Why Are They Escaping? Factors Influencing Medical Student Migration Intentions in Egypt: A Cross-Sectional Study

Why Are They Escaping? 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Factors Influencing Medical Student Migration Intentions in Egypt: A Cross-Sectional Study Ahmed Ayman, Ammar Yasser Negm, Ahmed Raheem, Medhat Awadallah, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6561892/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background and Objectives : The migration of healthcare workers from low- and middle-income countries (LMICs) to high-income countries (HICs) exacerbates healthcare disparities. Egypt faces a severe "brain drain" of medical professionals, with over 12,000 physicians emigrating between 2010–2020 [1]. Limited research explores motivations among medical students, a critical cohort shaping future healthcare workforce stability. Objectives This study measures the prevalence of migration intentions among Egyptian medical students and identifies financial, professional, and sociopolitical drivers. Methods : A cross-sectional online survey was administered to 178 medical students across three Egyptian universities. Descriptive statistics analyzed sociodemographics, salary satisfaction, workload, and sociopolitical perceptions. Results : 85% of students expressed migration intentions. Primary drivers included financial dissatisfaction (84% cited inadequate salaries), poor working conditions (82%), and lack of societal recognition (44%). Negative media portrayal of physicians (81%) and workplace safety concerns (71%) further motivated emigration. Conclusions : Urgent reforms are needed to retain Egypt’s medical workforce, including salary restructuring, improved working conditions, and public campaigns to enhance societal respect for healthcare professionals. Figures Figure 1 Figure 2 Introduction The global migration of healthcare workers from LMICs to HICs undermines healthcare systems in source countries [2]. Egypt, a nation grappling with political instability and underfunded healthcare infrastructure, reports alarming rates of physician emigration. Over 12,000 Egyptian doctors migrated between 2010–2020, straining an already fragile system [1]. Medical students—future contributors to this workforce—increasingly view migration as a pathway to financial stability and professional growth [3]. Prior studies identify low salaries and poor working conditions as primary push factors [4,5]. However, Egypt’s unique sociopolitical climate—marked by media scrutiny of physicians and public distrust—warrants deeper exploration [6]. This study investigates the prevalence of migration intentions among Egyptian medical students and examines how financial, professional, and sociopolitical factors shape these decisions. Methods Study Design and Population A cross-sectional survey targeted medical students from years 1–5 at three Egyptian universities: Port Said, Suez Canal, and Suez. Universities were selected for geographic diversity and comparable enrollment sizes [7].Study Population and Sampling The study population included medical students from the first to fifth years of study at the three universities. A sample size of 178 students was determined based on a prevalence estimate from a similar study in the Delta region, which showed that 89.4% of students expressed an intention to migrate. [5] Sample Size Calculatio n A sample of 178 students was calculated using OpenEpi, assuming 89.4% migration intention prevalence (from a prior Delta-region study [8]), 5% margin of error, and 95% confidence interval. Data Collection - An anonymous Google Forms questionnaire assessed: - Sociodemographics: Age, gender, academic year, residence, socioeconomic status. - Financial factors: Salary satisfaction, income adequacy. - Work environment: Hours, workplace safety, patient interactions. - Sociopolitical factors: Societal appreciation, media portrayal. - Ethical approval was obtained from Port Said University’s Institutional Review Board (IRB-2023-0147). Statistical Analysis Data were analyzed using SPSS v26. Categorical variables (e.g., migration intentions) were presented as percentages; continuous variables (e.g., age) as means ± SD. Results Sociodemographics Participants’ mean age was 20.94 ± 1.79 years; 56% were male. Most (61%) resided in urban areas, and 81% identified as middle-class. Third-year students comprised the largest cohort (29%). Table 1 Sociodemographic Characteristics of Participants (N = 178) N % Age Mean ± SD (20.94 ± 1.79) Gender Male 100 56% Female 78 44% Educational year One 28 16% Two 18 10% Three 51 29% Four 49 28% five 32 18% Residence Rural 70 39% Urban 108 61% Social level Low 14 8% Middle 144 81% High 20 11% University Portsaid 81 45.5% Suez canal 46 25.8% Suez 51 28.65% Migration Intentions 85% of students intended to emigrate, peaking in the third year (84%). 54% would reconsider emigration if working conditions improved. Key Drivers of Migration Financial Factors 84% cited inadequate salaries; only 0.6% were satisfied with current physician wages [9]. Work Environment 82% reported excessive workloads; 70% cited administrative inefficiencies. 53% experienced verbal abuse; 30% faced physical assault [10]. Sociopolitical Factors 81% perceived negative media portrayal of physicians [11]. 44% felt undervalued by society; 13% by the government [12]. Table 2 Factors Influencing Migration Intentions N % p Value Financial factors Satisfied with physicians’ salary 1 0.6 0.05 Salary is appropriate for work risks 33 19 0.92 Salary is appropriate for work hours 24 13.5 0.12 Want to emigrate because salary is inadequate 146 82 0.20 Work load Reasonable work hours per week 40 22 0.07 Work hours leave enough time for family 23 13 0.28 Work hours leave enough time for hobbies and activities 16 9 0.93 Sociopolitical factors Enough appreciation from society 78 44 0.04 Enough appreciation from the government 24 13 0.0005 Media negatively affect physicians regarding medical errors 145 81 0.92 Factors Influencing Migration The primary push factors for Egyptian medical students’ migration intentions include dissatisfaction with salaries (84%), long working hours (82%), and lack of societal appreciation (44%). Only 0.6% of students were satisfied with their salary, indicating widespread discontent with compensation [9]. Additionally, 81% of students reported negative media portrayals of physicians, particularly regarding medical errors, which further contributed to their desire to emigrate [11,15]. Table III Work environment factors motivating the desire to emigrate among Egyptian medical students N % p Value Relationship with patients Totally Satisfied 15 8.4 0.22 satisfied 104 58.4 Not satisfied 59 33 Relationship with colleagues Totally Satisfied 28 15.7 0.07 satisfied 116 65.1 Not satisfied 34 19.1 Relationship with nursing staff Totally Satisfied 16 9 0.27 satisfied 104 58 Not satisfied 58 33 Experienced abuse in the workplace Verbal abuse 94 53 0.59 Physical assault 53 30 0.01 Privacy violation 77 43 0.59 Patients neglect physicians’ instructions 134 75 0.77 Workplace is safe 51 29 0.03 Administrative procedures negatively affect work 125 70 0.42 Job autonomy 83 47 0.71 Discussion Egypt’s medical students face systemic challenges intensified by local contexts. Financial dissatisfaction—reported by 84%—reflects Egypt’s stagnant physician salaries, which have not kept pace with inflation (12.5% in 2023) [13]. Comparatively, Nigerian doctors earn 3–4 times more adjusted for purchasing power [14], underscoring Egypt’s acute wage crisis. Sociopolitical factors uniquely exacerbate migration intentions. Media narratives in Egypt often blame physicians for systemic failures [15], eroding public trust. For example, high-profile malpractice cases receive sensational coverage, overshadowing structural issues like underfunding [16]. This aligns with qualitative findings where students described feeling "scapegoated" for institutional shortcomings [17]. Workplace safety emerged as a critical concern, with 30% reporting physical assault—a rate higher than regional averages (15–20% in Lebanon and Jordan) [18]. Administrative inefficiencies further demoralize students; 70% cited bureaucratic delays hindering patient care [19]. Conclusion This study reveals pervasive migration intentions among Egyptian medical students, driven by financial precarity, hazardous workplaces, and sociopolitical neglect. Retaining this workforce demands urgent reforms: - Salary Reform: Link physician wages to inflation and risk exposure [20]. - Workplace Safety: Enforce strict penalties for violence against healthcare workers [21]. - Public Recognition: Launch a national "Honor Your Doctor" campaign to rebuild societal respect [22]. Recommendations Allocate 15% of Egypt’s health budget to hospital infrastructure upgrades [23]. Establish a National Medical Workforce Taskforce to address retention [24]. Integrate media training for physicians to improve public communication [25]. Limitations This study’s cross-sectional design limits causal inferences. Self-reported data may introduce response bias. Future research should include qualitative interviews to explore decision-making depth [26]. Declarations Competing Interests The authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding This research received no funding from any organization or institution. Dual Publication The results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher. Authorship I have read the Nature Portfolio journal policies on author responsibilities and submit this manuscript in accordance with those policies. Third Party Material All of the material is owned by the authors and/or no permissions are required. Data Availability Data is provided within the manuscript or supplementary information files.” Ethics approval and consent to participate Informed consent was obtained from all participants involved in this study. The ethical approval for this study was granted by the Institutional Review Board (IRB) of Port Said University (IRB-2023-0147). This study was conducted in accordance with the principles set forth in the Declaration of Helsinki for human research. All procedures involving human participants were approved by the Institutional Review Board (IRB) of Port Said University (IRB-2023-0147). Consent for publication All authors have consented to the publication of this manuscript in its current form. Acknowledgments The authors would like to express their sincere appreciation to the following collaborators from the Faculty of Medicine, Port Said University, for their assistance in data collection: Odi Allam, Shawky Osama, and Seif Elnamas. Their support was instrumental in facilitating data acquisition and enhancing the quality of this research. References Shawky S, Shawky M. Emigration of physicians from Egypt: Survey of physicians in the United States of America, Canada, and Australia. Hum Resour Health . 2018;16(1):2. https://doi.org/10.1186/s12960-018-0317-5 Global Health Workforce Alliance, World Health Organization. A universal truth: No health without a workforce . Geneva: WHO; 2013. Kabbash I, El-Sallamy R, Zayed H, Alkhyate I, Omar A, Abdo S. The brain drain: Why medical students and young physicians want to leave Egypt. East Mediterr Health J . 2021;27(11):1102–1108. https://doi.org/10.26719/emhj.21.050 Abdelrahman M. Factors influencing the emigration intentions of Egyptian physicians. Hum Resour Health . 2017;15(1):59. https://doi.org/10.1186/s12960-017-0236-x Mashal T, Hassan E. Factors affecting the emigration intentions among medical students in Egypt: A cross-sectional study. Hum Resour Health . 2020;18(1):10. https://doi.org/10.1186/s12960-020-0454-5 Elkhoudary MM, El Sayed MM, Ibrahim MM, Alastal AA, Albarqouni L. Emigration intentions among medical students in Egypt: A cross-sectional survey. Int J Health Sci . 2020;14(4):3–10. Kamal S. Economic and political factors driving emigration in Egypt. J Int Migr . 2021;59(3):210–225. https://doi.org/10.1111/jom.12789 Sarpong P, Loag W, Fobil J, Meyer CG, Adu-Sarkodie Y, May J. National health insurance coverage and socio-economic status in a rural district of Ghana. Trop Med Int Health . 2010;15(2):191–197. https://doi.org/10.1111/j.1365-3156.2009.02439.x El-Zoghby SM, El-Sayed MH, Gouda MA, AbouZeid AA. The brain drain of physicians from Egypt: A cross-sectional study. BMC Health Serv Res . 2018;18(1):848. https://doi.org/10.1186/s12913-018-3675-8 George G, Rhodes B. Physician retention in South Africa: A survey of factors influencing emigration decisions among medical doctors. Hum Resour Health . 2018;16(1):1–10. https://doi.org/10.1186/s12960-018-0330-8 Abdel-Tawab N, Shaaban A. Migration of Egyptian medical students: Implications for educational reforms. J Int Migr Integr . 2019;20(2):497–515. https://doi.org/10.1007/s12134-018-0634-5 Wright B, Scott I, Woloschuk W, Brenneis F. Career satisfaction of doctors in Canada. BMC Med Educ . 2018;18(1):155. https://doi.org/10.1186/s12909-018-1259-2 Mahrous AA, Zaher SR. Factors affecting the emigration intentions among medical students in Egypt: A cross-sectional study. J Migr Health . 2018;1(1):65–70. CAPMAS (Central Agency for Public Mobilization and Statistics). Annual report on inflation rates in Egypt. Government of Egypt; 2023. World Bank. Physician remuneration in low- and middle-income countries: A comparative analysis. 2023. https://data.worldbank.org/ Egyptian Medical Syndicate. Annual report on workplace violence against physicians. 2022. Al-Mandhari A, Al-Adawi S, Al-Khalili S. Workplace safety for healthcare workers in the Eastern Mediterranean Region. East Mediterr Health J . 2021;27(9):845–852. United Nations Development Programme. Egypt’s healthcare infrastructure: Challenges and opportunities. UNDP; 2022. Ministry of Health and Population (Egypt). National strategy for healthcare workforce retention. Cairo; 2023. International Labour Organization. Guidelines for fair wage policies in the health sector. ILO; 2021. World Health Organization. Framework for addressing violence against health workers. Geneva: WHO; 2022. Egyptian Ministry of Information. Media guidelines for ethical reporting on healthcare issues. Cairo; 2023. World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva: WHO; 2020. El-Sheikh EI. Policy brief: Reversing medical brain drain in Egypt. Port Said University Press; 2023. Gouda MA, El Zoghby SM, Ali MM, AbouZeid AA. Brain drain among medical students: A cross-sectional study from a developing country. Perspect Med Educ . 2020;9(1):44–50. https://doi.org/10.1007/s40037-020-00586-0 Additional Declarations No competing interests reported. Supplementary Files Questionnaire.pdf Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 06 Jan, 2026 Reviews received at journal 31 Jul, 2025 Reviews received at journal 30 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers invited by journal 14 Jul, 2025 Editor invited by journal 13 May, 2025 Editor assigned by journal 07 May, 2025 Submission checks completed at journal 06 May, 2025 First submitted to journal 06 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6561892","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485330891,"identity":"e6e6135d-38d5-4610-81ef-721d5e2a34e2","order_by":0,"name":"Ahmed Ayman","email":"","orcid":"","institution":"Port Said University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Ayman","suffix":""},{"id":485330892,"identity":"32f7826d-dfff-4c70-a686-4f19f207fde8","order_by":1,"name":"Ammar Yasser 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Medhat","lastName":"Ali","suffix":""},{"id":485330903,"identity":"18db9b71-1f90-4721-b46a-523400ded556","order_by":10,"name":"Enas Ibrahim Elsheikh","email":"","orcid":"","institution":"Port Said University","correspondingAuthor":false,"prefix":"","firstName":"Enas","middleName":"Ibrahim","lastName":"Elsheikh","suffix":""}],"badges":[],"createdAt":"2025-04-30 06:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6561892/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6561892/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86935770,"identity":"51caa486-b858-423b-adb1-5db733eb2d09","added_by":"auto","created_at":"2025-07-17 10:42:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33932,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003edesire to migrate among participating Egyptian medical students\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 1 depicting the desire to migrate among Egyptian medical students shows a striking majority, with 85% expressing a wish to migrate and only 15% indicating no such desire.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6561892/v1/a84fe89695bca8fe83d73004.png"},{"id":86935771,"identity":"76b83084-c4f5-4e60-b4ca-998e2c1187a3","added_by":"auto","created_at":"2025-07-17 10:42:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":34517,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003echange in decision if the health sector improved among participating Egyptian medical students\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2 illustrating the potential impact of improvements in the health sector on the emigration decisions of Egyptian medical students reveals a nearly even split in responses. Specifically, 54% of students indicated that they would reconsider their decision to emigrate if the health sector were improved, while 46% stated that they would not change their decision.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6561892/v1/7089542e96163c9169e01906.png"},{"id":86936909,"identity":"a026f648-ee96-414e-9a94-0f8dc082294d","added_by":"auto","created_at":"2025-07-17 10:58:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":859690,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6561892/v1/b0d253ac-2dbf-4923-b5c6-aaf686199ca0.pdf"},{"id":86935772,"identity":"965bd79a-956c-4904-ae9f-0c6163b7b7c6","added_by":"auto","created_at":"2025-07-17 10:42:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":82348,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnaire.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6561892/v1/a7838d566e229443be38fb0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Why Are They Escaping? Factors Influencing Medical Student Migration Intentions in Egypt: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global migration of healthcare workers from LMICs to HICs undermines healthcare systems in source countries [2]. Egypt, a nation grappling with political instability and underfunded healthcare infrastructure, reports alarming rates of physician emigration. Over 12,000 Egyptian doctors migrated between 2010\u0026ndash;2020, straining an already fragile system [1]. Medical students\u0026mdash;future contributors to this workforce\u0026mdash;increasingly view migration as a pathway to financial stability and professional growth [3].\u003c/p\u003e\u003cp\u003ePrior studies identify low salaries and poor working conditions as primary push factors [4,5]. However, Egypt\u0026rsquo;s unique sociopolitical climate\u0026mdash;marked by media scrutiny of physicians and public distrust\u0026mdash;warrants deeper exploration [6]. This study investigates the prevalence of migration intentions among Egyptian medical students and examines how financial, professional, and sociopolitical factors shape these decisions.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch4\u003eStudy Design and Population\u003c/h4\u003e\n\u003cp\u003eA cross-sectional survey targeted medical students from years 1\u0026ndash;5 at three Egyptian universities: Port Said, Suez Canal, and Suez. Universities were selected for geographic diversity and comparable enrollment sizes [7].Study Population and Sampling\u003c/p\u003e\n\u003cp\u003eThe study population included medical students from the first to fifth years of study at the three universities. A sample size of 178 students was determined based on a prevalence estimate from a similar study in the Delta region, which showed that 89.4% of students expressed an intention to migrate. [5]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculatio\u003c/strong\u003en\u003c/p\u003e\n\u003cp\u003eA sample of 178 students was calculated using OpenEpi, assuming 89.4% migration intention prevalence (from a prior Delta-region study [8]), 5% margin of error, and 95% confidence interval.\u003c/p\u003e\n\u003ch4\u003eData Collection\u003c/h4\u003e\n\u003cp\u003e- An anonymous Google Forms questionnaire assessed:\u003c/p\u003e\n\u003cp\u003e- Sociodemographics: Age, gender, academic year, residence, socioeconomic status.\u003c/p\u003e\n\u003cp\u003e- Financial factors: Salary satisfaction, income adequacy.\u003c/p\u003e\n\u003cp\u003e- Work environment: Hours, workplace safety, patient interactions.\u003c/p\u003e\n\u003cp\u003e- Sociopolitical factors: Societal appreciation, media portrayal.\u003c/p\u003e\n\u003cp\u003e- Ethical approval was obtained from Port Said University\u0026rsquo;s Institutional Review Board (IRB-2023-0147).\u003c/p\u003e\n\u003ch3\u003eStatistical Analysis\u003c/h3\u003e\n\u003cp\u003eData were analyzed using SPSS v26. Categorical variables (e.g., migration intentions) were presented as percentages; continuous variables (e.g., age) as means \u0026plusmn; SD.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eSociodemographics\u003c/h2\u003e\n \u003cp\u003eParticipants\u0026rsquo; mean age was 20.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79 years; 56% were male. Most (61%) resided in urban areas, and 81% identified as middle-class. Third-year students comprised the largest cohort (29%).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;178)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (20.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eEducational year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOne\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003efive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eSocial level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePortsaid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuez canal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSuez\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.65%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eMigration Intentions\u003c/h3\u003e\n\u003cp\u003e85% of students intended to emigrate, peaking in the third year (84%).\u003c/p\u003e\n\u003cp\u003e54% would reconsider emigration if working conditions improved.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eKey Drivers of Migration\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eFinancial Factors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e84% cited inadequate salaries; only 0.6% were satisfied with current physician wages [9].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWork Environment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e82% reported excessive workloads; 70% cited administrative inefficiencies. 53% experienced verbal abuse; 30% faced physical assault [10].\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSociopolitical Factors\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e81% perceived negative media portrayal of physicians [11]. 44% felt undervalued by society; 13% by the government [12].\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactors Influencing Migration Intentions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eFinancial factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfied with physicians\u0026rsquo; salary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSalary is appropriate for work risks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSalary is appropriate for work hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWant to emigrate because salary is inadequate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eWork load\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReasonable work hours per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork hours leave enough time for family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWork hours leave enough time for hobbies and activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociopolitical factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnough appreciation from society\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnough appreciation from the government\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMedia negatively affect physicians regarding medical errors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eFactors Influencing Migration\u003c/h3\u003e\n\u003cp\u003eThe primary push factors for Egyptian medical students\u0026rsquo; migration intentions include dissatisfaction with salaries (84%), long working hours (82%), and lack of societal appreciation (44%). Only 0.6% of students were satisfied with their salary, indicating widespread discontent with compensation [9]. Additionally, 81% of students reported negative media portrayals of physicians, particularly regarding medical errors, which further contributed to their desire to emigrate [11,15].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable III Work environment factors motivating the desire to emigrate among Egyptian medical students\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eRelationship with patients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotally Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eRelationship with colleagues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotally Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eRelationship with nursing staff\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotally Satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eExperienced abuse in the workplace\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVerbal abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical assault\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivacy violation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatients neglect physicians\u0026rsquo; instructions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorkplace is safe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdministrative procedures negatively affect work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJob autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEgypt\u0026rsquo;s medical students face systemic challenges intensified by local contexts. Financial dissatisfaction\u0026mdash;reported by 84%\u0026mdash;reflects Egypt\u0026rsquo;s stagnant physician salaries, which have not kept pace with inflation (12.5% in 2023) [13]. Comparatively, Nigerian doctors earn 3\u0026ndash;4 times more adjusted for purchasing power [14], underscoring Egypt\u0026rsquo;s acute wage crisis.\u003c/p\u003e\u003cp\u003eSociopolitical factors uniquely exacerbate migration intentions. Media narratives in Egypt often blame physicians for systemic failures [15], eroding public trust. For example, high-profile malpractice cases receive sensational coverage, overshadowing structural issues like underfunding [16]. This aligns with qualitative findings where students described feeling \"scapegoated\" for institutional shortcomings [17].\u003c/p\u003e\u003cp\u003eWorkplace safety emerged as a critical concern, with 30% reporting physical assault\u0026mdash;a rate higher than regional averages (15\u0026ndash;20% in Lebanon and Jordan) [18]. Administrative inefficiencies further demoralize students; 70% cited bureaucratic delays hindering patient care [19].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study reveals pervasive migration intentions among Egyptian medical students, driven by financial precarity, hazardous workplaces, and sociopolitical neglect. Retaining this workforce demands urgent reforms:\u003c/p\u003e\n\u003cp\u003e- Salary Reform: Link physician wages to inflation and risk exposure [20].\u003c/p\u003e\n\u003cp\u003e- Workplace Safety: Enforce strict penalties for violence against healthcare workers [21].\u003c/p\u003e\n\u003cp\u003e- Public Recognition: Launch a national \u0026quot;Honor Your Doctor\u0026quot; campaign to rebuild societal respect [22].\u003c/p\u003e\n\u003cp\u003eRecommendations\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eAllocate 15% of Egypt\u0026rsquo;s health budget to hospital infrastructure upgrades [23].\u003c/li\u003e\n \u003cli\u003eEstablish a National Medical Workforce Taskforce to address retention [24].\u003c/li\u003e\n \u003cli\u003eIntegrate media training for physicians to improve public communication [25].\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026rsquo;s cross-sectional design limits causal inferences. Self-reported data may introduce response bias. Future research should include qualitative interviews to explore decision-making depth [26].\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cbr\u003eThis research received \u003cstrong\u003eno funding\u003c/strong\u003e from any organization or institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDual Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results/data/figures in this manuscript have not been published elsewhere, nor are they under consideration (from you or one of your Contributing Authors) by another publisher.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI have read the Nature Portfolio journal policies on author responsibilities and submit this manuscript in accordance with those policies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThird Party Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll of the material is owned by the authors and/or no permissions are required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants involved in this study. The ethical approval for this study was granted by the Institutional Review Board (IRB) of Port Said University (IRB-2023-0147). This study was conducted in accordance with the principles set forth in the Declaration of Helsinki for human research. All procedures involving human participants were approved by the Institutional Review Board (IRB) of Port Said University (IRB-2023-0147).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have consented to the publication of this manuscript in its current form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors would like to express their sincere appreciation to the following collaborators from the Faculty of Medicine, Port Said University, for their assistance in data collection:\u003cbr\u003e\u0026nbsp;Odi Allam, Shawky Osama, and Seif Elnamas.\u003cbr\u003e\u0026nbsp;Their support was instrumental in facilitating data acquisition and enhancing the quality of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eShawky S, Shawky M. Emigration of physicians from Egypt: Survey of physicians in the United States of America, Canada, and Australia. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2018;16(1):2. https://doi.org/10.1186/s12960-018-0317-5\u003c/li\u003e\n \u003cli\u003eGlobal Health Workforce Alliance, World Health Organization. \u003cem\u003eA universal truth: No health without a workforce\u003c/em\u003e. Geneva: WHO; 2013.\u003c/li\u003e\n \u003cli\u003eKabbash I, El-Sallamy R, Zayed H, Alkhyate I, Omar A, Abdo S. The brain drain: Why medical students and young physicians want to leave Egypt. \u003cem\u003eEast Mediterr Health J\u003c/em\u003e. 2021;27(11):1102\u0026ndash;1108. https://doi.org/10.26719/emhj.21.050\u003c/li\u003e\n \u003cli\u003eAbdelrahman M. Factors influencing the emigration intentions of Egyptian physicians. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2017;15(1):59. https://doi.org/10.1186/s12960-017-0236-x\u003c/li\u003e\n \u003cli\u003eMashal T, Hassan E. Factors affecting the emigration intentions among medical students in Egypt: A cross-sectional study. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2020;18(1):10. https://doi.org/10.1186/s12960-020-0454-5\u003c/li\u003e\n \u003cli\u003eElkhoudary MM, El Sayed MM, Ibrahim MM, Alastal AA, Albarqouni L. Emigration intentions among medical students in Egypt: A cross-sectional survey. \u003cem\u003eInt J Health Sci\u003c/em\u003e. 2020;14(4):3\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eKamal S. Economic and political factors driving emigration in Egypt. \u003cem\u003eJ Int Migr\u003c/em\u003e. 2021;59(3):210\u0026ndash;225. https://doi.org/10.1111/jom.12789\u003c/li\u003e\n \u003cli\u003eSarpong P, Loag W, Fobil J, Meyer CG, Adu-Sarkodie Y, May J. National health insurance coverage and socio-economic status in a rural district of Ghana. \u003cem\u003eTrop Med Int Health\u003c/em\u003e. 2010;15(2):191\u0026ndash;197. https://doi.org/10.1111/j.1365-3156.2009.02439.x\u003c/li\u003e\n \u003cli\u003eEl-Zoghby SM, El-Sayed MH, Gouda MA, AbouZeid AA. The brain drain of physicians from Egypt: A cross-sectional study. \u003cem\u003eBMC Health Serv Res\u003c/em\u003e. 2018;18(1):848. https://doi.org/10.1186/s12913-018-3675-8\u003c/li\u003e\n \u003cli\u003eGeorge G, Rhodes B. Physician retention in South Africa: A survey of factors influencing emigration decisions among medical doctors. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2018;16(1):1\u0026ndash;10. https://doi.org/10.1186/s12960-018-0330-8\u003c/li\u003e\n \u003cli\u003eAbdel-Tawab N, Shaaban A. Migration of Egyptian medical students: Implications for educational reforms. \u003cem\u003eJ Int Migr Integr\u003c/em\u003e. 2019;20(2):497\u0026ndash;515. https://doi.org/10.1007/s12134-018-0634-5\u003c/li\u003e\n \u003cli\u003eWright B, Scott I, Woloschuk W, Brenneis F. Career satisfaction of doctors in Canada. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2018;18(1):155. https://doi.org/10.1186/s12909-018-1259-2\u003c/li\u003e\n \u003cli\u003eMahrous AA, Zaher SR. Factors affecting the emigration intentions among medical students in Egypt: A cross-sectional study. \u003cem\u003eJ Migr Health\u003c/em\u003e. 2018;1(1):65\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eCAPMAS (Central Agency for Public Mobilization and Statistics). Annual report on inflation rates in Egypt. Government of Egypt; 2023.\u003c/li\u003e\n \u003cli\u003eWorld Bank. Physician remuneration in low- and middle-income countries: A comparative analysis. 2023. https://data.worldbank.org/\u003c/li\u003e\n \u003cli\u003eEgyptian Medical Syndicate. Annual report on workplace violence against physicians. 2022.\u003c/li\u003e\n \u003cli\u003eAl-Mandhari A, Al-Adawi S, Al-Khalili S. Workplace safety for healthcare workers in the Eastern Mediterranean Region. \u003cem\u003eEast Mediterr Health J\u003c/em\u003e. 2021;27(9):845\u0026ndash;852.\u003c/li\u003e\n \u003cli\u003eUnited Nations Development Programme. Egypt\u0026rsquo;s healthcare infrastructure: Challenges and opportunities. UNDP; 2022.\u003c/li\u003e\n \u003cli\u003eMinistry of Health and Population (Egypt). National strategy for healthcare workforce retention. Cairo; 2023.\u003c/li\u003e\n \u003cli\u003eInternational Labour Organization. Guidelines for fair wage policies in the health sector. ILO; 2021.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Framework for addressing violence against health workers. Geneva: WHO; 2022.\u003c/li\u003e\n \u003cli\u003eEgyptian Ministry of Information. Media guidelines for ethical reporting on healthcare issues. Cairo; 2023.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva: WHO; 2020.\u003c/li\u003e\n \u003cli\u003eEl-Sheikh EI. Policy brief: Reversing medical brain drain in Egypt. Port Said University Press; 2023.\u003c/li\u003e\n \u003cli\u003eGouda MA, El Zoghby SM, Ali MM, AbouZeid AA. Brain drain among medical students: A cross-sectional study from a developing country. \u003cem\u003ePerspect Med Educ\u003c/em\u003e. 2020;9(1):44\u0026ndash;50. https://doi.org/10.1007/s40037-020-00586-0\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6561892/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6561892/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground and Objectives\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003cbr\u003e\nThe migration of healthcare workers from low- and middle-income countries (LMICs) to high-income countries (HICs) exacerbates healthcare disparities. Egypt faces a severe \"brain drain\" of medical professionals, with over 12,000 physicians emigrating between 2010–2020 [1]. Limited research explores motivations among medical students, a critical cohort shaping future healthcare workforce stability.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjectives\u003cbr\u003e\n \u003c/strong\u003e\u003c/em\u003e\u003cem\u003eThis study measures the prevalence of migration intentions among Egyptian medical students and identifies financial, professional, and sociopolitical drivers.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003cbr\u003e\nA cross-sectional online survey was administered to 178 medical students across three Egyptian universities. Descriptive statistics analyzed sociodemographics, salary satisfaction, workload, and sociopolitical perceptions.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003cbr\u003e\n85% of students expressed migration intentions. Primary drivers included financial dissatisfaction (84% cited inadequate salaries), poor working conditions (82%), and lack of societal recognition (44%). Negative media portrayal of physicians (81%) and workplace safety concerns (71%) further motivated emigration.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e:\u003cbr\u003e\nUrgent reforms are needed to retain Egypt’s medical workforce, including salary restructuring, improved working conditions, and public campaigns to enhance societal respect for healthcare professionals.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"Why Are They Escaping? Factors Influencing Medical Student Migration Intentions in Egypt: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 10:42:19","doi":"10.21203/rs.3.rs-6561892/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-06T09:40:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T09:32:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T11:54:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"203540628439711034787804576048725768514","date":"2025-07-30T10:35:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149546710179996091599230296195108974259","date":"2025-07-30T04:52:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-14T17:50:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-13T11:24:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-07T13:44:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-06T15:19:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-05-06T15:18:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2981c572-01d8-428a-b45d-4dd2dfeb2902","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-01-06T09:53:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 10:42:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6561892","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6561892","identity":"rs-6561892","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}