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The number of African doctors working in the US soared by almost two-fifths over a decade, according to a study showing the increasing extent of the �brain drain� from developing nations. More than 10,000 medical graduates born or trained in sub-Saharan Africa were registered to practise in the US in 2011, raising concerns that some of the poorest countries are subsidising medicine in the world�s biggest economy. The study, published in the online medical journal PLoS Medicine, showed that on average, African doctors practised for 6.5 years before entering the US. The greatest increase in emigration among medical workers to the US was from Liberia, which in 2008 had only 1.37 doctors person 100,000 people compared with 250 per 100,000 in the US.The figure � up 38 per cent from 2002 � was equivalent to more than the entire number of doctors currently working in Ethiopia, Ghana, Liberia, Tanzania, Uganda, Zambia and Zimbabwe combined. The trend will rekindle the debate over the need for new measures to attract and retain doctors in Africa. Some estimates suggest the continent has only 2 per cent of the physicians practising around the world but a quarter of the global burden of disease. Only in South Africa was there a fall in departing doctors during the first decade of the century. Akhenaten Benjamin Siankam Tankwanchi from the Peabody School of Education at Vanderbilt University in Nashville, Tennessee, and his fellow authors concluded that the research highlighted a �growing problem� and a �major loss� to Africa. They said their calculations underestimated the true extent of �brain waste� because the US figures � drawn from the American Medical Association�s Physician Master file � showed only those African doctors who qualified for a medical residency and not others who had quit medicine to seek alternative employment. The authors argued that emigration from Africa began in earnest in the mid-1980s following public sector budget cuts sought by international financial institutions, while immigration into the US was encouraged by relatively easy allocation of visas and permanent residency to qualified foreign physicians. They pointed to a need for improved job satisfaction and enhanced medical education for African doctors and the importance of tackling a culture encouraging emigration, notably at some Nigerian and Ghanaian university campuses where faculty actively encouraged it. An accompanying commentary by Giorgio Cometto at the Global Health Workforce Alliance, called for high-income countries to invest more in domestic medical education and to stop hiring from countries with the lowest coverage of doctors. He said poorer countries should focus on improving working and living conditions for medical staff, encouraging migrants to return home, and the expanded use of community health workers.