Where do the best go?

Global competition for healthcare professionals. What role does migration play in their career future?

In OECD countries, the health sector is one of the most important in terms of employment. The demand for qualified health professionals generally far exceeds domestic supply. In the case of Switzerland, about one third of the health workforce has foreign passports. This figure is expected to grow, the reasons for which are twofold. On the one hand, this can be attributed to steadily increasing demand, comparatively high salaries, good training opportunities and favourable working conditions. On the other hand, the insufficient number of people trained to replace those reaching retirement age will also play a significant role (see Careum Working Paper 1).

Neither the migration nor the shortage of health professionals is a recent phenomenon. Indeed, according to the WHO, there is a global shortage or, as the OECD puts it, “a looming crisis in the health workforce”. The number of health professionals required worldwide amounts to 4.25 million. This shortage is, in itself, a matter of concern because it compromises the quality of care delivery. The real issue, however, is seen in the migration of skilled health workers, which is characterised by a “cascade-type” pattern whereby the wealthier countries attract qualified personnel from countries in the East or South. This situation raises ethical issues because “care drain” results in the deterioration of already disadvantaged health systems. Moreover, it transfers considerable investments intended to provide relief and causes additional exposure and vulnerability. On the other hand, the labour market is very much global in nature and offers opportunities to talented and skilled labour. Several initiatives have been launched to address the discrepancy between these two opposing situations and to tackle the migration of health workers. The goal in this regard is to develop strategies to mitigate the adverse effects on health systems.

The Swiss Federal Office of Public Health has been commissioned with the present Careum Working Paper with the aim of stimulating discussions in the workshop focusing on the global competition for healthcare professionals at the “Careum Congress 2009”. This paper sheds light on the relevance of the migration of health workers for Switzerland, the measures taken to hopefully raise self-sufficiency, and it sets the country in regards to the WHO code of practice on the international recruitment of health personnel. It appears that the mobility of healthcare workers will remain an important element for the Swiss health care system. However, it cannot be seen as the definitive solution.

The Careum Foundation, which has been actively involved in educational matters within the healthcare sector for 130 years, would like to generate the new ways of thinking that are needed to improve the domestic supply through strategies that focus on education, practice and policies that will enable the recruitment, training and retention of many more health professionals.

Working Paper 3

Silberschmidt, G., & Merçay, C. (2009). Where do the best go? Zürich: Careum. PDF

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