Europe’s health worker shortages are being filled with foreign labour – but it could worsen those gaps elsewhere.
Albanian medical school graduates are now required to spend three years working in the Balkan country before they can leave – or pay full tuition fees – in a bid to stop the flow of health workers moving abroad, a problem facing many European countries.
Most countries need tens of thousands of doctors, nurses, and other medical staff as their populations age and develop more health problems, health workers quit or retire, and interest dwindles in nursing careers.
And many are trying to rebuild their workforces by enticing foreign talent from neighbouring countries and beyond. But while the medical reshuffling could alleviate labour shortages in countries that recruit workers from abroad, it could also aggravate them in their countries of origin, according to the European Labour Authority.
Up to 3,500 doctors left Albania alone over a recent 10-year period, according to the Federation of Albanian Doctors in Europe.
“Increasing the labour force requires long-term, costly investments, whereas recruiting foreign-trained professionals offers a quicker fix,” Isilda Mara, a researcher on labour and migration at the Vienna Institute for International Economic Studies, told Euronews Health.
Which countries have the most foreign-trained health workers?
Generally, doctors and nurses move from eastern and southern Europe to western and northern Europe, while workers in western and northern Europe move around within the region.
Romania, Spain, and France are the countries most likely to send nurses abroad, while Germany, Romania and Italy are most likely to export doctors.
Meanwhile, Ireland and Switzerland are the countries most dependent on both foreign-trained doctors and nurses. In Switzerland, the share of foreign-trained doctors rose from about 25 per cent between 2000 and 2010 to nearly 40 per cent a decade later.
Norway is also highly reliant on foreign doctors and Austria depends on nurses brought in from elsewhere.
Some of these countries are trying to plug gaps in health worker employment after being targeted by international recruitment themselves.
“The mobility of health professionals has created a domino effect,” Mara said.
“German doctors, for example, move to Switzerland or Austria, and their positions are often filled by doctors from neighbouring [European Union] countries. In turn, these neighbouring countries replace their doctors with professionals from non-EU countries, and the cycle continues”.
The trends are more extreme elsewhere in the world. An OECD analysis found that in 20 mostly African and Latin American countries, more than half of nurses leave to work abroad.
The United States is the most popular destination, attracting 45 per cent of all foreign-born nurses, followed by Germany (15 per cent) and the United Kingdom (11 per cent).
But “all of the EU countries are recruiting from somewhere … there’s not one who isn’t,” Paul de Raeve, secretary general of the European Federation of Nursing Associations, told Euronews Health.
These workers can be a lifeline for struggling medical systems. Without immigrants to Germany, for example, the “health system would face a collapse,” according to the German Expert Council on Integration and Migration.
Impact of brain drain on health
Even so, economists, health experts, and advocacy groups have raised concerns about brain drain from lower-income regions as wealthy countries poach their workers.
While medical professionals can benefit from better pay and working conditions in magnet countries, their home countries lose out on the investment they put into training and wind up with fewer resources of their own.
That creates a cycle where fewer doctors work in certain areas, leading to less access to care, poorer quality services, longer waiting times, and overall unmet needs, according to Milena Šantrić Milićević, a professor at the University of Belgrade and an adviser on health system capacity, workforce, and equity.
“The whole resilience, the health potential of the population goes down,” Šantrić Milićević told Euronews Health.
In March, the World Health Organisation (WHO) updated its guidelines on the ethical recruitment of foreign healthcare professionals, after introducing them in 2010.
The agreement says countries shouldn’t actively recruit health workers from 55 lower-income nations with their own shortages, including 37 in Africa as well as Nepal, Haiti, and a few Western Pacific countries.
Beyond those countries, though, recruitment can still fall in an ethical grey area because there’s a “thin line” between countries without enough health workers today and those which are only a couple of years behind, Šantrić Milićević said.
In recent years, for example, German organisations have funded medical training programmes in countries like Kosovo that promise to help graduates find jobs in Germany. Mara said these initiatives could help develop the local workforce but should be regulated to ensure a “balanced supply” of health workers.
Health analysts and advocacy groups say European governments can do more to incentivise their newly trained workforce to stay in their home countries.
They have proposed narrowing the wage gap for health workers between countries, investments in health systems and training in areas that are struggling to retain their medical personnel, and stronger regulations to protect immigrant health workers from exploitation.
Ultimately, though, bolstering the health workforce will require long-term political commitment and funding, and despite politicians’ frequent calls for solidarity with health workers – and a €1.3 million nursing workforce boost from the EU – not everyone is optimistic.
“There are many experts providing many recommendations,” Šantrić Milićević said.
“However, I do not see that this has been really taken up high on the policy agenda, not at the level of the country, and not at the international level”.
