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Most of the United Kingdom's healthcare is provided by the tax funded and state organised National Health Service. Since it was created in 1948 the NHS has always required foreign doctors. In 2014 although only 11% of all NHS staff were foreign, 26% of its doctors were non-British.

A 2017 report by the British Medical Association found that the NHS is encountering staffing shortages because fewer people are choosing to enter medicine or stay within the NHS. They put this down to a number of factors; principally increasing job stress, increasing student debt, falling wages, inflexible working hours.

Is the proportion of foreign doctors in the NHS comparable to healthcare systems in other developed economies? If not, why not? If yes, is there a reason why developed economies can't produce enough doctors locally?

P.S. In British English "doctor" is used more commonly than "physician".

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    @Bregalad: One of the meanings of “doctor” in English is physician. See, e.g., the Merriam–Webster entry. – chirlu Jan 25 '18 at 16:03
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    @Bregalad British English defines doctor first and foremost to mean someone qualified to heal the sick. It is not wrong and confusing in this context. Having a certain type of degree is the second definition. The ambiguity is not native to British English or the context of discussing healthcare. I have added this clarification to the question. – inappropriateCode Jan 25 '18 at 16:34
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    @Bregalad: The use of "doctor" = physician is neither wrong nor confusing, at least if you're a native speaker. It's also the norm in American English, and far more common than the use as an academic title, which is generally only used in academic circles. In fact, any confusion goes the other way: hearing your new neighbor referred to as Dr. Smith, your default assumption is that she's a physician, not a literature professor :-) – jamesqf Jan 25 '18 at 20:01
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    @Bregalad. "Correction" may not be the best word to use, given common and official usage in the UK means that a medical practitioner is a doctor. Unfortunately human language is ambiguous. – origimbo Jan 26 '18 at 13:23
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    @Bregalad: Yes, it IS about English, because "doctor" is the most common term for a physician in English. It's also the most common use of the word, other uses being reserved to formal academic settings, or to coinages like "spin doctor" that play off the physician definition. Perhaps other languanges as well, though I'm not fluent enough in any to judge. You need to correct yourself, not native speakers of the language :-) – jamesqf Jan 27 '18 at 18:44
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+200

The UK does have one of the highest percentages but not the highest. So yes, the same phenomena is common to plenty of other developed nations, although "typical" might be to much of a strong word. The reasons are likely different for each one of them (see the plot at the end of the answer) but it does not seem to depend on the level of development (check Denmark or Italy by comparison with the UK, for example).

You can see the data in OECD.stat, more specifically in a query such as this (change variable to % of Foreign trained Doctors to reproduce the data in the following "table").


Country .............. % of Foreign trained Doctors

Israel..................... 57

New Zealand........ 42

Ireland.................. 41

Australia............... 32

UK........................ 28

USA...................... 24

Canada................ 23

France................. 10

Germany.............. 10

Austria.................. 5

Denmark............... 5

Italy....................... <1


I've tried to find some explanation to these numbers but even the more obvious seem to somehow elude a reasonable explanation. For example check this bar plot for the number of Medical Graduates per 100 000 people. Ireland having more than double the number of graduates, also as almost double the percentage of foreign trained doctors by comparison with the US (check the chart here).

enter image description here

EDIT: Apparently this subject has been widely studied in the EU.

Costigliola (2011), quoting the World Health Organization report "Health professional mobility and health systems. Evidence from 17 European countries (2011)" , argues that:

Among the most-cited factors for physicians’ mobility is the financial motivation. As regards the salaries, major differences between European countries can be observed. ...

Another factor influencing physicians to move across borders is the working environment and conditions. The economic situation of a country has a major impact on the quality and standards of healthcare facilities and on the social benefits offered for health professionals. ...

Training and career opportunities are also among the relevant decision-making factors for physicians who consider leaving their country of origin, either temporary or for a long period of time. ...

... and adds:

According to a WHO report on healthcare workforce migration in Europe, there are also other factors associated with migration flows that can stimulate migration and affect the choice of a destination country:

  • Organizational factors, such as heavy workload, occupational risks, poor management, favouritism or lack of due process, lack of recognition;
  • Healthcare system factors, such as the absence or inadequacy of human resource policies, insufficient funding of health services, and centralised decision-making;
  • General environmental factors, such as poor economic conditions and lack of security.

Specifically for the UK the NHS seems to be in favor of professional mobility. I would also recommend the Politico.eu article "The EU exodus: When doctors and nurses follow the money" where this chart can be seen (for some countries it seems to somewhat contradict the OECD data):

enter image description here

As well as this one that show the sending vs the receiving country for these doctors (EU only):

enter image description here

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    The English-speaking countries probably all have a high percentage because it is easy for doctors to move among them. Learning a foreign language to a degree that you can work as a doctor is not easy. – chirlu Jan 25 '18 at 17:55
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    Interesting data! Also, I found this. Average earnings don't seem to explain it much either. I can't imagine there's a substantial number of say, Danish or Italian specialists in the Netherlands and Australia. – inappropriateCode Jan 25 '18 at 17:57
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    fyi, Israel is a major outlier because they likely count doctors from enormous former-USSR population, which is specific to that country and not to anything easily genralisable. – user4012 Jan 25 '18 at 18:48
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    @chirlu Yes, I agree. I do feel language plays an important role, but it does not explain everything. For example many of the Scandinavian (Nordic) nations also have high percentages (Finland: 19%, Sweden: 27%, Norway: 38%). The same for Switzerland (27%). By the way, in the plot, if you change the variable to "Foreign-trained doctors by country of origin - Stock" you'll have the absolute values by country of origin. For example Norway has a lot of German, Polish, and Hungarian Doctors. – armatita Jan 26 '18 at 9:07
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    @inappropriateCode True, but it does explain some things. For example while checking the data tables I saw many countries with a large percentage of German Doctors. Your table seems to show that by comparison with neighboring countries German Doctors don't make that much. I did a bit more of search and I'll edit the answer in a minute. – armatita Jan 26 '18 at 11:25

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