Mobility of healthcare workers from Western Balkans

- Professional development and the need for higher income are the main reasons for the expansive trend of migration of the healthcare workers;

- In all countries (Macedonia, Serbia, Kosovo, Albania) which are the subject of our research, the doctors feel that they are in a inferior position to their patients and they feel threatened;

- Employment using political connections and affiliations is one of the factors that stimulates the young doctors to think about leaving abroad;

- Doctors believe that the attitude patients have towards doctors is completely opposite in the Western and developed countries;

December 24, 2014 Healthgrouper (Skopje, Sofia, Tirana, Belgrade, Pristina)

Press releases are also available in local languages for MacedoniaAlbania, Serbia and Kosovo

Professional development opportunities and the needs for higher income are the main causes of the expansive trend of migration of healthcare workers from the Western Balkan countries in the past several years. These are the initial results from the regional study that Healthgrouper is conducting in Macedonia, Serbia, Kosovo and Albania with financial support from the University in Fribourg from Switzerland via the Regional Research Promotion Programme for the Western Balkans. Over 1700 doctors from Serbia, Macedonia, Albania and Kosovo have left over the past three years to work abroad. This numbers may increase in the following years, which brings this problem to be recognized and put in the center of development of further health and educational policies in these countries.

The migration of doctors is a global phenomenon and it is of tremendous importance to know the exact causes that motivate the healthcare workers from Western Balkan countries to seek employment abroad. Although part of the reasons are somewhat known, a well-planned research approach will offer new answers.

This research outlines and groups the problems and causes for the health workforce migration in five categories: economic, professional, political, personal and social factors for migration, including questions concerning the index of satisfaction for the profession. In doing so, differences in the reasons for migration abroad have been established in relation to the age groups of the doctors. For example, the young doctors in all countries - Macedonia, Albania, Serbia and Kosovo – are more determined to migrate in comparison to their older colleagues. The basic reasons for this determination are the opportunities for professional development, as well as higher income. In addition to economic issues, political issues tend to be a considerable reason for migration as well. In the focus discussion with the doctors in Albania, Serbia, Macedonia and Kosovo, the young doctors directly associate the possibilities for employment with political affiliations and connections. The influence that politics has on their employment is almost equally recognized in all countries and inevitably contributes to the increased emigration of these disappointed individuals.

On the other hand, older doctors who have more experience in their field state another problem besides the economic and social causes, which influences their job satisfaction – the attitude patients have towards doctors. Specifically, in almost all the countries that are the subject of our study, the doctors feel they are in inferior position to their patients. Doctors are exposed to threats, verbal and physical attacks, blackmail and other pressure and generally do not feel safe at their workplace. This situation leads them to consider migration, because they believe that the patient-doctor relationships in the developed countries is quite the opposite.

-We, as doctors are not satisfied because the institutions that are obligated to support us are not doing anything of the sort. Patients have the right to tell us whatever they want, record videos and raise initiatives for alleged corruption. It places us in a position where we view the patients not as clients, but as an enemy that can be very hostile, a doctor form Albania state for the need of our study.

In relation to the social status that doctors have in Kosovo, a young Kosovar doctor says – As a specialist they might treat you somewhat better, but as a general practitioner - you are nobody! “I want to be respected in society and to have a particular legal status, which is not happening now." – says a specialist doctor from Albania. -It is honestly not worth being a doctor. I would not recommend this profession neither to my children, nephews or anyone else who aspires to have a successful career in the future. Especially if they plan on living in Kosovo – says an experienced Kosovar doctor.

What is most concerning and present in all these countries is that the doctors in all the age groups do not want to recommend the medical profession to their younger colleagues. This regional research is conducted using the same methodology and instrument-questionnaires in all four countries. The research is divided into several phases, each of which uses qualitative and quantitative research techniques. In the first phase the research instruments have been prepared and the questions and main issues listed. Discussions were conducted with young and older, more experienced doctors in all four countries. In addition the discussions with key members of the educational and healthcare systems from these countries are currently in progress. Moreover, the research team is contacting embassies of recipient countries in order to make interviews on their policies of recruitment of health personnel.

The need for this type of research is seen in the ever increasing problem of migration of the healthcare workforce. Namely, the migration of the healthcare personnel is not new – it is a phenomenon that has existed and has been registered long ago. However, unlike in the past, the current conditions for professional mobility, as well as the possibilities for development and career planning abroad are now present with young doctors even at the time of their university studies. This motivation for migration develops during the studies, while realization of the migration is made after completing the studies. The dynamic way of living, the economic conditions, professional opportunities and development, change in the demographic structure of the population in the developed countries as well as the increased production of healthcare workers are just part of the causes that contribute for their emigration to the developed countries.

Public debate has been lead over this issue in the last 10 years or so. The migration of healthcare workers might be considered a problem or a beneficial trend, depending on how it is perceived. If irreversible migration is the case, especially with specialist doctors with decade long experience, then this poses a problem for the entire healthcare system in Macedonia. But if the migration is reversible, meaning the stay abroad is limited to professional development, further qualification and the study of new techniques and skills, and if all that is applied in the healthcare system in Macedonia, then it is of great importance not only to the system itself, but to entire society as a whole, claim representatives from the educational system of Macedonia.

The health workforce migration reveals a special rising trend in the past few years, where the chances for successful migration of the health workforce in the developed countries are considerably higher. It seems that some developed countries might even have a carefully planned, clandestine or official policies and mechanisms that aim to recruit and integrate healthcare personnel from Western Balkan countries or elsewhere, in order to compensate for the lack of their own health workforce. In this process, at the one end of the chain, in the role of financial and organizational support, are the donor countries, families of potential migrants and healthcare institutions (if the migrants were employed). At the other end of this chain are the recipient countries. They are responsible to plan and create the necessary conditions to recruit and keep the qualified health workforce using the system of “cherry picking”. This system is well known in the private health insurance systems during the selection of “favorable” healthy clients. Thus, recipient countries select health workforce that will meet specific criteria to enable their smooth integration in the recipient countries health systems. In this way the recipient countries are active participants in this whole chain mechanism of health workforce recruitment, while the side actors’ role is assumed by the donor countries that in fact produce the health workforce. Donor countries do not have clearly defined policies for human resource planning in healthcare systems and clearly defined opportunities for professional development, but it seems these countries lack any interest in changing the current situation. These countries have no specific strategy to control the enrolment policies of the medical universities; an absence that leads to overproduction of healthcare workers. This creates new generations of young doctors without a clear way for employment and development of their careers. The absence of opportunities for the valorization of their work efforts even after the employment is also an issue.

“Migration always boils down to the following: those of the highest quality are the most wanted, they can fulfill their desires, and leave the country that remains empty and neglected. In other words, healthcare system in Serbia remains with no potential for change and cannot offer good service to its own people. As soon as there is no investment things starts slowly crumbling and vanishing. I'm afraid that Serbia will have in the coming decades the deteriorating medical care of its own people.” – stated a senior specialist from Serbia.

All this contributes to the emergence of a new phenomenon in our region where a channel is formed with the production and the absorption of workforce personnel each on both ends. We designate it as a new phenomenon because the trend of taking over and recruiting the healthcare personnel from the developing countries to the developed countries has been present for a long time worldwide. This applies particularly to the countries of Africa and Central America. These trends of emigration of the healthcare workforce from the developing countries to the developed countries, which have been going on for years, are the object of interest of the WHO (World Health Organization). In 2010, at the General Assembly of WHO in Geneva, the member countries ratified the Global Code of ethical recruitment of healthcare personnel in order to adhere to the ethical guidelines and problems that this process presents. This relates especially to countries that are facing a chronic deficiency of healthcare workers. Still, it seems that the influence of this document is still very small and unnoticeable in respect to ceasing or reducing the migration of the healthcare personnel from our countries.

The migration of healthcare personnel in the region is becoming a rising phenomenon that can jeopardize the stability of the healthcare systems in these countries with its rising intensity. It also contributes to the lowering of quality of services rendered and at the same time reduces the necessary transfer of knowledge to the younger generations. The sooner this problem of mass emigration of the healthcare workforce is recognized, the sooner will the authorities be ready to take the specific steps for its’ solution, which are more than necessary given the present state of affairs.

To be continued...

Project coordinator and main researcher: Vladimir Lazarevik
Researchers for Macedonia: Neda Popovska Kamnar, Blashko Kasapinov, Sanja Spasova
Researchers for Serbia: Maja Krstic, Miljan Lubichic
Researchers for Albania: Ardita Kongjonaj, Gazment Koduzi
Researchers for Kosovo: Teuta Demjaha Agai, Vlera Shpatia


This press release has been prepared in the framework of the Regional Research Promotion Programme in the Western Balkans implemented by University of Fribourg upon a mandate of the Swiss Agency for Development and Cooperation (SDC), Federal Department of Foreign Affairs.

The views expressed in this press release are those of the authors and do not necessarily represent opinions of the Swiss Agency for Development and Cooperation and the University of Fribourg.