The Mobility Transition in Health Professional Emigration

Abstract

Abstract Introduction Human resources for health (HRH) emigration is a topic of great concern to policymakers. In what is called the “mobility transition”, emigration rates for the general population follow an inverted U-shaped curve, with migration rising at a positive relationship to GDP/capita until source countries reach a GDP/capita of $7,000 or more, after which emigration rates fall. It is unclear whether HRH emigration trends follow a similar pattern. Methods We drew OECD-destination physician and nurse emigration data from the OECD.Stat database from 2000-2016 and charted it against real GDP/capita (2011 $ international). We censored data from small island states and country-years with known coups or conflicts. We fit a mixed-effects model testing for a quadratic (U-shaped) relationship between the natural log of real GDP/capita and annual emigration flows, controlled for source country physician/nurse density and year. Results We drew data from 145 sending countries and 28 destination countries over 17 years. Scatter and fitted trend plots showed a regular, not inverted, U-shaped distribution of physician/nurse emigration rates, with low-income countries represented on the left end of the curve (with declining emigration with increasing GDP/capita) and high income, European nations represented on the rightmost end (with rising emigration with increasing GDP/capita) after an inflection point around $7,000 GDP/capita. Model estimates demonstrated a significant positive quadratic relationship between the natural log of GDP/capita and physician (p = 0.005) but not nurse emigration rates when controlled for other variables. Conclusions There appears to be a mobility transition in HRH emigration rates, with an increase in HRH emigration with rising GDP/capita in countries with greater than $7,000 GDP/capita. Of note, some European nations have emigration rates of similar magnitude to low-income African nations, likely due to relatively relaxed EU mobility regulations. Key messages Physician Emigration Trends follow a U-shaped transition with elevated rates in low- and high-income countries and depressed rates in middle income countries. Some European nations have emigration rates similar to low-income African/Asian countries.