Factors Influencing Physicians Migration—A Case Study from Romania

Physician migration in Romania: a study on the emigration preferences within the Cluj County healthcare system

Introduction

Medical migration represents the movement of healthcare professionals from one country to another. The migration of Romanian doctors has evolved as a captivating and diverse phenomenon in the complex framework of global healthcare. As Romania struggles with its healthcare issues, many of its experienced medical personnel travel to foreign areas, lured by various factors ranging from economic concerns to the desire to gain clinical experience. The aim of this study is to elucidate the dynamics of this migratory phenomenon among physicians from Cluj County, Romania, between 2017 and 2022.

Methods

This retrospective study was performed between 2017 to 2022, and it was based on data from Cluj County Romanian College of Physicians, which included 571 specialist and consultant physicians from Cluj County who permanently migrated to other countries.

Results

Between 2017 and 2022, a total of 571 physicians permanently migrated from Cluj, Romania, to various other countries. Analysis of the gender distribution among these emigrants reveals a predominant female presence (58.1%) and a trend toward younger emigrating physicians, predominantly those under 30 years. In terms of professional specialties, Anesthesia and Intensive Care, as well as General Medicine/Family Medicine, are the most represented specialties, constituting 11% and 9.1% of the emigrating physicians, respectively. There was a declining trend from 2017 to 2021, followed by an upward trend in 2021.

Conclusions

Medical migration significantly impacts Romania's Cluj County healthcare, intensifying workforce shortages and possibly in the future compromising patient care. Failure to address this may perpetuate systemic vulnerabilities, hindering optimal healthcare provision and necessitating some reforms for resilience and sustainability.

The impact of international health worker migration and recruitment on health systems in source countries: Stakeholder perspectives from Colombia, Indonesia, and Jordan

INTRODUCTION

To address domestic shortages, high-income countries are increasingly recruiting health workers from low- and middle-income countries. This practice is much debated. Proponents underline benefits of return migration and remittances. Critics point in particular to the risk of brain drain. Empirical evidence supporting either position is yet rare. This study contributes to filling this gap in knowledge by reporting high-level stakeholders' perspectives on health system impacts of international migration in general, and active recruitment of health workers in specific, in Colombia, Indonesia, and Jordan.

METHOD

We used a multiple case study methodology, based on qualitative methods integrated with information available in the published literature.

RESULTS

All respondents decried a lack of robust and detailed data as a serious challenge in ascertaining their perspectives on impacts of health worker migration. Stakeholders described current emigration levels as not substantially aggravating existing health workforce availability challenges. This is due to the fact that all three countries are faced with health worker unemployment grounded in unwillingness to work in rural areas and/or overproduction of certain cadres. Respondents, however, pleaded against targeting very experienced and specialised individuals. While observing little harm of health worker migration at present, stakeholders also noted few benefits such as brain gain, describing how various barriers to skill enhancement, return, and reintegration into the health system hamper in practice what may be possible in theory.

CONCLUSION

Improved availability of data on health worker migration, including their potential return and reintegration into their country of origin's health system, is urgently necessary to understand and continuously monitor costs and benefits in dynamic national and international health labour markets. Our results imply that potential benefits of migration do not come into being automatically, but need in-country supportive policy and programming, such as favourable reintegration policies or programs targeting engagement of the diaspora.

World Psychiatric Association-Asian Journal of Psychiatry Commission on the Mental Health and Wellbeing of International Medical Graduates

Historically, doctors have migrated for a range of personal, educational, economic, and political reasons. Likewise, medical students from many countries have moved abroad to complete their training and education and may or may not return to their country of origin. Within this context, globalisation has had a major impact on medical education and healthcare workforces, contributing to recent migration trends. Globalisation is a complex phenomenon with positive and negative outcomes. For example, lower-income countries are regularly losing doctors to higher-income areas, thereby exacerbating strains on existing services. Across various national healthcare settings, migrating International Medical Graduates (IMGs) can face socioenvironmental and psychosocial pressures, which can lead to lower mental wellbeing and undermine their contributions to clinical care. Rates of stress and burnout are generally increasing for doctors and medical students. For IMGs, stressors related to migration, acculturation, and adjustment are not dissimilar to other migrants but may carry with them specific nuances. Accordingly, this Commission will explore the history of IMG trends and the challenges faced by IMGs, proposing recommendations and solutions to support their mental health and wellbeing.

Are We Facing a Radical Change in the Migration Behavior of Medical Graduates from Less Developed Countries? Demographic Profile vs. Social Push Factors

The phenomenon of migration among medical personnel from less developed countries is a large one, with negative effects on the origin country, but more worrying is graduates' propensity to migrate during or immediately after university studies. The analysis of the labor market in the health sector from the last two decades shows us greater attractiveness of employment in (more) economically developed states compared to the demand from the health sector in graduates' origin countries. This research's purpose is to identify the determinants of the propensity to study and work abroad of medical students as a defined factor for better employment, and to identify the push factors in the origin country. As a result of the dichotomous nature of the dependent variables, logistic regression was applied. The independent variables (gender, residence, medical specialization, grades and perceived economic status) were used to identify the odds of the intention to migrate for studies. The results highlighted a higher propensity to migrate for studies among medical students, with opportunities offered by universities differing across countries and geographical areas. Moreover, students with a lower level of household income have openness to migrate, the tuition fees being managed through part-time/temporary employment during studies.

Migration Intent of Health Care Workers during the COVID-19 Pandemic in Kosovo

The migration of healthcare workers from developing countries to more economically developed countries is a long-standing and ongoing trend. Loss of qualified staff due to migration can negatively impact healthcare systems. Understanding factors that drive migration is essential to identifying and managing health system needs. Our study explored factors related to the migration intent of healthcare staff in Kosovo, particularly after the COVID-19 pandemic. We carried out a cross-sectional survey of healthcare workers from public and private institutions. The survey analysed the prevalence of willingness to migrate and whether willingness was affected by the pandemic, and calculated crude and adjusted odds ratios for variables which may influence migration willingness. 14.43% of healthcare workers reported aspiration to migrate, and 23.68% reported an increased chance of migrating after the pandemic. Dissatisfaction with wages and working conditions, higher education and private sector engagement were associated with increased odds of migration willingness. After the pandemic, factors related to interpersonal relationships and state response gave lower odds of migration intent. These findings point to potential factors associated with the migration of healthcare workers, which can help policymakers address gaps in national health system strategy.