Reliance on foreign health professionals

The analysis of reliance on foreign health professionals in the workforce starts with medical doctors and moves on to nurses and dentists. Countries are grouped according to their level of reliance on each profession: negligible to low reliance (less than 5%), moderate reliance (5%–less than 10%); high reliance (10%–less than 20%); and very high reliance (more than 20%). Differences between the EU-12 and the EU-15 will be discussed. The section ends with a comparison of the three professions.

Turkey, Estonia, Slovakia and Poland show negligible reliance on foreign medical doctors, ranging from 0.02% to 0.7%. Hungary, Italy and France also have relatively low reliance on foreign medical doctors – less than 5% (see Fig. 2.1).

Moderate reliance on foreign medical doctors can be observed for Germany and Finland (5.2% and 6.2%, respectively). Belgium, Portugal, Spain, Austria, Norway, Canada and Sweden have a high reliance (11.1–18.4%). Ranging between 22.5%

and 36.8%, Switzerland, Slovenia, Ireland and the United Kingdom are the European countries with very high reliance on foreign medical doctors.

No registry data on foreign medical doctors were available for Romania, Serbia and Lithuania. As a proxy, data on work permits for foreign medical doctors in Lithuania point to a negligible number of foreign health professionals, although issue of a work permit does not necessarily mean that the medical doctor will go on to join the health workforce.

Reliance on foreign medical doctors in Europe is characterized by large differences across countries. The United Kingdom and Ireland are at one extreme, with more than one in three medical doctors being foreign trained.

Reliance levels gradually decrease towards the eastern part of Europe (ranging between <1% and 2% in most 2004 and 2007 accession countries), pointing towards east–west asymmetries. Set in a global context, the scales of mobility in the “top four” European countries (United Kingdom, Ireland, Slovenia, Switzerland) are comparable to those in New Zealand, the United States, Australia and Canada, four of the major destinations worldwide.

Sources: data sources from case studies³ – Estonia: Health Care Board; Slovakia: National Health Information Centre, National Register of Health Professionals; Poland: Polish Chamber of Physicians and Dentists; Hungary: Office of Health Authorisation and Administrative Procedures; France: National Medical Council; Germany: Federal Chamber of Physicians; Finland: Statistics Finland; Belgium: Federal Database of Health Care Professions; Spain: Organization of Medical Colleges; Austria: Census data (foreign-born) Austrian Medical Chamber (foreign-national), OECD 2010 (foreign-trained); Slovenia: Medical Chamber of Slovenia; United Kingdom: General Medical Council. OECD (2010) data were used for the following countries: Turkey, Italy, Portugal, Norway, Canada, Sweden, Switzerland, Australia, United States, Ireland, New Zealand.

Notes: Data not available in Romania, Serbia, Lithuania; ^a very low percentages ^b 2009 (all indicators); ^c 2006; ^d2007; ^e 2001 (applies only to indicator: foreign-born).

Overall, it appears that Europe is less reliant on foreign nurses than on foreign doctors, although fewer countries in the sample can provide data (Fig. 2.2).

Reliance on foreign nurses is negligible in Turkey and Slovakia and relatively low in Spain, Hungary, France, Finland, Sweden, Germany, the United States, Portugal and Belgium. Canada and Italy are the only countries in the cluster having moderate reliance on foreign nurses. Within Europe, the United Kingdom, Austria and Ireland have high or very high reliance on foreign nurses – ranging between 10% and 47.1%.

EU-15 countries show much greater reliance on foreign nurses than those in the EU-12, mirroring the findings for medical doctors. Hungary is the EU-12 country with the highest reliance on foreign nurses (1.3%), a sharp contrast to Ireland (47%). However, Ireland seems to be an outlier as even the non-European OECD countries included in the analysis have lower reliance on foreign nurses (although high reliance on foreign medical doctors).

3 Full references for countries are given in the reference lists of the individual country case studies.

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Fig. 2.1 Reliance on foreign medical doctors in selected European and non-European OECD countries, 2008 or latest year available

28 Health Professional Mobility and Health Systems

No data were available in eight countries – Estonia, Lithuania, Norway, Poland, Romania, Serbia, Slovenia and Switzerland. The case studies from Italy, Germany and Austria reveal a severe lack of data on a related issue – the numbers of foreign nurses and care workers working mainly in the provision of care to elderly people in private settings outside the official sector. This is predominantly an unofficial market either for non-EU nurses who are not eligible for diploma recognition or for EU nurses subject to labour market restrictions.

Their working conditions give cause for concern and official information on the quality and nature of services they deliver is largely non-existent.

With regard to dentists,⁴ the findings from Slovakia, Germany, France, Poland, Hungary and Finland show negligible to relatively low reliance on foreign dentists (0.7–4.0%); Belgium has moderate reliance (6.1%); and Austria (21.3%) and Slovenia (22.7%) have very high reliance (Fig. 2.3). Although no national data were presented for Spain, regional data from 2007 point to high and very high reliance on foreign dentists in Madrid and Valencia (approximately 20%) and Las Palmas (43%).

4 Dental doctors in Slovakia.

Fig. 2.2 Reliance on foreign nurses in selected European and non-European OECD countries, 2008 or latest year available

Sources: Slovakia: National Health Information Centre; Spain: Council of Nurses; Hungary: Office of Health Authorisation and Administrative Procedures; France: Cash & Ulmann 2008; Finland: Statistics Finland; Germany: Federal Employment Agency; Belgium: Federal Database of Health Care Professions; United Kingdom: Nursing and Midwifery Council; Austria:

Census data. OECD (2010) data were used for the following countries: Turkey, Italy, Portugal, Norway, Canada, Sweden, Switzerland, Australia, United States, Ireland, New Zealand.

Notes: No data provided for Estonia, Lithuania, Norway, Poland, Romania, Serbia, Slovenia, Switzerland; ^a 2005; ^b 2007,

c 2006; ^d covers nurses and midwives subject to social insurance contributions; ^e 2004; ^f 2001.

Analysis of the reliance on foreign dentists is limited by the lack of data.

Only eight of the case studies included data on dentists and there were no OECD data to complement the analysis. In light of the paucity of quantitative information, no conclusions could be drawn or characteristics identified across Europe. However, it should be noted that the very high reliance on foreign dentists in Slovenia corresponds with the results for medical doctors.