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Germany
Italy
Spain
Lithuania
Slovakia
Serbia
2009). However, inflows from the Maghreb have been decreasing, falling from 45.6% of new registrants in 1999
to 12.1% in 2010 (CNOM 2010).
Immigration from Romania has increased considerably since the country’s accession to the EU – there were 174
registered Romanian doctors in 2007, 819 in 2008 and 1160 as at 1 January 2009 (CNOM 2009). In 2009,
Romanians represented 73% of medical doctors from the new EU countries registered by the CNOM.
The mobility of health professionals from non EU countries is not encouraged. France has signed bilateral
agreements with Monaco, Morocco, Tunisia, and state agreement with some African countries – the Central
African Republic, Chad, the Congo, Gabon, Mali and Togo. Medical doctors from the countries listed can
practise in France if they have a French medical degree or one title mentioned (see Article L431-1 of the CSP
(2011).
The total number and the annual inflows of foreign-national medical doctors registered in Germany are recorded
by the regional chambers of physicians. At the end of 2008 there were 21 784 medical doctors of foreign
nationality in Germany, approximately 5.2% of the total number of registered medical doctors, and 18 105 active
(practising) foreign medical doctors, around 5.7% of all active medical doctors in the country. The main source
countries for medical doctors in 2008 are: Austria (1802), Greece (1708), Russia (1685), Poland (1428), and
Iran (1092).
In 2008, a total of 3065 medical doctors who originally practised in Germany, moved abroad, about 67 % held
German nationality. This represents around a 10% increase in the total number of German medical doctors are
leaving the country. Importantly, there is no information on the number of medical doctors who returned to
Germany after practicing, as return immigration is not recorded.
The actual number of foreign medical doctors is 14 548 that is equivalent around the 5% of the medical
workforce. Mainly they come from Germany, Switzerland, Iran, France Venezuela, and Argentina. OECD
(2010) data show slightly more – 14 747 foreign-national medical doctors in Italy in 2008, representing 3.7% of
the medical workforce.
Data from the inflows of foreign come from the Ministry of Health. In particular, 1310 holders of foreign
diplomas were recognized to work as medical doctors in Italy. There is a numerus clausus introduced in 1994.
The government limits the number of specialist doctors to be trained at 8848 in the 2009-2010 academic year
and the number of graduate posts in medicine or surgery to 9527 in 2010-2011. There is no a clear immigration
policy related to the immigration of health professionals. Foreign health professionals wishing to exercise a
health profession must register with the relevant professional order and pass an oral Italian language exam.
There have not been significant inflows from the accession countries. The only exception was Poland, and
Romania. It should be noticed that there was a surplus of doctors which began in the 1980s to a shortage that
started around 2003. It is important the presence of foreign doctors in specialist training, particularly from Latin
America. This is reflected in the increasing number of foreign candidates attending the medical residence exam
(MIR). For instance, in 2007, foreign candidates gained 16% of the MIR places. The main source countries are:
Peru, Argentina, Colombia and Venezuela. Although there is no data available, there is a significant number of
foreign students in Spanish universities.
The accession to the EU did not produce the anticipated outflows and proportions of health professionals leaving
the country still remain low. The foreign doctors come from third countries such as China, Israel, Pakistan,
Lebanon, and Russia among others. The main destination country for Lithuanian medical doctors, nurses and
dentists proved to be the UK, followed by Scandinavian countries. In terms of stocks, the number of medical
doctors per 100,000 populations is 407.8 in 2007 which is higher than the European average (315.22).
The most popular destinations for Slovakian health professionals were Austria, the Czech Republic, the United
Kingdom, and Germany. In terms of inflows, the foreign health professionals comprises less than 1% of the total
number of medical doctors, nurses, dentists, and midwives. In 2007, there were only 125 foreign medical
doctors. The most important countries of origin of foreign doctors were Czech Republic (27), followed by
Ukraine (19). Between 2000 and 2006, the number of Slovak nationals working abroad increased from 49,300 to
168,800. Slovakia was self-sufficient before 1989 but now is facing to significant outflows of health
professionals.Currently; there is no numerus clausus in place. One of the main problems of attracting foreign
student is that medical education is often not compatible with the EU’s minimum educational standards.
The report also includes as special case: Serbia. Serbia has been an important provider of health professionals
over the last 50 years. It is estimated that around 10,000 Serbian health professionals are working abroad
(Statistical Office of the Republic of Serbia, 2000). The main destination European countries for Serbian health
professionals are Germany (28%) and Switzerland (15%) (see Djikanovich, 2006), but now Slovenia is
becoming more popular after its accession to the EU. The main concern is the overproduction of health
professionals, and therefore high unemployment rates among medical doctors. These factors suggest the
potential for increasing outflows rates. Young medical doctors are looking for better opportunities abroad,
leaving behind an increasingly age working force. Medical doctors are also employed in lower professional
positions in the recipient countries. It should be noted that an explicit policy for human resources in the health
sector was introduced in 2002 when the government implemented the Health Policy of Serbia.
Source: Who (2011): Editors Matthias Wismar, Claudia B. Maier, Irene A. Glinos, Gilles Dussault & Josep Figueras, editors (2011):
Health professional mobility and health systems. Evidence from 17 European countries, 2011, xxxii + 597 pages
ISBN 978 92 890 0247 9.
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