Foreign-trained doctors and nurses

International migration of doctors and nurses is not a new phenomenon, but it has drawn considerable attention in recent years due to concerns that it might exacerbate shortages of skilled health workers in some countries. The Global Code of Practice on the International Recruitment of Health Personnel, adopted by the World Health Assembly in May 2010, was designed to respond to these concerns. It provides an instrument for countries to promote a more ethical recruitment of health personnel, encouraging countries to achieve greater “self-sufficiency” in the training of health workers, while recognising the basic human right of every person to migrate.

In 2015, the share of foreign-trained doctors ranged from 3% or less in Estonia, the Slovak Republic, the Netherlands, Poland, Italy and Turkey, to more than 30% in Israel, New Zealand, Ireland, Norway and Australia (Figure 8.19). The very high proportion of foreign-trained doctors in Israel reflects not only the importance of immigration in this country, but also that about one third of new licenses are issued to people born in Israel but trained abroad. In Norway, roughly half of foreign-trained doctors are people who were born in the country but went to pursue their medical studies in another country. In Luxembourg, all doctors are foreign-trained, in the absence of a medical school in the country.

8.19. Share of foreign-trained doctors, 2015 (or nearest year)
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1. In Germany and some regions in Spain, the data are based on nationality (or place of birth in the case of Spain), not on the place of training.

Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933604875

Since 2000, the number and share of foreign-trained doctors has increased in many OECD countries (Figure 8.21). In the United States, the share has remained relatively stable over time, but the absolute number of doctors trained abroad has continued to increase (OECD, 2016). Sweden has experienced a strong rise in the number and share of foreign-trained doctors, with most of these doctors coming from Germany, Poland and Iraq. The number and share of foreign-trained doctors has also increased in France and Germany, though at a slower pace. In France, the rise is partly due to a fuller recognition of qualifications of foreign-trained doctors who were already working in the country, as well as the inflow of doctors from new EU member states.

In nearly all OECD countries, the proportion of foreign-trained nurses is much lower than that of foreign-trained doctors. However, given that the overall number of nurses is usually much greater than the number of doctors, the absolute number of foreign-trained nurses tends to be greater than for doctors (OECD, 2016). OECD countries vary widely in the number and share of foreign-trained nurses working in their health system (Figure 8.20). While there were almost no foreign-trained nurses working in Slovenia, Turkey, the Netherlands and Estonia in 2015, they make up over 25% of the nursing workforce in New Zealand, and between 10% and 20% in Switzerland, Australia and the United Kingdom.

8.20. Share of foreign-trained nurses, 2015 (or nearest year)
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1. The data for some regions in Spain are based on nationality or place of birth, not on the place of training.

Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933604894

8.21. Evolution in the share of foreign-trained doctors, selected OECD countries, 2000 to 2015
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Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933604913

The number and share of foreign-trained nurses has increased over the past ten years in several OECD countries, including New Zealand, Australia and Canada (Figure 8.22). In Italy, an increase in the immigration of foreign-trained nurses between 2000 and 2008 was primarily driven by the arrival of many nurses trained in Romania, who now account for nearly half of all foreign-trained nurses. In France the share of nurses trained abroad remains low, but their numbers have been increasing, and many of these foreign-trained nurses are French citizens who received their diploma from Belgium. Israel has shown a steady decline in the share of nurses trained abroad while increasing the number of domestic nursing graduates (see the indicator on “Nursing graduates”).

8.22. Evolution in the share of foreign-trained nurses, selected OECD countries, 2000 to 2015
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Source: OECD Health Statistics 2017.

 http://dx.doi.org/10.1787/888933604932

Definition and comparability

The data relate to foreign-trained doctors and nurses working in OECD countries measured in terms of total stocks. The OECD health database also includes data on the annual flows for most of the countries shown here, as well as by country of origin. The data sources in most countries are professional registries or other administrative sources.

The main comparability limitation relates to differences in the activity status of doctors and nurses. Some registries are regularly updated, making it possible to distinguish doctors and nurses who are still actively working in health systems, while other sources include all doctors and nurses licensed to practice, regardless of whether they are still active or not. The latter will tend to over-estimate not only the number of foreign-trained doctors and nurses, but also the total number of doctors and nurses (including the domestically-trained), making the impact on the share unclear.

The data source in some countries includes interns and residents, while these physicians in training are not included in other countries. Because foreign-trained doctors are often over-represented in the categories of interns and residents, this may result in an under-estimation of the share of foreign-trained doctors in countries where they are not included (e.g., Austria, France and Switzerland).

The data for Germany (on foreign-trained doctors) and some regions in Spain are based on nationality (or place of birth in the case of Spain), not on the place of training.

References

OECD (2016), Health Workforce Policies in OECD Countries: Right Jobs, Right Skills, Right Places, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264239517-en.

UN High-Level Commission on Health Employment and Economic Growth (2016), “Working for Health and Growth: Investing in the Health Workforce”, WHO, Geneva, retrieved from http://www.who.int/hrh/com-heeg/reports.