The Exodus and Its Toll: Sri Lanka's Economic Crisis and the Migration of Doctors.

Abstract

The migration of qualified medical doctors from low- and middle-income countries (LMICs) to high-income countries (HICs) presents substantial challenges for healthcare systems, particularly in resource-limited settings. This study examines the recent surge in doctor migration from Sri Lanka following its unprecedented economic crisis. We aimed to quantify the economic and systemic impacts of the migration of qualified doctors on healthcare service delivery, medical education, and health equity, and explore feasible policy interventions to mitigate these effects. We conducted a mixed-methods policy analysis using national and international data between 2022 and 2024, including Ministry of Health data, Post-Graduate Institute of Medicine figures and international Medical Council reports. We estimate that nearly 1489 doctors, including specialists, migrated during this period, resulting in a financial loss of approximately LKR 12.5 billion (USD 41.5 million) to the Sri Lankan government and taxpayers. This migration has strained healthcare infrastructure, particularly in rural and underserved areas, led to shortages in critical specialities, disrupted medical education, and exacerbated inequities in access to care. Existing retention mechanisms, such as post-training service bonds, have been largely ineffective. We discuss a range of policy options, including improved enforcement of bonds, strategic use of dual citizenship, bilateral tax-sharing agreements, and investments in working conditions and training infrastructure to retain medical talent. In conclusion, the migration of doctors presents a multidimensional threat to Sri Lanka's public healthcare system. Urgent, evidence-based interventions are essential to preserve the sustainability of free healthcare and medical education systems in LMICs under similar duress.