Contribution of migrant doctors and nurses to tackling COVID-19 crisis in OECD countries

 Foreign doctors and nurses are key assets for health systems in many OECD countries

The availability of a sufficient number of skilled and motivated health workers is central to the performance of any health system, as illustrated once more by the current COVID‑19 pandemic. Along with bringing into the spotlight the important role and dedication of frontline health workers, the COVID‑19 crisis further highlights the deeply embedded challenge of staff shortages as well as the significant contribution that migrant doctors and nurses make to the health workforce in many OECD countries.

During the #COVID‑19 pandemic, many OECD countries have recognised #migrant health workers as key assets and introduced policies to help their arrival and the recognition of their qualifications

While the number of medical and nursing graduates has increased significantly in the majority of the OECD countries over the past two decades, the shares of foreign-trained or foreign-born doctors and nurses have also continued to rise (OECD, 2019[1]). As a result, across the OECD countries, nearly one‑quarter of all doctors are born abroad and close to one‑fifth are trained abroad. Among nurses, nearly 16% are foreign-born and more than 7% are foreign-trained (Table 1).

The share of foreign-trained doctors ranges from less than 3% in a number of OECD countries, to around 40% in Norway, Ireland, or New Zealand, and to nearly 60% in Israel. However, not all of these foreign-trained doctors are foreigners. In some of the main destination countries (e.g. Israel and Norway), a large number (more than half in the case of Norway) are people born in the country who went to study abroad before coming back (OECD, 2019[2]). In the majority of OECD countries, the share of foreign-trained nurses is below 5%, but in Australia, Switzerland, and New Zealand, this share goes up to around 20 to 25%.

As for doctors born abroad, their share ranges from less than 2% in the Slovak Republic to more than 50% in Australia and Luxembourg. The share of foreign-born among nurses is insignificant in the Czech Republic and the Slovak Republic, but over 30% in Switzerland, Australia and Israel. In nearly all OECD countries, the number of doctors or nurses born abroad is higher than the number of those trained abroad, reflecting the fact that destination countries provide education to migrants who may have moved at an early age or to pursue their studies. Also, the migration of doctors and nurses takes place against a backdrop of larger migration trends, including increasing overall highly skilled migration. Indeed the share of migrants in the overall tertiary educated OECD population (15+) is on average about 20%, as compared to 24% for foreign-born physicians (d’Aiglepierre et al., 2020[3]).

During the COVID‑19 pandemic, many of the OECD countries already reliant on migrant health workers have further recognised them as key assets, and implemented additional policy measures to ease their entry and the recognition of their professional qualifications.

Migrants care for us – 16% of nurses in the OECD are foreign born

 The main countries of origin of migrant doctors and nurses working in OECD countries vary considerably

Regarding the countries of origin, around a third all foreign-born or foreign-trained doctors or nurses working in OECD countries originate from within the OECD area and another third from non-OECD upper-middle-income countries. The lower-middle-income countries account for around 30% and low-income countries for 3 to 6% of migrant doctors or nurses. The top 20 countries of origin comprise non-OECD as well as the OECD or EU countries, and represent all income levels (Figure 1).

 

Figure 1. Top 20 countries of origin for foreign-trained or foreign-born doctors and nurses working in the OECD area

Note: Most recent data is from 2017/18 (or nearest year) for foreign-trained and 2015/16 for foreign-born doctors/nurses. For some countries of origin, the number of home-trained nurses working in the OECD area might be underestimated due to data gaps in large countries of destination such as the United States, the United Kingdom, or Germany. Doctors/nurses whose place of birth is unknown are excluded from the calculation. Foreign-trained doctors are defined as those who have completed at least their first medical degree abroad.

Source: OECD Health Statistics 2019, DIOC 2015/16 and LFS 2015/16.

 Impact on countries of origin

Increasing international mobility and the emergence of shortages of health professionals in many OECD countries and worldwide have raised concerns about international interdependency in the management of health human resources. As OECD countries strive to respond to their own needs, there is indeed a risk for shortages to be exported within and beyond the OECD area, putting excessive burden on the poorest countries in the world (OECD, 2007[4]; OECD, 2008[5]; OECD, 2015[6]; OECD, 2016[7]).

Emigration rates, defined as the number of doctors or nurses born or trained in a given country but working abroad to the total number of doctors or nurses originating from that country, illustrate the scope of the phenomenon. Generally, in the largest countries of origin, migration to (other) OECD countries remains moderate, but in some smaller countries, some of which have relatively weak health systems, emigration can be substantial (Figure 2 and Figure 3).

Among the three main countries of origin for migrant doctors working in OECD countries, emigration rates for home-trained or native-born doctors are low (India) or very low (China), but not in Romania with an emigration rate of about one‑third of all home-trained and native-born doctors. Emigration rates of between one‑third and one‑half, for doctors either born or trained in a country, are found in 20 out of the 188 countries of origin, predominantly in Africa and Latin America, but also in Europe (e.g. in Malta and Albania), Middle East, and Western Pacific. Lower but still substantial emigration rates of around 20% to 30% for home-trained doctors are also found in a number of European countries such as Iceland, Ireland, the Slovak Republic and Estonia (Figure 2).

For 10 other countries of origin – again in Africa and Latin America – the emigration rates for native-born doctors exceed 50%, which means that more doctors born in these countries are working in the OECD area than in their country of origin. For a number of Caribbean countries (Antigua and Barbuda, Dominica, Grenada, Saint Lucia, as well as Saint Kitts and Nevis – all excluded from Figure 2), emigration rates for home-trained doctors are as high as 80 to 99%. However, these four countries are renowned international medical education hubs training predominantly fee-paying foreign students from the United States and Canada. Despite their small population, the size of their medical schools rivals and sometimes exceeds that of the largest medical schools in the United States.

 

Figure 2. Countries of origin – top 25 emigration rates for home-trained or native-born doctors

Note: Data for 188 countries of origin. Data on native-born doctors is from 2015/16. Data for home-trained doctors is from 2017/18 (or nearest year). Emigration rates are computed as follows: Xi = number of foreign-born or foreign-trained doctors working in OECD countries born in country i; Yi = number of doctors working in country i; emigration rate = Xi / (Xi + Yi).

Source: OECD Health Statistics 2019, DIOC 2015/16 and LFS 2015/16 for numbers of foreign-trained and foreign-born doctors; OECD Health Statistics 2019 and WHO Global Health Observatory 2019 for number of doctors working in countries of origin.

For most countries of origin, the emigration rate for home-trained or native-born nurses are generally much lower than for doctors (Figure 3). Among the three main countries of origin, the emigration rates are very low for India, but more significant for Poland and the Philippines, especially considering the native-born nurses. For some countries of origin, however, the emigration rates for foreign-trained nurses might be underestimated due to data gaps in large countries of destination such as the United States, the United Kingdom, and Germany. Among other main countries of origin for migrant nurses, Jamaica stands out with the highest and second highest emigration rates for native-born and home-trained nurses, respectively.

 

Figure 3. Countries of origin – top 25 emigration rates for home-trained or native-born nurses

Note: Data for 188 countries of origin. Data on native-born nurses is from 2015/16. Data for home-trained nurses is from 2017/18 (or nearest year). Emigration rates are computed as follows: Xi = number of foreign-born or foreign-trained nurses working in OECD countries born in country i; Yi = number of nurses working in country i; emigration rate = Xi / (Xi + Yi). For some countries of origin, the emigration rates for foreign-trained nurses might be underestimated due to data gaps in large countries of destination such as the United States, the United Kingdom, or Germany.

Source: OECD Health Statistics 2019, DIOC 2015/16 and LFS 2015/16 for numbers of foreign-trained and foreign-born nurses; OECD Health Statistics 2019 and WHO Global Health Observatory 2019 for number of nurses working in countries of origin.

For 20 out of the 188 countries – mostly in Africa and Latin America, the emigration rates for native-born nurses exceed 50%. Among these countries, Guyana stands out with the highest emigration rate (28%) also for home trained nurses. Emigration rates for native-born nurses of between one‑third and one‑half are found for another 10 countries of origin, in Africa, Latin America, Western Pacific, and Europe (Albania).

However, the low density of doctors and nurses in many low-income countries shows that the global health workforce crisis goes far beyond the migration issue. International migration is neither the main cause nor would its reduction be the solution to the worldwide health human resources crisis, although it exacerbates the acuteness of the problems in some countries.

While the international recruitment of foreign health workers has been considered as a quick fix to address skills shortages in some countries during the COVID‑19 crisis, it cannot be seen as an efficient or equitable solution. First, it does not address more structural imbalances between the supply of and the demand for health professionals. Moreover, given the global nature of the pandemic, it deprives sending countries – often characterised by weak health systems – with essential health workers when facing a major epidemic. A collective response is needed to address in a sustainable way the global shortage of health workers that the COVID‑19 pandemic has once again revealed.