Anna Jaroń
Agnieszka Łada
Karolina Socha-Dietrich
Recent Trends in International Migration of Doctors, Nurses and Medical Students
5. International students in Polish medical schools
Abstract
Since 1993, most Polish medical schools have opened full-cycle study programmes in English for international students seeking education outside their home country either due to high tuition fees or limits on student intake. The schools continually adapt their international offer and promote recognition of their degrees also outside the European Union. Initially, the schools attracted students mainly from the United States; later also from Middle Eastern and South-East Asian countries; more recently from Norway, Sweden and Canada, and increasingly also from India. International students bring additional income for the schools; this helps to increase the attractiveness of faculty jobs, thereby addressing the emigration of medical educators from Poland. Simultaneously, meeting the domestic demand for medical graduates has been prioritised by the government: the capacity in Polish programmes has increased much more rapidly than in the English programmes. While the number of domestic medical graduates has increased, the emigration of Polish doctors is a concern.
The statistical data for Israel are supplied by and under the responsibility of the relevant Israeli authorities. The use of such data by the OECD is without prejudice to the status of the Golan Heights, East Jerusalem and Israeli settlements in the West Bank under the terms of international law.
5.1. Introduction
The Polish institutions of higher education have a long-standing and successful tradition of welcoming international students. This is particularly the case for medical studies: Polish medical schools have attracted increasing numbers of international students since the early 1990s. Most offer full-cycle study programmes in English for international students seeking education outside their home country due to high tuition fees, limits on student intake imposed by numerus clausus policies, and/or other capacity constraints.
The number of medical students is decided jointly between the Ministry of Science and Higher Education, the Ministry of Health, and the medical schools. The decisions concern both the number of students admitted to the Polish programmes and those admitted to the English programmes, which target international students. One factor taken into consideration in setting the capacity in the English programmes is that the tuition fees derived from these students can be used to improve the recruitment and retention of medical educators, who also train students in the Polish programmes. Hence, by hosting a large number of international medical students, the Polish medical schools receive additional funding that is used to serve all students, including the growing number of domestic students. In fact, the growth in the number of new-entrant study places in the Polish programmes over the past decade has been more rapid than in English programmes. This indicates that the expansion has not “crowded out” places for Polish students.
Despite its internationally recognised medical education system and the growing number of international and domestic medical students, however, Poland is facing shortages of practising doctors. In particular, with 2.4 doctors per 1 000 inhabitants in 2016, Poland ranks lowest of all European Union (EU) countries and fifth lowest among the OECD countries.
Against this background, this chapter describes the findings from an in-depth case study on the internationalisation of the medical education in Poland – in particular its dynamics, magnitude, and main drivers, as well as whether and how it affects the availability of places for domestic students and the training of new doctors. The discussion relates to international medical students enrolled in long-cycle study programmes, not those on, for example, a one-year study exchange programme.
The study was undertaken in 2018 and completed in January 2019. It was based on key informant interviews with representatives of the main actors in the education and health sectors in Poland – including the government, regulatory bodies, professional and student associations, and medical schools (see Annex Table 5.A.1 for a complete list of interviewees’ institutional affiliations) – in addition to a review of the literature.
5.2. One-quarter of new-entrant medicine study places in English programmes for international students
As result of a development that started in 1993, in the academic year 2018/19, 15 of the 20 medical schools in Poland offered English programmes targeting international students, along with Polish programmes mainly for domestic students. One-quarter of the total new-entrant capacity was allocated to the English programmes. In Poland, as in other OECD countries, the medical education lasts six years, leading to a medical degree that is equivalent to a master’s degree.
The Law on Higher Education and Science regulates the Polish medical education system. Unlike in other fields of studies, the regulatory body consists of not only the Ministry of Science and Higher Education but also the Ministry of Health: the maximum number of new places in medical schools is set by the Minister of Health in consultation with the Minister of Science and Higher Education, taking into consideration the educational capacities of the medical schools and the demand for medical graduates. The medical schools make proposals regarding these limits.
For the academic year 2018/19, the admission limits in all Polish medical schools were:
4 691 places for Polish and other EU/European Free Trade Association (EFTA) citizens and 87 places for non-EU/EFTA international students in full-time studies in Polish programmes;
1 891 places in English programmes.
The schools also offered 1 345 places in Polish evening study programmes for students wanting to combine studying with work. In total, this adds up to a maximum of 8 014 new-entrant places, of which nearly a quarter are in the English programmes (Figure 5.1).
In response to shortages of doctors in the Polish health system, the number of places in the Polish programmes was increased sizeably over the past decade (by two thirds between 2009/10 and 2018/19). Moreover, the number of students in Polish evening programmes has also increased greatly (by three quarters) over the same period. The simultaneous increase of students in English programmes was less (a little over one half).
Figure 5.1. Trends in admission limits in medicine, Poland, 2009/10 to 2018/19
Note: Evening programmes in Polish are targeted at students who want to combine studying with work.
Source: Compilation based on data received from the Ministry of Health and data published in the Ministry of Health Regulations of 18 July and 26 September 2018.
In 2018/19, the three medical schools in Poland that accepted the largest number of new medical students were in Katowice (1 036), Warsaw (892) and Łódź (849) (Figure 5.2). These three schools also have the largest Polish programmes (for full-time or evening studies).
For the English programmes in 2018/19, the largest numbers of new-entrant places were at the Medical University in Lublin (210), the University of Medical Sciences in Poznań and the Medical University in Gdańsk (both 180), and the Medical University of Silesia in Katowice (164) (Figure 5.2).
Figure 5.2. Admission limits by Polish medical school and type of programme, 2018/19
Notes: * indicates a private medical school. Evening programmes in Polish are targeted at students who want to combine studying with work.
Source: Compilation based on data published in the Ministry of Health Regulations of 18 July and 26 September 2018.
The highest shares of new-entrant places reserved for students in English programmes were at the Modrzewski Academy (100 of 200 or 50%), the University of Olsztyn (110 of 230 or 48%), and the Medical University of Szczecin (140 of 382 or37%) (Figure 5.3).
Figure 5.3. Share of admissions by type of programme in Polish medical schools, 2018/19
Note: * indicates a private medical school. Evening programmes in Polish are targeted at students who want to combine studying with work.
Source: Compilation based on data published in the Ministry of Health Regulations of 18 July and 26 September 2018.
5.2.1. Medical schools do not necessarily fill all the study places in English programmes
The medical schools reject a sizeable share of candidates based on their results in the entry exam, to the extent that the pre-defined admission limits are often not exhausted. It is difficult to establish the actual number of students admitted to most medical schools since these numbers are not readily available.
One exception is the country’s largest medical school (by absolute numbers), Katowice, where readily available data show that the number of students in the English programme accounted for less than 5% of all new medical students in 2017/18 – a much lower proportion than the admission limits of 14-17% that the school was granted between 2014/15 and 2018/19.
The third and fourth biggest medical schools, Łódź and Poznań, reported that students in the English programmes in medicine, pharmacy, and dentistry combined accounted for 5-9% of all students in these fields in 2017/18, while the admissions limits in the English programme in medicine alone were 12-36% of all places in these two schools between 2014/15 and 2018/19.
The data reported by the four largest medical schools (which together admitted more than 40% of all new students in 2018/19) indicate that these schools rejected at least 40% of all candidates between 2015/16 and 2017/18. Łódź received between 900 and 1 235 applications each year – the highest number of applicants among the four schools – but accepted less than one fifth of them each year. Here again, the numbers include also students in the English programmes in pharmacy as well as stomatology.
As for the total number of medical students in all years of study, data from the Ministry of Health show that in the academic year 2017/2018 (as of 31 December 2017) there were:
19 622 Polish citizens following full-time studies;
3 923 Polish citizens following evening studies; and
6 759 international students (i.e. about 22% of all students), down from 7 000 in 2016/17.
Medical students constitute the third largest group of international students in Poland by subject, after business administration and social sciences.
5.2.2. Many medical students come from North America, Scandinavia, and the Middle East
At the national level, no data are collected on the countries of origin of international students enrolled in medicine. In each medical school, such data are not always readily available or are organised by broad faculty rather than more specific field of studies, meaning that students in medicine, pharmacy, and stomatology are reported together.
The data available from six medical schools (the four largest as well as the Medical College of University of Cracow and the Medical University of Białystok) for the period 2013/14 to 2017/18 (Table 5.1) show that the largest groups of students came from:
Norway (around 700) [Norwegian data based on student loans indicate that there were about 1 200 Norwegian students studying in all Polish medical schools during this period (see Box 5.1)]
Saudi Arabia (around 500)
United States (around 300)
Sweden (around 200) [Swedish data based on student loans indicate that there were about 1 100 Swedish students studying in all Polish medical schools during this period (see Box 5.1)]
Canada (around 170).
Table 5.1. Top countries of origin of students in English programmes in selected Polish medical schools, 2017/18
Note: For some medical schools, data include also students in pharmacy as well as stomatology.
Source: Compilation based on data provided by the medical schools.
Box 5.1. Norwegian and Swedish medical students in Poland, 1994/95 to 2017/18
During the past two decades, thousands of Norwegian and Swedish medical students have enrolled in English programmes in different European countries, and Poland has become the most popular choice. About half of all the Norwegian students enrolled in medicine are studying outside Norway, with 18% in Poland in 2017/18 (Figure 5.4). The number of Norwegian medical students in Poland increased strongly during the 2000s, but has remained stable at around 1 200 since 2010.
Figure 5.4. Norwegian students studying medicine abroad, 1994/95 to 2017/18
Source: Norwegian State Educational Loan Fund, July 2018.
Poland has also been the main destination for Swedish medical students, attracting over 40% (1 044) of those enrolled in countries other than Sweden in 2017/18 (Figure 5.5).
Figure 5.5. Swedish students studying medicine abroad, 2001/02 to 2017/18
Source: Swedish Board of Student Finance, July 2018.
Some medical schools have a concentration of students coming from certain countries. The majority of students from Norway, for example, are in the Medical College of the University Cracow; while students from the United States, Canada, and Taiwan are predominantly in Poznań; and students from Saudi Arabia are mostly in Łódź and Warsaw. These differences depend on several factors – mainly on agents who mediate by reaching out to candidates in a given region of the world, but sometimes also on a country’s decision to award scholarships for students to study in a specific school (e.g. Saudi Arabia in Warsaw).
Also, a number of Polish students study in English programmes. Among them are people who started their studies in English in Ukraine or the Slovak Republic but were not admitted to full-time medical programmes in Polish.
5.3. Differences in admission processes and tuition fees for Polish and international students
5.3.1. Admission requirements and processes in the Polish and English programmes
To be admitted to a Polish medical programme, students must have a school-leaving certificate (in Poland, the Matura certificate) qualifying for entrance to higher education; they must also have taken certain subjects. Typically, these include biology, chemistry, and a foreign language, although some universities also require successful examinations in physics or mathematics. A candidate’s proficiency in subjects that were not covered in a school-leaving certificate may be verified in an additional entrance exam. These are also frequently carried out for candidates with a school-leaving certificate from outside Poland. The minimum marks for admission are set by each medical school.
For studies in the English programme, the rules are different – both from the Polish programme and between schools. Medical schools enjoy significant autonomy in decisions regarding the admission to English programmes. Generally, an entrance exam is required. Some medical schools consider only this result and do not take into account the average score of the school-leaving exam; others combine the scores (for subjects such as biology, chemistry, physics, and mathematics). Extra points may be awarded for voluntary services in the field of medicine. The schools organise the entrance exam on several dates during the year and in several countries, with the involvement of agents employed by the school and with promotional or organisational support provided by Polish consulates.
Polish candidates can also enter the English programme (if they have proof of English language proficiency) via the Polish enrolment process, which is important from the point of view of subsidies to cover the cost of tuition fees.
5.3.2. The Polish programme is generally free of charge, while the English programme is subject to tuition fees
Full-time studies at a public institution of higher education in Poland are generally free of charge in the Polish programmes for Polish students and other citizens of the EU/EFTA countries (Box 5.2). Other foreign students may pursue their education in the Polish programme but subject to tuition fees, unless they have a scholarship exempting them from such fees.
Box 5.2. State subsidies for medical schools
For each full-time student in the Polish programme, public medical schools used to receive a state subsidy, calculated on a per student basis until the academic year 2017/18. According to the estimates of the Ministry of Health, the average annual cost per student in a medical programme was USD 10 500 (PLN 38 806) in 2015/2016, making it the most expensive of all study programmes offered in Poland. These costs vary to some extent from one medical school to another.
From 2018/19, state subsidies also depend on the student-staff ratio, defined as the number of students per one academic teacher. The target ratio was set at 13:1; if there are more than 13 students per teacher, the subsidy might be lowered.
Under the new law, grants to medical schools also include a subsidy for maintaining and developing their teaching and research potential, social benefits for students, education-related investment, and support for students with disabilities. Medical schools can receive earmarked subsidies related to the professional development of the medical staff, from the Ministry of Health.
Students in an English programme also have to pay for their studies, unless they receive a scholarship. The annual fee is set by each medical school. In the medical schools for which this information is readily available, these tuition fees range from EUR 9 950 to EUR 14 250 per year (Table 5.2).
The evening study programmes in Polish also involve tuition fees; these are set by each school, ranging from EUR 6 950 (PLN 30 000) to EUR 8 800 (PLN 38 000) annually, in 2018/19.
Table 5.2. Annual tuition fees in English programmes in Polish medical schools (EUR), 2018/19
Note: * In general, annual tuition fees differ for each year of studies.
Source: Compilation based on information available on medical schools’ websites.
Private medical schools charge tuition fees for all study programmes (in English and in Polish). In 2018/19, these ranged from EUR 9 200 to EUR 14 700 per year, which is comparable to the annual fees for the English programmes in public medical schools.
Among the 6 759 international medical students in 2017/18:
218 were studying according to the rules applicable to Polish citizens (i.e. not paying any tuition fees).
185 were admitted on the basis of an international agreement or of a ministerial decision (holders of a scholarship from the Polish government or another government with which Poland has an agreement on education of medical students).
6 356 were paying tuition fees – the vast majority of these were in the English programme.
5.3.3. Many international students finance their studies through loans from their home countries or pay for their education themselves
International students in Poland mostly finance their studies:
through student loans, scholarships, sponsors, and other third parties in their home countries;
out-of-pocket or via personal/family savings.
Scholarships for international students at Polish medical schools remain rare, but their prevalence is increasing, especially to attract gifted candidates to the English programmes. The new Law on Higher Education and Science of 20 July 2018 introduced more scholarship options for students from other EU/EFTA countries.
The main source of financing for international students depends greatly on their country of origin. For example:
Taiwanese and Thai students are mainly financed by their parents;
Norwegians often obtain loans from their government through the Norwegian State Educational Loan Fund, covering tuition fees and costs of living;
Swedes receive financial support from their National Board of Student Finance;
Saudis’ expenses are in most cases covered in total from scholarships for the education of professionals abroad under a Saudi Ministry of Education programme;
Americans have access to federal loans through the Federal Student Aid Office of the US Department of Education, or commercial loans from companies such as Sallie Mae, just as if they studied in the United States;
Canadians sometimes receive some financial support from their provincial government (such as via the Ontario Student Assistance Program).
5.4. Education and training pathways are the same for all
Studies in the field of medicine are provided in the form of a master’s degree programme lasting six years. Thereafter, graduates are required to follow an obligatory 13-month internship and pass a final medical exam to obtain the right to practise as a physician in Poland and enter residency (specialist medical training).
All Polish and international medical graduates have the same right to access internships and take the final exam, as long as they have completed their master’s degree. Both these steps are only available in Polish, and foreign candidates must also pass a Polish language exam organised by the Supreme Chamber of Physicians.
The number of posts for interns is set annually by each regional government in consultation with the Regional Chamber of Physicians. Traditionally, the number of internships available does not take into account graduates from the English programmes, based on the assumption that most of these graduates will leave the country after obtaining their first medical degree. This is indeed the case for the majority of international graduates of Polish medical schools (see also Section 5.6.1).
The internship is based on an employment contract with an accredited institution (selected hospitals but also outpatient clinics) for a defined period (usually 13 months). The Regional Chamber of Physicians determines the place of internship, giving priority to candidates already living in the region and taking into account their average study scores.
Following the internship, the next step is the residency (postgraduate specialist training) usually lasting 4‑6 years, depending on the specialty. Access to residency placements follows the same regulations as for internships: Polish and international medical graduates of Polish medical schools have the same right to access.
The annual number of new residency openings is determined by the Minister of Health in consultation with the regional governments. Estimates by the regional governments should take into account the free training posts available in the region, the current and future health care needs of the region’s population, and any available data on the access to services in particular medical specialty. The qualification procedure is carried out biannually, in March and October.
Following the increase in the number of medical students in Polish programmes over the last decade (see Figure 5.1), the number of new residency places also increased (Table 5.3). However, the expansion in the number of residency places occurred with some delay to the increase in the number of medical graduates, which was compensated by a larger increment in residency openings between 2014 and 2015. The allocation of openings between medical specialties also changed, prioritising certain specialties, such as general practice or oncology. In 2015, for example, the largest share of new residency openings – nearly 10% of all openings – was in general practice (Domagala and Klich, 2018[1]). The residents’ salaries are slightly higher in prioritised specialties to incentivise physicians to apply for them. The competition for the most popular residency openings is stiff. This is not the case, however, for the less popular specialty areas. In 2015, for example, in at least eight out of 70 specialties – including emergency medicine, palliative medicine, or paediatric haematology/oncology – more than 90% of the available residency placements remained unfilled due to a shortage of candidates (Supreme Audit Office, 2017[2]).
Table 5.3. Trends in number of new residency places for medical specialisations in Poland, 2012‑16
Note: Numbers for 2017-2019 include residency places in dental specialisations.
Source: Ministry of Health, July 2019.
Since 2018, Poland has recognised an additional pathway to become a specialist as an alternative to residency: obtaining a specialisation certificate by passing exams validated by the European medical societies for five specialties: anaesthesiology and intensive care; urology; thoracic surgery; radiology and traumatic diagnostics; and ophthalmology.
5.5. Drivers of internationalisation of medical education in Poland
5.5.1. Admission limits in home countries, relatively low tuition fees in Poland, and international recognition of Polish medical degrees
According to international students and representatives of the medical schools, the primary motivations for international students to pursue medical studies in Poland are:
limits on admission to medicine programmes imposed by numerus clausus policies or other capacity constraints in the students’ home countries;
the wide recognition of Polish medical diplomas, not only in EU/EFTA but also in other countries, combined with the perceived high quality of medical education in Poland;
the comparatively low cost of living and moderate tuition fees in Poland;
the relatively transparent admission process, which also includes many entrance options, to Polish medical schools.
The large medical education system in Poland gives students from countries with strict numerus clausus policies (or tight capacity constraints) or relatively high tuition fees the opportunity to obtain a diploma in their desired field of studies. This is one of the main reasons given by students from Scandinavia, the United States, Israel, and India for pursuing their medical studies in Poland. As noted above, some countries, such as Saudi Arabia, also award scholarships for education at specific medical schools in Poland.
Polish medical schools are continuing efforts to have their diplomas recognised not only in other EU/EFTA countries but also in a growing number of countries in Asia and North America. For example, the Indian Medical Council now recognises diplomas awarded by several Polish medical universities (including Warsaw, Poznań, and Gdańsk), which is why most students from India in Poland attend these universities. The diplomas obtained at the end of the English programme in Polish medical schools are also recognised automatically in the United States, Canada, as well as many Asian and Middle Eastern countries.
5.5.2. Active marketing abroad to recruit international students and bring additional revenue to medical schools
Accepting international students yields additional funding for the medical schools in Poland in at least two ways. First, most of these students study in the English programme, which is subject to tuition fees. Second, the degree of internationalisation of a medical school (which is judged at least partly by the presence of international students) accounts for 5% of the total subsidy received from the state.
Medical schools in Poland estimate that the tuition fees paid by international students are close to the marginal cost of education for each additional student. Indeed, the tuition fees (see Table 5.2) are of the order of the official estimated average of USD 10 500 per student in medical education programmes (Ministry of Health, 2016). The fees permit to scale up workforce hours. This is frequently done by offering extra pay to the staff in the form of paid overtime and serves to bind and attract highly qualified staff to the medical schools, which is an acute concern.
In order to attract enough good international students, the medical schools run horizon scanning and active recruitment strategies.
The schools recognise that interest from the international student population is contextual and fluid, depending on changes in the students’ countries of origin. Therefore, they are agile in responding to legislative changes in the home countries of international students and strive to address more countries of origin of potential candidates.
Active recruitment strategies include a range of promotional activities. Apart from the activities of agents and the participation in education fairs, medical schools also organise seminars for candidates in their countries and courses preparing them for the entrance exam.
Polish medical schools have recently identified Indian students as candidates for being attracted to pursue their medical studies in Poland: Following a legislative change in India in 2017, both Indian and foreign medical school diploma holders have to pass the same exam to be able to practise as a doctor in India. This means that studies outside India potentially bring the same benefits and are often cheaper than a private education within the country. Therefore, an increase in the number of Indian students is expected in the near future.
In order to attract new international candidates, Polish medical schools have also developed strategies to facilitate their return to their home country after they have completed their degree (Box 5.3). The aim is to help students to pass the exams that will allow them to obtain a licence to practise their profession in their home country. Schools’ staff, for example, go to selected countries to gain a better understanding of the requirements and respond to students’ needs with relevant additional offers for studying in Poland.
Nonetheless, the biggest medical schools reject between 30% and 85% of all applicants to their English programmes. This is not simply because they have reached the maximum limits of students they can admit, as several medical schools end up admitting fewer students to these programmes than they are allowed to. The schools only accept candidates with high enough grades in the entrance exam (and in their school-leaving exams for those that also take these into account), even if this means that some places remain unfilled, as a matter of principle and prestige.
Box 5.3. Preparing international students to return home – strategies of the Medical University Poznań
The Medical University Poznań offers several types of course that prepare international students for the exams they will have to take in their home country on their return.
For students who plan to pursue their career in the United States, the University offers a preparatory course for the US bachelor’s degree examination (United States Medical Licensing Examination step 1). The course has been added to the curriculum and includes approximately 1.5 months of additional lectures and mock exams, with the participation of visiting professors from the United States.
For students planning to do an internship in the United States or Canada, the University offers, as elective courses, basic life support and advanced life support courses necessary to obtain certificates in these fields.
For students choosing the Taiwanese or Thai study pathway, it is possible to receive from between several hundred to over one thousand additional hours of study, mainly as clinical practice within their existing chosen subjects, as well as in new subjects (such as an introduction to biotechnology or social sciences). This allows graduates to meet the professional guidelines in place in Taiwan and Thailand.
5.6. Growing numbers of international and domestic medical graduates, but persisting doctor shortages
5.6.1. Emigration of international students on completion of degree
In most cases, graduates of the English programmes do not intend to pursue their medical internship and specialist training (residency) in Poland after their first degree. The few who choose to stay and complete their internship and enter specialist training are usually students of Polish origin or have strong Polish ties.
The relatively low pay and poor working conditions during the internship period and the subsequent residency, together with language barriers, are the main factors contributing to low retention rates of international graduates of Polish medical schools. Moreover, graduates from non-EU/EFTA countries are generally not entitled to any remuneration during their internship in Poland. For this reason, the few non-EU/EFTA graduates of Polish medical schools who decide to stay in Poland choose to complete their internship in smaller towns with staff shortages, where the hospital management may be willing to pay them for their work.
In addition, language often remains an obstacle. International medical students are expected to achieve a good command of Polish during their studies. Yet, as they are generally not expected to pursue their professional career in Poland, this requirement is not always enforced.
Hence, nearly all international graduates of Polish medical schools return to their home countries or move to countries in which either their mother tongue or English is spoken. Also, some students are bound to return to their homeland by the conditions of the scholarship they receive.
5.6.2. Emigration of Polish medical graduates and doctors
There is no source of data within the country to establish the exact magnitude of the emigration (permanent or temporary) of Polish medical graduates and fully-trained doctors. Official data regarding physician outflows are limited to the number of requests for certificates of conformity/good standing issued by the Supreme Chamber of Physicians for doctors intending to practise medicine in other EU countries, but these requests do not provide any information on whether or not they have achieved this intention.
Based on the number of such certificates issued since Poland’s accession to the EU on 1 May 2004, the number of doctors intending to emigrate was estimated to be 7% of the total stock of practising physicians in 2016 (Domagala and Klich, 2018[1]; Zuk, Zuk and Lisiewicz-Jakubaszko, 2019[3]; Supreme Audit Office, 2017[2]). These certificates, however, remain valid for as little as three months, so some physicians might obtain the certificate more than once (resulting in double-counting or triple-counting). On the other hand, these data do not capture those who may be emigrating to countries outside the EU, such as Australia, Canada and the United States.
Another unknown is whether the emigration of doctors is permanent or temporary and whether it affects mostly medical graduates and junior doctors or rather medical specialists (Zuk, Zuk and Lisiewicz-Jakubaszko, 2019[3]). Interviews with medical students and representatives of medical schools indicated that most medical graduates of Polish programmes prefer to pursue their internships in Poland – even those who intend to move to another country later on – as they wish to acquire the option to practise the profession in Poland in the future, especially since not all countries have such 13-month internships as part of their medical education and training programme.
Medical students and graduates of the Polish programmes also point the relatively low pay and poor working conditions during the internship and residency as the main factors behind their intention to emigrate. Indeed, in autumn 2017, junior physicians in Poland, frustrated with their workload and employment conditions during their residency, went on strike and demanded reforms. The strike was supported by the majority of physician associations and other health professional organisations in Poland. As a result, their employment conditions were revised, including a salary rise (Domagala and Klich, 2018[1]), but the exact impact of the reform – in particular on the retention rate – remains to be seen.
More generally, the lack of reliable data within the country to establish the exact magnitude of emigration (permanent or temporary) limits the capacity to assess the effectiveness of any retention initiatives to address the shortages of doctors.
5.7. Conclusions
Poland has a sizeable and internationally recognised medical education system with a long tradition of welcoming international students. The country makes the best of this good reputation by investing the tuition fees that international medical students are willing to pay for the English study programmes into the retention of highly-qualified faculty members, who also train students in the Polish programmes.
At the same time, in co-ordination with the government, the medical schools have shown moderation in their efforts to attract international students. Places for national medical students have not been sacrificed for international medical students. Over the last decade, the number of national medical students has in fact increased much more rapidly than the number of students in the English programmes, with the hope that the growing number of Polish medical graduates will remain in the country and help address the shortage of doctors.
While the medical education system in Poland produces a rapidly growing number of Polish and international medical graduates, the Polish health system faces difficulties in retaining them. The success of Polish medical schools in attracting international students is due to readily available and affordable places in English programmes that lead to internationally recognised diplomas. However, most of these international students have no intention to pursue their postgraduate specialist training and to work in Poland as they can get more lucrative internship and job offers in their home country or in a third country. . What is worse is that many Polish medical graduates, who in theory should have a stronger attachment to their home country and do not face any language barrier, often express an intention to emigrate because of relatively poor working conditions. While the exact emigration rate of Polish medical graduates, junior doctors and specialists fully-trained in Poland remains unknown, it is presumed to be sizable.
The bottom line is that despite the success of the Polish medical education system in training a growing number of both Polish and international students, the Polish health system still faces physician shortages. This highlights the importance of a more comprehensive approach to health workforce planning and policies that addresses not only education and training policies, but also the problem of retention.
References
[1] Domagala, A. and J. Klich (2018), “Planning of Polish physician workforce - Systemic inconsistencies, challenges and possible ways forward”, Helath Policy, Vol. 122, pp. 102-108, http://dx.doi.org/10.1016/j.healthpol.2017.11.013.
[2] Supreme Audit Office (2017), Informacja o wynikach kontroli - Kształcenie i przygotowanie zawodowe kadr medycznych (Report dedicated to training of medical staff), Supreme Audit Office, https://www.nik.gov.pl/kontrole/P/15/060/.
[3] Zuk, P., P. Zuk and J. Lisiewicz-Jakubaszko (2019), “Labour migration of doctors and nurses and the impact on the quality of health care in Eastern European countries: The case of Poland”, The Economic and Labour Relations Review, pp. 1-14, http://dx.doi.org/10.1177/1035304619847335journals.sagepub.com/home/elra.