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18
Health professional mobility in a changing Europe
Although the magnitude, directions and composition of migratory flows
change, their importance does not diminish. The development of this volume
coincided with the onset of the financial and economic crisis in Europe, at a time
when it was not known what the downturn would mean for health professional
mobility. The insights from the study show the persistence of mobility in
turbulent and unpredictable times (Chapter 3), confirm its continued relevance
and underscore the need to understand the dynamics of the phenomenon.
The changing and unpredictable patterns of health professional mobility and
its enduring importance, together with the evolving context in which it takes
place (explained in detail in section 2.1.3 below), mean that no country can
disregard health professional mobility or consider itself “safe”: it might benefit
from inflows of health professionals today, but be losing health workforce
tomorrow. “No health without a workforce” (Campbell et al., 2013) captures
the exceptional importance of health professionals for the functioning of health
systems, and the vulnerability of health systems to workforce fluctuations;
countries have few certainties as to which health professionals will come, go or
stay. The economic instability that many European countries face adds to the
uncertainty. In the span of two decades, countries such as Ireland and Spain
have gone from being exporters of health professionals in the 1990s to being
importers around the mid-2000s to meet increasing demand, to then again
experiencing outflows of doctors and/or nurses since around 2010 when the
effects of the economic crisis hit (López-Valcárcel, Pérez & Quintana, 2011;
Buchan & Seccombe, 2012). Other countries, such as Bulgaria, Greece,
Portugal, Romania and the United Kingdom, are also witnessing changes in
the directions and extent of mobility, not least in connection with the financial
crisis (Galan, Olsavszky & Vladescu, 2011; Labrianidis, 2011; see also Chapter
3), suggesting the re-emergence of flows from poorer to wealthier countries,
often going south to north, and widening asymmetries in Europe.
The second reason why mobility cannot safely be disregarded is that countries,
in particular within the free mobility zone of the EU (Chapter 6), do not have
complete control over flows. Measures taken by destination or source countries
are but one of the many factors influencing mobility. For example, between
2006 and 2012 the number of nurses from Poland registering in the United
Kingdom fell by more than 50%, while that of nurses from Portugal grew 10-
fold, neither a result of a United Kingdom policy but rather a consequence of
the wider economic situation improving and worsening, respectively, in the
home countries (Chapter 3). Countries that previously attracted, or even relied
on, foreign arrivals witness changing directions of flows as home countries
attract returners – Polish medical doctors are known to be returning to Poland,
while Swiss hospitals experience the return of German medical doctors to