Introduction

The international emigration of health professionals is a complex global phenomenon with profound implications for health systems worldwide.¹ While mobility can facilitate knowledge exchange, the predominant flow from low- and middle-income countries (LMICs) to high-income countries (HICs) can produce a “brain drain” and exacerbate health workforce shortages and inequities in resource-limited settings.^1-3 Radiology relies on specialized expertise and technology and is critical for high-quality diagnosis and patient care.⁴

Lebanon, a nation historically recognized as a medical hub in the Middle East,⁵ represents a case study of physician emigration under duress. The American University of Beirut Medical Center (AUBMC) has long maintained a radiology residency program known for its high standards in the context of graduate medical education programs with international accreditation, such as ACGME International (ACGME-I).⁶ However, since 2019, the country has been engulfed by a series of overlapping crises: a catastrophic economic collapse,^5,7 extreme currency devaluation,⁵ sociopolitical instability,⁵ the devastating Beirut Port explosion of August 2020,⁸ the COVID-19 pandemic,⁹ and the ongoing regional conflict that began in 2023.¹⁰ These crises have crippled the nation’s health care infrastructure,^9,11 leading to shortages of medications, medical supplies, and equipment repairs and maintenance, as well as frequent power outages affecting operations.⁵ These recent stresses build upon past national crises such as the 1975-1990 Lebanese Civil War.¹²

The exodus of Lebanese physicians has been documented even prior to 2019, with some reports showing the highest physician emigration numbers in the Middle East/North Africa region.^13-15 Recent reports, including studies on workforce emigration and statements from the World Health Organization and other international organizations, suggest that the emigration of skilled physicians may have accelerated dramatically in recent years.^5,7-10,15-18 However, the actual extent of radiologist emigration from Lebanon remains unclear.

We investigated the amount and patterns of emigration among AUBMC-trained radiologists graduating over the past 2 decades (2004-2024) to determine implications for the nation’s health care capacity.

KEY POINTS

Methods

This investigation employed a retrospective, descriptive study design to analyze the career trajectories and geographic locations of physicians who completed their radiology residency training at AUBMC between 2004 and 2024. Data were compiled from internal departmental and institutional sources, primarily residency program records and alumni databases maintained by the AUBMC Department of Diagnostic Radiology. These were supplemented by publicly accessible information from institutional websites or professional platforms to corroborate information. Key variables collected for each graduate included sex, nationality, the year of residency completion, the current country of practice, the type of professional position currently held, and documented subspecialty training.

The analysis focused on quantifying the proportion of graduates who remained practicing in Lebanon versus those who pursued opportunities abroad. Destinations of emigrated graduates were categorized by country and region. Trends in emigration were examined over the 20-year study period, noting any shifts corresponding to major national events, particularly the post-2019 crisis period. Quantitative data were analyzed using descriptive statistics (frequencies and percentages) in Microsoft Excel to assess emigration trends over time and across cohorts.

This study was exempt from review by the institutional review board at AUBMC, as it involved retrospective analysis of nonidentifiable institutional data and did not include human subjects.

Results

Over the 2-decade period from 2004 to 2024, a total of 62 physicians successfully completed the radiology residency program at AUBMC. Within this cohort, there were 24 women (38.7%) and 38 men (61.3%). Data regarding 2 graduates could not be found; consequently, they were excluded from the cohort, and the remaining 60 graduates were included in the analysis.

The geographic distribution of these graduates reveals a consistent pattern of emigration following residency completion. Only 10 individuals (16.7%) remained in Lebanon to practice, whereas the remaining 50 graduates (83.3%) pursued further training or employment opportunities outside the country, reflecting a substantial post-residency relocation trend. No significant differences in emigration patterns were observed between male and female graduates.

Among the 50 graduates who emigrated, 42 (84.0%)—or 70.0% of all graduates—moved to the United States. The remaining 8 emigrants dispersed to other HICs, including Canada (n=2), the United Kingdom (n=1), and Gulf Cooperation Council countries (n=5), specifically Saudi Arabia and the United Arab Emirates (Figure).

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This pattern of high emigration was consistent across most graduation years, particularly from 2010 onward, and culminated with 100% of graduates from the 2021-2024 cohort emigrating immediately after graduation (Table). Among the 60 graduates included in the analysis, 10 (16.7%) were non-Lebanese nationals, primarily from other Arab countries such as Syria, Iraq, and Jordan. All non-Lebanese graduates moved abroad after graduation.

TableEmigration Trends by Graduation Cohort (2004-2024): Number of American University of Beirut Medical Center Radiology Graduates Practicing Abroad vs Remaining in Lebanon

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Regarding professional trajectories, all graduates have established successful careers: 53 (88.3%) currently hold faculty or attending-level positions in either academic or clinical settings. The remaining 7 graduates (11.7%) are in fellowship training, pursuing subspecialties such as body imaging, neuroradiology, pediatric radiology, and interventional radiology. These fellowships include training at competitive programs in the United States, such as The Johns Hopkins Hospital, Brigham and Women’s Hospital, Boston Children’s Hospital, Memorial Sloan Kettering Cancer Center, and The Mount Sinai Hospital (New York).

Ten graduates remained in Lebanon after graduation and were in academic roles at local universities or joined private radiology practices, mainly in Beirut. Nine of these completed their training between 2004 and 2016, while only one graduate from the 2017-2024 cohort remained in the country, reflecting a decline in local retention in recent years.

Discussion

This study found that over 80% of AUBMC radiology residency graduates emigrated from Lebanon between 2004 and 2024, with the rate increasing to 100% in recent cohorts. Most graduates relocated to the United States, highlighting an accelerating brain drain of skilled radiologists. All non-Lebanese graduates of the AUBMC residency program during this period left Lebanon. Graduates were engaged in academic and clinical careers as well as subspecialty fellowships, including at highly competitive institutions in the United States, after completing their internationally accredited AUBMC training.

This accelerating loss of highly skilled young radiologists is alarming in its magnitude and, if continued, potentially devastating to critical health care services and academic faculty needed for training. The loss is occurring in the context of several academic and private institutions in Lebanon, including AUBMC itself, that require more radiologists. These findings align with other studies reporting that thousands of physicians across various specialties have left Lebanon since 2019, suggesting system-wide causal factors.¹⁸ Although this study did not examine the reasons for emigration, other research has identified key drivers such as economic collapse, political instability, security concerns, health care infrastructure deterioration, and lack of professional opportunities as major “push” factors for physicians to leave Lebanon.^{3,5,7,9,11,19} The Beirut Port explosion, in particular, served as a traumatic catalyst and crystallized decisions for many to seek safety and stability elsewhere.^5,8 A severe economic downturn has been shown to financially strain radiology practices even in HICs.^20,21 Radiology may be particularly sensitive to economic downturns, which can jeopardize the maintenance and upgrading of costly imaging equipment essential for high-quality services.²²

Simultaneously, strong “pull” factors may attract radiologists to destinations like the United States, Canada, and Europe.^5,14 These HICs offer structured and funded pathways for advanced subspecialty fellowship training, access to state-of-the-art imaging technology, robust support for research and academic advancement, clearer career progression ladders, higher remuneration, and a more stable and predictable environment.^5,14 Economic instability, such as during the COVID-19 pandemic, has been shown to raise concerns about the job market and career prospects within radiology, and may amplify the appeal of opportunities in more stable economies.^20,21 The limited scope and availability of comparable advanced fellowship opportunities within Lebanon may also exacerbate this outward flow.⁵ Similar emigration patterns have been documented in conflict-affected or resource-constrained Arab countries such as Syria, Iraq, Yemen, and Algeria, where comparable push factors have prompted skilled health care professionals to seek careers abroad.^2,4,23,24 In parallel, well-funded training programs, structured career paths, and greater stability in HICs continue to act as strong pull factors, attracting physicians from across the Middle East and North Africa.^4,24,25 Globally, health systems in countries like the United Kingdom and those within the Organisation for Economic Co-operation and Development have become increasingly reliant on foreign-trained physicians, further amplifying this trend.^26,27 Within this broader context, the consistent outflow of both Lebanese and non-Lebanese AUBMC graduates reflects not only Lebanon’s internal crises but also a wider regional and international brain drain phenomenon. However, evolving immigration policies in HICs—such as increasing visa restrictions or changes in licensure pathways—may affect future emigration trends and the accessibility of international opportunities for new graduates.

The departure of a large proportion of newly trained radiologists can lead to major gaps in specialized services,⁵ potentially increasing wait times, reducing access to advanced diagnostics,⁴ and compromising the quality of patient care,⁵ particularly outside major urban centers.^4,28 Furthermore, the emigration of academically inclined physicians weakens the capacity for future medical education and residency training within Lebanon, creating a vicious cycle.¹⁸ The loss of experienced faculty and the lack of returning specialists mean fewer mentors and educators for subsequent generations. Economically, the substantial investment made by individuals, families, AUBMC, and the state in training these specialists yields minimal return for the local health system when graduates predominantly leave.^2,3,29,30 This situation mirrors challenges faced by other LMICs struggling with health workforce retention amid instability or resource constraints.^{1,19,28,30,31}

As a retrospective study of program records and publicly available sources, this study is limited by their accuracy and completeness, as individual graduates were not contacted. Although the study reflects a full cohort from a single major academic institution, the findings may not generalize to all radiology residency programs in Lebanon or across specialties.

Future studies could examine graduates’ perceptions of the systemic and personal factors that influence emigration decisions at the time of these decisions, rather than retrospectively. A database of residency graduates across institutions in Lebanon could provide insights if variability is observed. Targeted retention strategies need to be implemented and tracked longitudinally, as the current emigration patterns appear unsustainable.

Conclusions

From 2004 to 2024, 83.3% of AUBMC radiology residency program graduates emigrated from Lebanon, with the emigration rate rising to 100% in recent cohorts. Most graduates from this internationally accredited residency relocated to the United States; all non-Lebanese residency graduates also emigrated after graduation. This occurred in the context of open positions at AUBMC and other Lebanese institutions, as well as economic distress, conflict, and other upheavals.