Recent Trends in International Migration of Doctors, Nurses and Medical Students

Foreword
Executive summary
1 Recent trends in international mobility of doctors and nurses
	1.1. Introduction
	1.2. The number of doctors and nurses has increased in most OECD countries, driven mainly by growing numbers of domestic graduates
	1.3. Foreign-born doctors and nurses have contributed significantly to the growing number of doctors and nurses in many OECD countries
	1.4. Many OECD countries have also relied increasingly on foreign-trained doctors and nurses
	1.5. Conclusions
	References
	Annex 1.A. Trends in number of medical and nursing graduates in OECD countries
	Annex 1.B. Countries of education of foreign-trained doctors working in the United States and the United Kingdom
	Notes
2 Recent trends in internationalisation of medical education
	2.1. Introduction
	2.2. A growing number of students follow medical education abroad before returning to their home countries
	2.3. A number of “push” and “pull” factors drive student mobility
	2.4. In some countries international medical graduates face a bottleneck in accessing postgraduate training required to become a doctor
	2.5. The international mobility of students brings additional challenges to national health workforce planning and policies
	2.6. Conclusions
	References
	Notes
3 The internationalisation of medical education in France
	3.1. Introduction
	3.2. Overview of the French medical education system, and recent and proposed reforms
	3.2.1. The French medical education system is characterised by a strict numerus clausus at entry, but a much more flexible admission system in internship
	3.2.2. The numerus clausus policy in France has fluctuated greatly since its introduction in the 1970s
	3.3. Over 12 000 foreign students were enrolled in French medical schools in 2017-18 – fewer than in 2010-11
	3.4. The number of French students studying medicine abroad has increased but remains relatively low
	3.5. Student ranking in the ECN is mainly influenced by the place of first medical degree
	3.6. A number of options have been proposed to strengthen the selection and evaluation of medical students pursuing postgraduate training in France
	3.7. Conclusions
	References
	Note
4 The Irish paradox: Doctor shortages despite high numbers of domestic and foreign medical graduates
	4.1. Introduction
	4.2. International students account for half of all medical students in Ireland
	4.2.1. Canadians are the most numerous group of international medical students in Ireland
	4.3. Admission rules and tuition fees differ for Irish and EU/EFTA students and those from non-EU/EFTA countries
	4.3.1. Non-EU/EFTA students face no numerus clausus policy for entry into medical education but have limited access to internships
	4.3.2. The selection process for non-EU/EFTA candidates is separate
	4.3.3. Non-EU/EFTA students pay significantly higher tuition fees
	4.4. Medical schools in Ireland seized the opportunity to respond to the unmet demand from international students to study medicine
	4.4.1. Push and pull factors for international students include restrictions on access in home countries and the reputation of Irish medical schools
	4.4.2. International students are an important source of income for medical schools
	4.5. Despite having the highest number of medical graduates relative to its population, Ireland is heavily reliant on foreign-trained doctors
	4.5.1. The reliance on foreign-trained doctors in Ireland has increased
	4.5.2. High numbers of international and Irish medical graduates and fully-trained doctors emigrate
	The vast majority of international graduates cannot proceed beyond their first medical degree and obtain the right to practise medicine in Ireland
	Also many Irish medical graduates and doctors move to other countries
	Many junior doctors with a foreign medical degree are employed in non-training posts and reemigrate in search of specialist training opportunities
	4.6. Conclusions
	Annex 4.A. Auxiliary tables
	References
	Notes
5 International students in Polish medical schools
	5.1. Introduction
	5.2. One-quarter of new-entrant medicine study places in English programmes for international students
	5.2.1. Medical schools do not necessarily fill all the study places in English programmes
	5.2.2. Many medical students come from North America, Scandinavia, and the Middle East
	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
	5.3.2. The Polish programme is generally free of charge, while the English programme is subject to tuition fees
	5.3.3. Many international students finance their studies through loans from their home countries or pay for their education themselves
	5.4. Education and training pathways are the same for all
	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
	5.5.2. Active marketing abroad to recruit international students and bring additional revenue to medical schools
	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
	5.6.2. Emigration of Polish medical graduates and doctors
	5.7. Conclusions
	References
	Annex 5.A. Institutional affiliations of the interviewees
6 Romania: A growing international medical education hub
	6.1. Introduction
	6.2. Nearly 30% of new-entrant places in medical schools in English- and French-language programmes
	6.2.1. A large share of international medical students come from Israel and EU/EFTA countries
	6.3. Admission rules, tuition fees, education and training pathways for international and domestic students
	6.3.1. Medical schools enjoy significant autonomy in their decisions on student intake
	6.3.2. The Ministry of Education subsidises places in the Romanian programme
	6.3.3. Domestic and international students follow the same medical education and training pathways
	6.4. Drivers of internationalisation of medical education in Romania
	6.4.1. Internationalisation of medical schools as part of general internationalisation efforts in higher education
	6.4.2. Push and pull factors for international students: limits on access in home countries, low tuition fees, and EU-wide recognition of medical diplomas
	6.4.3. International students as an additional source of income for medical schools
	6.4.4. Further impetus for internationalisation from competition between medical schools
	6.5. Growing numbers of international medical graduates but low retention
	6.6. Conclusions
	References
	Annex 6.A. Institutional affiliations of the interviewees
7 Brain gain and waste in Canada: Physicians and nurses by place of birth and training
	7.1. Introduction
	7.2. Canadian and foreign trained physicians and nurses are required to pass entry tests to be licensed
	7.3. Census data are used to analyse occupational access of Canadian and foreign trained physicians and nurses
	7.4. Foreign trained physicians and nurses have contributed to the growth in the number of physicians and nurses in Canada, but many have not found jobs in their profession
	7.5. Conclusions
	References
	Annex 7.A. Comparing data on physicians and nurses based on census and administrative sources
	Notes
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