Pushed, Pulled, and Moored: A Systematic Review and Meta-analysis of Migration Intentions Among Medical Trainees in the Arab Region.

Abstract

Introduction: The Arab region is experiencing substantial outward migration amid persistent healthcare workforce shortages. However, reported prevalence estimates and reasons vary considerably across studies. Therefore, we aimed to estimate the pooled prevalence of migration intentions among medical trainees in the Arab region and summarize the reported drivers of migration using the Push-Pull-Mooring (PPM) framework.

Methods: We searched PubMed, Scopus, Embase, and Web of Science in April 2026, supplemented by backward and forward citation searching. Studies were eligible if they reported discrete prevalence estimates of migration intentions among medical students, interns, or residents in Arab countries. The pooled prevalence was calculated using a random-effects model with a generalized linear mixed model and logit transformation. Heterogeneity was primarily assessed using Tau². Risk of bias was assessed using the Newcastle-Ottawa Scale adapted for descriptive cross-sectional studies (NOS-xs2).

Results: Thirty-one studies comprising 21,614 Arab medical trainees were included. The overall pooled prevalence of migration intention was 70.7% (95% CI: 63.2%-77.2%), with substantial heterogeneity (Tau² = 0.84). Subgroup analyses were not statistically significant except for region (p = 0.030), with the Nile Valley reporting the highest prevalence (74.3%; k = 14) and the Arabian Peninsula reporting the lowest (41.5%; k = 3). Prevalence was numerically highest among medical students (76.0%), followed by residents (65.4%) and interns (56.7%). By intention type, general migration intent was highest (74.1%), followed by training-related (71.5%) and work-related migration (61.9%). War and insecurity (k = 10), financial insecurity (k = 9), and poor working conditions (k = 7) were the most frequently reported push factors, while higher pay (k = 11), better training opportunities (k = 10), and career growth (k = 10) were the frequently reported pull factors. Family ties (k = 6) and patriotism (k = 5) were the frequently reported mooring influences.

Conclusions: More than two-thirds of medical trainees in the Arab region report intentions to migrate abroad, highlighting a major regional health workforce challenge. While intentions do not equate to actual migration behavior, the findings nevertheless support the need for health workforce policies that strengthen physician retention through investment in competitive remuneration, safe working environments, and high-quality local postgraduate training pathways while addressing broader sociopolitical drivers of migration.