Europe’s Dependence on Foreign-Trained Doctors and Nurses Has Cross-Border Ripple Effects

In the same period, annual inflows – new entries into the health labour market – of doctors nearly tripled, and inflows of nurses increased 5-fold.

Strikingly, most of these health professionals were trained outside Europe: 60% of doctors and 72% of nurses arriving in 2023 were trained outside the Region.

“This is not just about numbers. Behind every migrating doctor or nurse is a story of ambition and opportunity, but also, often, of strain on families and on the national health systems they left behind,” said Dr Natasha Azzopardi-Muscat, Director of WHO/Europe’s Division of Country Health Policies and Systems.

“Health worker migration is a reality in Europe’s interconnected labour market, and it must be managed more fairly and sustainably.”

This rapid growth in mobility is creating new challenges. Some countries, particularly in eastern and southern Europe, are losing large numbers of doctors and nurses to neighbouring countries, exacerbating existing shortages and undermining workforce sustainability.

At the same time, many western and northern European countries are becoming heavily dependent on foreign-trained professionals. In Ireland, for example, more than half of all nurses and 43% of doctors are foreign-trained.

With a projected shortfall of 950 000 health workers in the Region by 2030, the report emphasizes that countries must implement strong retention policies and better workforce planning.

These measures are crucial for ensuring a sustainable health workforce in both the countries where workers are trained (sending countries) and those where they eventually work (receiving countries).

“As WHO, we support better working conditions in sending countries on one hand, and better self-sufficiency in receiving countries on the other,” explained Dr Tomas Zapata, Regional Adviser for Health Workforce and Service Delivery at WHO/Europe.

“That is why we continue to support governments with the implementation of retention strategies, better planning capacity (including workforce modelling), long-term financing strategies, and education reforms to build a workforce that can respond to changing health needs now and in the future.”

Complex mobility patterns

While migration was once perceived as a one-way flow from south to north, the report reveals a far more complex and dynamic picture. Diverse mobility patterns exist within subregions, among high-income countries and between neighbouring countries.   

Language, geography and shared training systems also shape mobility; for instance, Germany is the leading source of foreign-trained doctors in Austria, Switzerland and Bulgaria, while Moldovan-trained doctors form the largest foreign group working in Romania.

Policy responses and lessons learned

The report includes 9 country case studies – Albania, Armenia, Georgia, Ireland, Malta, Norway, the Republic of Moldova, Romania and Tajikistan – that demonstrate the diversity of migration pathways, the specific challenges that each country faces, and particular challenges and opportunities linked to the migration of health workers.

The case studies also provide insights into important data gaps that need to be addressed to ensure informed approaches to policy design and implementation.

For example, Romania – long a major source of doctors and nurses for other countries – has managed to reduce the migration of doctors in the last 10 years, from 1500 doctors migrating in 2012 to just 461 in 2021.

This has mainly been the result of better pay, training and working conditions inside Romania. The Republic of Moldova has seen a drop in requests from doctors seeking to move abroad.

Ireland, one of the countries most reliant on foreign-trained staff, has increased medical training spaces for domestic students in an effort to build self-sufficiency.

WHO calls for coordinated action

The report sets out a series of actions countries can take, including investing in domestic training, strengthening retention strategies, aligning education with health system needs, and promoting ethical international recruitment through transparent bilateral agreements.

“Health worker migration is a reality in our interconnected and globalized world, and we have the solutions to ensure it works for all parties. Countries can learn from each other’s experiences,” Dr Azzopardi-Muscat pointed out.

“If we fail to support the movement of health workers fairly, we risk widening health inequities and leaving already-fragile health systems unable to cope.”

About the report

WHO/Europe developed the new report in collaboration with Member States and partners. The report draws on the Joint Questionnaire on Non-Monetary Health Statistics of WHO/Europe, Eurostat and the Organisation for Economic Co-operation and Development, as well as National Health Workforce Accounts.

It aligns with the WHO Global Code of Practice on the International Recruitment of Health Personnel, and WHO/Europe’s Framework for Action on the Health and Care Workforce 2023–2030.