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Health professional mobility in a changing Europe
diversity. 1 Several chapters (Chapters 6–11) in this volume focus on mobile
individuals, their experiences and their migratory journeys. By zooming in,
the approach complements the insights from the macro-analysis of health
professional mobility (Chapters 3–5). Two observations in particular enrich
the debate.
First, behind the statistics and aggregated data, health professional mobility
is a phenomenon composed of different types of mobile health professional
each having a particular set of motivations and behaviours. The livelihood
migrant, career oriented, backpacker, commuter, undocumented and returner
differ in terms of their purpose of migration (e.g. settling down or acquiring
specialized training), length of stay, personal profile and direction of movement
(Chapter 6). Identifying and distinguishing between the types is of relevance to
policy-makers and managers who try to steer in- and outflows because it allows
targeting health workforce measures to retain and recruit health professionals
more effectively. A senior nurse looking for further career development
opportunities will not be motivated by the same incentives as a recently
graduated medical doctor curious to experience other health systems and
cultures. The individual decision to stay or leave is a complex process influenced
by considerations endogenous to the health systems (e.g. training opportunities
and job satisfaction), and by factors lying outside of those systems (e.g. work–
life balance or political stability) (Chapter 10), but is often also an ongoing,
gradual process as individuals more or less continuously decide whether to
remain or to move on (Chapter 8). It also seems to suggest that the likelihood
of further mobility is higher among migrants than among those who have never
moved – “once a migrant, always a migrant”.
Second, and much in line with the findings of the first PROMeTHEUS
volume, health professional mobility is far from always an easy or “happy”
experience for the individual, with implications for the systems involved. As
for all types of migration, the accounts of health professionals who in some way
have experienced migration are littered with difficult choices, frustration of
having to leave to find something better and challenging circumstances in the
new country, but also in the old, for those who return or those who stay behind
(Chapters 7–11). Integration into the new system and the role that the migrant
health professional has within that system play a key role in the migration
experience. There is compelling evidence that migrant health professionals are
at greater risk of being required to work below their skill level, which can then
lead to disappointment for the individuals involved and to suboptimal wasteful
situations in the health systems (Chapters 10 and 11). Discrimination and
unfavourable working conditions also appear to disproportionally affect foreign
1 In this chapter, the terms “mobility” and “migration”, as well as “mobile individual” and “individual migrant”, are used
interchangeably. Chapter 6 has a detailed discussion of terminology.