Yazar
Cemal KOÇAK
Doç. Dr., Ankara Üniversitesi. Tıp Fakültesi. Halk Sağlığı AD. Epidemiyoloji B.D (ORCID No: 0000-0003-4799-5669)

Yazar
Zeynep ALTIN
Arş. Gör. Dr., Ankara Üniversitesi,Tıp Fakültesi Halk Sağlığı AD. (ORCID No: 0009-0000-2813-8691)

Özet

  • Daha iyi iş ve yaşam kalitesi için vasıflı işgücünün göçü anlamına gelen beyin göçü, tıp öğrencileri arasında artmaktadır. Bu çalışma, tıp öğrencilerinin gelecek kaygılarını ve beyin göçüne yönelik tutum ve davranışlarını etkileyen faktörleri incelemektedir. Ankara Üniversitesi Tıp Fakültesi'nde karma yöntemle gerçekleştirilen çalışmanın nicel aşamasında 460, nitel aşamasında 30 öğrenci yer almıştır. Veriler 20 soruluk anket, Gelecek Kaygısı ile Beyin Göçüne Yönelik Tutum Ölçeği’yle toplanmış ve SPSS ile MAXQDA kullanılarak analiz edilmiştir. Gelecek kaygısı; kadınlarda, gelir düzeyi ve akademik performansı düşük olanlarda yüksektir. Sağlık hizmetlerini kötü olarak değerlendiren katılımcıların 3,16, toplumun hekimlere yönelik tutumunu olumsuz algılayanların 9,26, yurtdışında kariyer yapmak isteyenlerin 2,32 kat fazla gelecek kaygısı yaşadığı görülmüştür. Yüksek anne eğitimi ve daha iyi İngilizce/Almanca yeterliliği, yüksek beyin göçü puanlarıyla ilişkilendirilmiştir. Toplumun hekimlere yönelik tutumunu olumsuz değerlendiren öğrencilerin beyin göçü eğilimi olasılığı 7,33 kat fazladır. Beyin Göçüne Yönelik Tutum Ölçeği puanı; ekonomik fırsatlar için 2,16, politik/yönetimsel nedenler için 2,90, itibar için 2,67, daha iyi eğitim için 4,48, sağlıkta şiddetten kaçınmak için 3,82, daha iyi yaşam standartları için 5,60 kat yüksektir. Yarı yapılandırılmış görüşmelerde; toplum yapısı ve mesleki itibar, ekonomik nedenler, yaşam standartları, çalışma koşulları, sağlıkta şiddet, mesleki gelişim, politik/yönetimsel nedenler olarak yedi tema saptanmıştır. Nitel bulgular; toplumun hekimlere yönelik olumsuz tutumu ve sağlıkta şiddetin, nicel analizlerde saptanan gelecek kaygısı ve beyin göçü eğilimini artıran temel faktörler olduğunu ortaya koymuştur. Beyin göçünü azaltmak için sağlık, eğitim ve sosyal alanlarda reform yapılması şarttır. Kilit adımlar arasında sağlık çalışanlarına yönelik şiddetin önlenmesi, ekonomik ve mesleki koşulların iyileştirilmesi ve destekleyici çalışma ortamının yaratılması yer almaktadır.   

Summary

  • Brain drain, the migration of skilled labor for better work and life quality, is increasing among medical students. This study examines the factors affecting medical students' future anxiety and attitudes, behaviors towards brain drain. This mixed-methods study at X University Faculty of Medicine involved 460 students in the quantitative phase, 30 students in the qualitative phase. Data were collected via a 20-question questionnaire, Future Anxiety Scale, Attitude Scale for Brain Drain, and analyzed using SPSS and MAXQDA. Future anxiety was higher among women, those with low income, and poor academic performance. Participants rating healthcare services as poor were 3.16 times, those perceiving society's attitude towards physicians negatively were 9.26 times, those wanting to pursue career abroad were 2.32 times more likely to experience future anxiety. Higher maternal education and better English/German proficiency were associated with higher brain drain scores. Students rating society’s attitude towards physicians negatively were 7.33 times more likely to have brain drain tendency. The likelihood of pursuing career abroad is higher for various reasons: 2.16 times for economic opportunities, 2.90 times for political/administrative reasons, 2.67 times for reputation, 4.48 times for better education, 3.82 times for healthcare violence, 5.60 times for better living standards. In semi-structured interviews, seven themes were identified: social structure and professional reputation, economic reasons, living standards, working conditions, violence in healthcare, professional development, and political/administrative reasons. Qualitative results revealed that negative societal attitudes towards physicians and violence in healthcare are key factors increasing future anxiety and brain drain tendencies identified in quantitative analyses. To reduce brain drain, reforms in healthcare, education, social services are essential. Key steps include preventing violence against healthcare workers, improving economic and professional conditions, and creating a supportive work environment.   

Anahtar Sözcükler / Keywords

  • TR: Tıp fakültesi öğrencileri; gelecek kaygısı; beyin göçü; tutum ve davranışlar; karma yöntemli araştırma
    EN: Medical faculty students; Future anxiety; Brain drain; Attitudes and behaviors; Mixed methods study

Kaynaklar / References

  • Abukmail, E., Albarqouni, L. (2021). Postgraduate training abroad and migration intentions of medical doctors and students in Gaza: a cross-sectional survey. Lancet. 398(Suppl 1):S6. https://doi.org/10.1016/S0140-6736(21)01492-6. Adovor, E., Czaika, M., Docquier, F., Moullan, Y. (2021). Medical brain drain: How many, where and why? J Health Econ. 76(102409):102409. https://doi.org/10.1016/j.jheale-co.2020.102409. Alsuhaibani, M., Alharbi, A., Alqaryan, S. K., Aldress, T., Alharbi, M., Alharethy, S. (2018). The impact of the “brain drain” involving Saudi physicians: a cross-sectional study. J Nat Sci Med. 1(2):69-73. https://doi.org/10.4103/JNSM.JNSM_32_18. Anastasiou, E., Anagnostou, G., Theodossiou, G., Papamargaritis, V. (2020). Physicians’ brain drain: Investigatingthe determinants to emigrate through empirical evi-dence. Int J Bus Econ Sci Appl Res. 13(2):83-92. https://doi.org/10.25103/ijbesar.132.07. Aydan, S. (2023). Evaluation of Türkiye’s working conditions in terms of physician migration. Hacettepe Health Administration Journal. 26(3):895-920. Baş, H. (2023). Bibliometric analysis of publications on brain drain with VOSviewer. Turkish Journal of Social Policy. 4(1):52-65. Bolanowski, W. (2005). Anxiety about professional future among young doctors. Int J Occup Med Environ Health. 18(4):367-74. Botezat, A., Ramos, R. (2020). Physicians’ brain drain- a gravity model of migration flows. Globalization and Health. 16(1):7. https://doi.org/10.1186/s12992-019-0536-0. Buchan, J. (2008). Migration of health workers. Cah Sociol Demogr Med. 48(2):246-52. Cansız, A. (2006). The effects of brain drain on Turkish higher education in recent years. TMMOB Electrical-Electronics Computer Engineering Education. 3(1):7-10. Chaet, A., Fessehaie, N., Rajaguru, P. R., ve ark. (2021). Comparing the drivers of medical student emigration intentionacross two African nations. Med Educ. 55(10):1194-1204. https://doi.org/10.1111/medu.14562. Creswell, J. W., Clark, V. L. P. (2011). Designing and conducting mixed methods research. (Trans. editor: Dede Y, Demir SB). Anı Publishing. Ankara. Dağtekin, G., Dalkılıç, M., Çakıcı, F., Çakır, A., Ekin, A. E., Öztünç, D., Işıklı, B. (2020). Future anxiety, depression and stress among medical students. Turkish Medical Students Research Journal, 2(3):135-142. Demiray, A., İlaslan, N., Açıl, A. (2020). Evaluation of nursing students’ attıtudes towards brain drain. Journal of Human Sciences. 17(2):632-641. https://doi.org/10.14687/jhs.v17i2.5956. Dormon, F., Balen, J., Schmidtke, K. A., Vlaev, I. (2017). Healthworkers’ motivation in low and middle income countries: A systematic review of the Literature. Medical Research Archives. 5(8):1-32. Dyer, O. (2022). Doctors in Turkey strike after murder of cardiologist. BMJ. 378:o1768. https://doi.org/10.1136/bmj.o1768. Ebeye, T., Lee, H. (2023). Down the brain drain: a rapid review exploring physician emigration from West Africa. Global Health Research and Policy. 8(1):23. https://doi.org/10.1186/s41256-023-00307-0. Ekingen, E., Yıldız, A., Korku, C., Korkmazer, F. (2017). A Research on the effects of the performance based additional payment system on motivation and performance of employees in hospitals. Dicle University Journal of Economics and Administrative Sciences. 7(12):71-83. Erdoğan Kaya, A., Erdoğan Aktürk, B., Aslan, E. (2023). Factors predicting the motivation to study abroad in Turkish medical students: a causal investigation into the problem of brain drain. Journal of Health Sciences and Medicine. 6(2):526-531. https://doi.org/10.32322/jhsm.1253308. Eser, E., Cil, E., Sen Gundogan, N. E., ve ark. (2024). Push and pull factors of why medical students want to leave Türkiye: A countrywide multicenter study. Teach Learn Med. 36(5):588-600. https://doi.org/10.1080/10401334.2023.2229810. Filiz, M., Karagöz, M. B., Karagöz, N. (2022). Evaluation of attitudes of medical faculty students towards brain drain. Black Sea Journal of Social Sciences. 14(27):679-692. https://doi.org/10.38155/ksbd.1171838. Gall, C. (2022). Turkey’s doctors are leaving, the latest casualty of spiraling inflation. The New York Times. www.nytimes.com/2022/02/07/world/asia/turkey-inflation-doctors.html. Accessed March 11, 2025. Genç, K. (2022). Turkish doctors emigrate amid low pay and rising violence. Lancet. 400(10351):482-483. https://doi.org/10.1016/s0140-6736(22)01524-0. Geylani, M., Çiriş Yıldız, C. (2022). Development of “Future Anxiety Scale in University Students”: validity and reliability. Journal of Inonu University Health Services Vocational School. 10(1):284-300. https://doi.org/10.33715/inonusaglik.1011330. Goštautaitė, B., Bučiūnienė, I., Milašauskienė, Ž., Bareikis, K., Bertašiūtė, E., Mikelionienė, G. (2018). Migration intentions of Lithuanian physicians, nurses, residents and medical students. Health Policy. 122(10):1126-1131. https://doi.org/10.1016/j.healthpol.2018.07.001. Güngör, N. D. (2004). Brain drain from Türkiye: An empirical investigation. ERC (Economic Research Center) Working Papers in Economics. 4(02):1-10. Győrffy, Z., Szél, Z. (2018). Magyarországi orvostanhallgatókkülföldi munkavállalási szándékai [Willingness to workabroad among Hungarian medical students.]. Orv Hetil. 159(1):31-37. https://doi.org/10.1556/650.2018.30912. Hamzaoglu, N., Türk, B. (2019). Prevalence of physical and verbal violence against health care workers in Turkey. Int J Health Serv. 49(4):844-861. https://doi.org/10.1177/0020731419859828. Humphries, N., Connell, J., Negin, J., Buchan, J. (2019). Trackingthe leavers: towards a better understanding of doctormigration from Ireland to Australia 2008-2018. Hum Resour Health. 17(1):36. https://doi.org/10.1186/s12960-019-0365-5. Ifanti, A. A., Argyriou, A. A., Kalofonou, F. H., Kalofonos, H. P. (2014). Physicians’ brain drain in Greece: A perspective on the reasons why and how to address it. Health Policy. 117(2):210-215. https://doi.org/10.1016/j.healthpol.2014.03.014. Istanbul Economic Research, Turkey Report. (2022). Quality of life of doctors in Türkiye. turkiyeraporu.com/wp-content/uploads/2022/05/Doktorlar-Raporu-Mayis-2022.pdf Accessed March 11, 2025. Kabbash, I., El-Sallamy, R., Zayed, H., Alkhyate, I., Omar, A., Abdo, S. (2021). The brain drain: why medical students and young physicians want to leave Egypt. East Mediterr Health J. 27(11):1102-1108. https://doi.org/10.26719/emhj.21.050. Khan, K. W., Nadeem, S., Ain, Q., Muhammad, F., Zafar T., Nisa, M. (2021). Attitude of medical students about migrating abroad: a cross sectional study. L&S. 2(2):3. https://doi.org/10.37185/LnS.1.1.135. Li, W., Sun, H. (2019). Migration intentions of Asian and African medical students educated in China: a cross-sectional study. Hum Resour Health. 17(1):88. https://doi.org/10.1186/s12960-019-0431-z. Lofters, A., Slater, M., Fumakia, N., Thulien, N. (2014). “Brain drain” and “brain waste”: experiences of international medical graduates in Ontario. Risk Manag Healthc Policy. 7:81-89. https://doi.org/10.2147/rmhp.s60708. Meo, S. A., Sultan, T. (2023). Brain drain of health professionals from Pakistan from 1971 to 2022: Evidence-based analysis. Pakistan Journal of Medical Sciences. 39(4):921. Miles, M. B., Huberman, M. (1994). Qualitative data analysis. An expanded sourcebook (2nd ed.). Sage. New Delhi. Najib, M., Abdullah, S., Narresh, S., Juni, M. H. (2019). Brain-drain phenomenon among healthcare workers. International Journal of Public Health and Clinical Sciences. 6(3):90-103. Nasir, G. A., Nasir, S. A., Usman, A. (2018). Intention of final year medical students to go abroad and impact of central induction policy on brain draining. Pak J Med Health Sci. 12:696-699. O’Connor, K., Muller Neff, D., Pitman, S. (2018). Burnout in mental health professionals: A systematic review and meta-analysis of prevalence and determinants. EurPsychiatry. 53:74-99. https://doi.org/10.1016/j.eurpsy.2018.06.003. Oghenekaro, E. G. (2019). Physician migration at its roots: emigration intentions and preferences among medical students of a Nigerian University in the Niger Delta Region. Niger Delta J Med Sci. 2(2):7-18. Öncü, E., Selvi, H. K., Vayisoğlu, S., Ceyhan, H. (2018). Development of an Attitude Scale for Brain Drain among nursing students: a reliability and validity study. Cukurova Medical Journal. 43(Suppl 1):207-215. https://doi.org/10.17826/cumj.427962. Patton, M. Q. (2014). Qualitative research and evaluation methods. (Trans. editor: Bütün M, Demir SB). Pegem Academy. Ankara. Sarcan, E. (2022). Migration of highly skilled workforce: Brain drain. The Ankara University Journal of Social Sciences. 13(2):69-75. https://doi.org/10.33537/sobild.2022.13.2.7. Suciu, Ş. M., Popescu, C. A., Ciumageanu, M. D., Buzoianu, A. D. (2017). Physician migration at its roots: a study on the emigration preferences and plans among medical students in Romania. Hum Resour Health. 15(1):6. https://doi.org/10.1186/s12960-017-0181-8. Tengiz, F. İ., Babaoğlu, A. B. (2020). Career preferences of senior students in faculty of medicine and factors affecting these preferences. Medical Journal of Süleyman Demirel University. 27(1):67-78. https://doi.org/10.17343/sdutfd.560350. Yıldırım, A., Şimşek, H. (2013). Qualitative research methods in social sciences. Seçkin Publishing. Ankara.

Geliş Tarihi / Received Date

  • 21.10.2025

Kabul Tarihi / Accepted Date

  • 25.06.2026