed in a western study (Sharma et al. 2012). Furthermore, our study’s findings indicated that a decrease in the job benefit satisfaction categories outlined in Table 2 might result in a 2.4-fold increase in the intention to migrate. However, after using a multivariate regression test to control all the variables, the results changed, indicating that migration intentions could increase in response to employment benefit satisfaction. This finding contrasts with the findings of another study, which noted that migration was motivated by the desire for career advancement (Dubas-Jakóbczyk et al. 2020).

One item from the work conditions satisfaction group outlined in Table 2 that showed a strong correlation with migration intention was satisfaction with income. Furthermore, the decision to leave was positively correlated with being both financially responsible and, in each person’s opinion, having a low economic status. Nevertheless, no correlation was found when comparing the participants’ income to their intention to work abroad. This finding indicates that a physician’s decision to stay or go is not solely based on their pay; rather, it is influenced by a variety of factors, including their working environment, which can lead to either a high or low degree of satisfaction. According to an Egyptian study, financial concerns did not have a primary influence on the decision to migrate (Schumann et al. 2019). In addition, according to a different study, the majority of participants said that their pay did not match their working hours (Kabbash et al. 2021). While income is typically cited as the primary motivator for departing, our research indicates that environmental factors have a greater impact on individuals’ choices. For instance, in our study, a t-test and univariate analysis revealed a positive correlation between working hours and individuals’ intention to move (p < 0.05). In parallel, a Polish study found that physicians considering migration worked more hours than those who did not (Dubas-Jakóbczyk et al. 2020).

The findings suggested that male physicians were more likely than females to consider migration (p < 0.05). In addition, physicians under the age of 32 were 12 times more likely to consider working overseas (p < 0.05). This suggests that younger physicians and those who are still completing their residency program are more likely to work abroad, whereas more experienced physicians might be more established. Moreover, the results showed that physicians who were financially responsible were more likely to consider working abroad (p < 0.05). Dubas-Jakóbczyk et al. (2020), who reported that young male physicians were likewise more likely to seek migration, provided some support for the earlier findings (Dubas-Jakóbczyk et al. 2020). However, those with children were less likely to consider migration, which contrasts with our findings concerning the intentions of financially responsible physicians. Additionally, another study reported that Irish single male physicians who were 30 years of age or younger had a higher attrition rate, which supports our age results (Brugha et al. 2021).

Alarmingly, there is a warning in the percentage of participants who had experienced violence in the past. The high incidence of violent incidents among physicians raises concerns, even if it was not linked to migration intentions in this study. In our study, more than 50% of the respondents thought that their jobs were dangerous. One-third of the sample reported having already experienced verbal or physical abuse, or both, from patients and their family. Some reported that physical violence could result in fatal injuries. Currently, a single violent occurrence can quickly go viral on social media and impact a sizable number of medical professionals, lowering their motivation and increasing their dissatisfaction rate. Another Egyptian study stated that the harassment of physicians was one of the driving forces behind their decision to leave the country, with a mean agreement score of 4.49 out of 5 (Fouad et al. 2015). Furthermore, additional research revealed a significant rate of harassment among healthcare workers in several hospitals’ emergency rooms in Egypt (Abdel-Salam 2014; Bakr et al. 2019).

A key limitation of this study is the generalizability of the findings due to the use of snowball sampling. Generalization of the results may be impacted by the small sample size in relation to the size of the population. To assess the reliability of our study, we compared certain characteristics of our participants with national data published by the Central Agency for Public Mobilization and Statistics in Egypt, which reported the distribution of physicians working in directorates of health affairs across different governorates (Central Agency for Public Mobilization and Statistics 2022). Although our sample included participants from thirteen different governorates, the majority were from only two: Cairo (31%) and El-Sharkia (46%). According to the report, these two governorates have a notably high proportion of female physicians, with female-to-male ratios of approximately 2:1 in Cairo and 1.6:1 in El-Sharkia. This aligns with our sample, which had a higher percentage of female participants. We also compared the distribution of participants by professional level with national data. The report classified physicians who are already working in the medical medicine sector into residents, specialists, and consultants with a reported ratio of approximately 4:4:1. In our sample, the ratio was approximately 2:2:1, indicating a relatively higher proportion of consultants. This difference may be attributed to the snowball sampling method, where senior physicians might have been more likely to participate or be referred by peers. While these comparisons provide some context for assessing sample reliability, they do not eliminate the limitations associated with our non-probability sampling method.

Another limitation is response bias in which the physicians who are less satisfied may be more inclined to take part than those who are more satisfied. It was challenging to obtain responses from physicians, as physicians typically do not participate in surveys. Other studies (Dubas-Jakóbczyk et al. 2020; Taylor and Scott 2018; VanGeest et al. 2007) also revealed that surveying them was difficult. Additionally, most of the responses were from physicians living in urban areas, so we did not obtain the insight of physicians in rural areas. In addition, the sex of each group was not similar, as more females responded to our questionnaire. Our recommendation for future studies is to conduct in-depth interviews to dig deeper into the issues facing physicians and the reasons behind their answers.

5. Conclusions

To sum up, keeping Egyptian physicians in their country should be a top priority, so it is advised that policymakers in Egypt concentrate on creating a healthy and supportive work environment for our physicians and other healthcare workers if Egypt is to meet its Vision 2030 objectives. A clean workspace, readily available tools and equipment, appropriate training, a manageable task, and pay that corresponds with reasonable working hours are all indicators of a good work environment. Additionally, maintaining an appropriate workload requires a sufficient number of employees, underscoring the need to retain our physicians in the nation. The fact that more medical school graduates do not alleviate the physician shortage as long as they continue to choose to leave after graduation must be emphasized. On the other hand, because of the restricted resources, the large number of graduates may limit the opportunity for good quality training. Furthermore, maintaining positive connections between coworkers and supervisors is a key component of having fair policies and job autonomy in the workplace, which is a predictor of increased job satisfaction. It is imperative that all workers have a safe workplace, which is why it is strongly advised to enact legislation that makes any form of violence against physicians or other healthcare professionals illegal. It is important to consider the precedent of other nations that went before us, and realize that the rule of law will have a significant amount of control over such violent episodes (Ministry of Health Saudi Arabia 2018). It is crucial to understand that globalization currently offers physicians many chances; therefore, it is our responsibility to keep our physicians here by offering them better working and living conditions, thus lowering the likelihood that they will search for similar benefits overseas.