CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(02): 160-167
DOI: 10.1055/s-0043-1778086
Research Article

Brain Drain: A Cross-Sectional Study Evaluating Migration Intentions of Neurosurgery Trainees in Pakistan

1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
2   Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
Muhammad Ali Akbar Khan
2   Medical Student, Medical College, Aga Khan University, Karachi, Pakistan
Syed Ather Enam
1   Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
› Author Affiliations
Funding None.


Background Pakistan has a significant proportion of medical graduates who intend to leave the country for better opportunities abroad, leading to a brain drain. However, the push and pull factors within neurosurgery remain unexplored, emphasizing the need for evaluation to enact policy changes.

Materials and Methods We conducted a nationwide survey across 22 College of Physicians and Surgeons of Pakistan accredited neurosurgery training centers in all provinces of Pakistan. SPSS version 26 and STATA 15 were used for data analysis.

Results We collected responses from 120 neurosurgery trainees across Pakistan. Trainees were categorized into two groups: those intending to leave (64%) and those intending to stay (36%) in Pakistan. A significant association was observed between the availability of fellowship training in the residents' hospital and the decision to leave or remain in Pakistan (p = 0.034). About 67.5% of our respondents did not have any publication, and among the intention to leave group, a greater percentage had academic involvement, when compared with the stay group. A significant association (p = 0.012) was also observed between the decision to leave or remain in Pakistan and the number of publications in nonindexed journals.

Conclusion There remains a need for improvement in the standard of training provided by neurosurgery programs across the country. Our study found that disparities in research and academic exposure, as well as the lack of fellowship opportunities, may serve as stimuli for residents to leave Pakistan.

Ethics Approval

Our study was approved by Aga Khan University Ethical Review Committee.

Consent for Publication

All authors have approved the results, reviewed the manuscript, and consented for publication.

Data Availability Statement

Datasets are available from the corresponding author upon reasonable request.

Authors' Contributions

M.S. and A.A. conceptualized the study and designed the methodology for the study. H.A.I., and M.A.A.K. contributed significantly to the analysis and interpretation of the data. H.A.I. contributed significantly to data collection and data acquisition. M.A.A.K. wrote the initial manuscript and H.A.I., A.A., and A.E. made final edits to the manuscript. All authors reviewed the final manuscript and approved its submission for publication.

Supplementary Material

Publication History

Article published online:
10 May 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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