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Health professionals moving to ... and from Portugal
Abstract
The mobility of health professionals in the European Union is a phenomenon which policy-makers must take into account to provide the conditions to adjust for demand and supply of health services. This paper presents the case of Portugal, a country which at the same time imports and exports health workers. Since the early 1990s Portugal became a destination country receiving foreign health care professionals. This situation is now changing with the current economic situation as fewer immigrants come and more Portuguese emigrate. Foreigners coming to Portugal do so in part for similar reasons that bring Portuguese to want to emigrate, mainly the search for better work conditions and professional development opportunities. The emigration of Portuguese health professionals is also stimulated by the difficulty for recently graduated nurses, dentists and diagnostic and therapeutic technicians to find employment, low salaries in the public and private sectors, heavy workloads, remuneration not related to performance and poor career prospects. The paradoxes described in this study illustrate the consequences of the absence of a policy for the health professions. Strategies based on evidence, and on an integrated information system that captures the dynamic evolution of the workforce in health are not only necessary but also a good investment.
... This is due to the requirements for qualifications [39]. The mobility of healthcare workers in the EU is a very significant phenomenon [40]. The growing need for qualified workers in direct long-term health and social care is linked to aging populations. ...
... As in the hospitality industry, for healthcare jobs, the reason for working abroad is associated with the search for better working conditions and opportunities for professional development [40][41][42]. ...
... Studies on DM have described the motives and expectations of foreign workers [36,40], including the opportunity for personal and professional development, the search for better working conditions, or (particularly in the case of women) improvement of their family situation in their native country [46]. In the case of those with disabilities, the primary motivation is their incorporation into society, social recognition, and the development of their own talents. ...
Diversity is a phenomenon that, due to increasing globalization, appears ever more frequently in all areas of human activity and performance, including the labor market and working teams. In light of these changes, this article aims to identify and evaluate the practice of diversity management as a factor of the sustainability of competitive advantage with regard to the examined factors of diversity. The results were obtained through primary analysis via a questionnaire survey at 549 Czech companies. The results indicate that there is a statistical dependence between the application of diversity management and the commercial sector in which the organization operates and the size of the organization. Organizations identified the following as the most significant benefits of the application of diversity management: retention of key employees (43.9%), improved motivation and performance of existing employees (39.3%), and improvement to the actual atmosphere in the workplace (33.9%). One recommendation for organizations is to focus more on this current topic, as the lack of a qualified workforce is becoming more pronounced. In this regard, it will also be necessary to devote sufficient attention to groups of potential workers who have hitherto been overlooked. The application of diversity management can be a successful tool to gain a competitive advantage in managing human resources.
... doctors still move to access better wages, better working conditions and better career prospects), the direction of migration flows change in response to local and global economic conditions. For instance, the 2008 global economic recession and resultant austerity measures-including widespread pay cuts, recruitment embargoes, staff reductions and increased workloads [7]-led to high rates of emigration and intent to migrate among doctors in higher income countries across the European Union (EU), including Ireland [8][9][10], Hungary [11], Romania [12] and Portugal [13]. ...
... It is difficult-but imperative-to see how this 'vicious circle' [52] of emigration, understaffing and extreme working might be broken. In this regard, the experiences in Ireland mirror those in other EU countries impacted by austerity, including Romania [12] which has seen working conditions, low salaries and discontent with the health system, act as 'push' factors driving doctor emigration, and Portugal [13], which has seen salary reductions and public sector downsizing since 2009. The availability of better working conditions and salaries internationally [3,13] are also driving doctor emigration flows. ...
... In this regard, the experiences in Ireland mirror those in other EU countries impacted by austerity, including Romania [12] which has seen working conditions, low salaries and discontent with the health system, act as 'push' factors driving doctor emigration, and Portugal [13], which has seen salary reductions and public sector downsizing since 2009. The availability of better working conditions and salaries internationally [3,13] are also driving doctor emigration flows. The similarities across countries highlight the extent to which doctor emigration flows may be altered by unanticipated 'shocks' to the system, such as the 2008 economic recession and austerity. ...
Background:
Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job-high pay, high job control, challenging demands, with those of a low-quality job-long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return.
Methods:
Semi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July-August 2018.
Results:
Respondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman's work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland.
Discussion:
The deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.
... Health and medical experts' immigration status in Portugal was examined by Ribeiro et al. (2014). They pointed out that Portugal was the migration destination for many specialists in the field of health care from other parts of the world in the early 1990s; however, its status has then changed. ...
... The researchers concluded that it was caused by factors such as looking for better employment opportunities and professional development opportunities. They added that some Portuguese emigrants of medical fields such as nursing and dentistry graduates abandoned the country because of low wages in public and private sectors, heavy workload, bonuses disproportionate to performance, and poor occupational prospects (Ribeiro et al. 2014). ...
... From the perspective of Benedict and Ukpere (2012), economic attractions of the destination countries were one of the major factors affecting the African brain drain phenomenon. Ribeiro et al. (2014) focused on the attraction and repulsions underpinning the Portuguese medical skilled workers' emigration. In other words, the greater the attractions of the host country and the repulsions of the origin country are and the more the benefits of emigration compared to its cost and difficulties are for one, the greater the likelihood of emigration will be. ...
Brain drain has direct and indirect impacts on the progress and development of societies. Thus, the efforts to preserve and employ the skilled workers are one of the priorities in today's societies. In order to avoid the brain drain phenomenon, the causes and consequences should be detected prior to taking any actions. This study aimed to analyze the causes and consequences of the brain drain and its effects on the development of human resources in Yazd Province, Iran using the qualitative paradigms and grounded theory principles. Research data were collected with semi-structured in-depth interviews. The interviewees consisted of experts, skilled workers, and provincial managers of human resources in Yazd Province who were most knowledgeable about the phenomenon under study (n = 45). They were selected by purposive sampling. Data were analyzed by continuous data analysis and Strauss and Corbin's method. According to the findings, the following were considered as the secondary categories of their emigration: “Obstacles against providing the skilled workers with a proper workspace”, “poor regulations and parameters of skilled worker selection”, “poor facilities for the skilled workers”, “poor administration systems”, and “improper attitude towards the skilled workers”. The key causes derived by the principles of grounded theory were “inappropriate business climate” and “inability to preserve skilled worker”. Using these categories, a paradigm model is presented that consists of causal, contextual and intervening factors, strategies and consequence.
Keywords: Skilled workers, Immigration, Brain drain, Grounded Theory (GT), Iran.
... Solberg et al., identified economic factors as the most important in migration among Icelandic physicians (22). Income, payment, to improve income, to secure a better rate of pay abroad, inconsistency in level of income, economic factors, higher income, financial success, the search for more money, economic problems, salary cuts, low wages, more remuneration, expectation of a higher salary, high-income tax and low salary were the most important factors influencing migration of health human resources in European, Asian and African countries (28,(31)(32)(33)(34)(35). ...
... Our findings show a significant relationship between marital status and inclination to migrate, while single people were more likely to migrate, and similar results are reported in Santric-Milicevic et al., (38). Ribeiro et al., reports that marital status and marriage were factors that affected non-return to the country of origin (35). In the present study, there was a significant relationship between inclination to migrate and variables such as familiarity with foreign language, foreign language skills, and having taken a foreign language course (Table 1). ...
... Santric-Milicevic demonstrated that the reasons for Serbian nurses to work abroad were related to foreign language skills (38). Other studies have also reported that language was effective in selecting a country for immigration, and linguistic similarities facilitate migration (35). But another study reported that the number of foreign languages that a person could speak had no relationship with inclination to migrate (42). ...
Background:
Loss of human resources in the health sector through migration has caused many problems in the delivery of healthcare services in developing countries.
Objective:
The aim of this study was to determine factors influencing intention to migrate in skilled human resources in Iran's healthcare sector.
Methods:
This cross-sectional study was carried out in 2016 in Iran. The study population included health sector human resources at the Tehran and Iran University of Medical Sciences. Using multi-stage cluster sampling, 827 people were selected for participation. Participants included four groups: hospital staff, health workers, medical students, and postgraduate students (Masters and PhD). Data were collected using a valid and reliable questionnaire and analyzed by descriptive parameters, chi-square and logistic regression test using SPSS version 18.
Results:
Inclination to migrate, in the study population, was 54.77%. There was a significant relationship between inclination to migrate and age, work experience, employment status, marital status, familiarity with a foreign language, foreign language skills, foreign language courses, having relatives or family living abroad, and prior experience of being abroad (p<0.05). The most important factors influencing inclination to migrate were: reaching out for better life (81.92±21.95), interdisciplinary discrimination (80.83±20.75), and experience of living and studying abroad. (80.55±18.12).
Conclusion:
Considering the high rate of intention to emigrate in the studied population (54.77%), a lot of whom will emigrate if their situation is ready, it can be a serious problem for the health system in the near future in which it will face lack of skilled health workers, and so requires more attention of health sector authorities.
... Imbalances in the geographical distribution of qualified Human Resources for Health (HRH) in rural or poor areas are observed in almost all countries in the world [1][2][3][4][5][6][7], including Portugal in spite of its small dimension [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Their impact is that access to health services is limited for segments of the population whose health needs may not be addressed adequately in a timely manner. ...
... No analysis other than forecasting the numbers of future graduates and future retirees has been found. There is no monitoring of outflows to the private sector, to other sectors other than health or to other countries; dual practice is not monitored either [12,23,39,41,42]. Emigration flows are estimated by proxy indicators such as cancellation or suspension of registration and requests of Certificates of Good Standing [43,44], which rose from 191 in 2009 to 650 requests in 2012 only in the South Regional Session of the Portuguese Medical Council [43]. ...
... The geographical maldistribution of physicians is acknowledged in Portugal; it is discussed in six scientific research documents, four political documents and nine policy analysis documents [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The distribution of physicians favours the three main urban areas of Oporto, Coimbra and Lisbon [8,11,22,47,48] (Fig. 2) where the most advanced technology and the oldest medical schools and teaching hospitals are found [10,48]. ...
Background
Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development. Methods
We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search. ResultsThe challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements. Conclusions
Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.
... It works as follows. Each year, the model summons a given number of foreign doctors, with the number of physicians generated varying according to historical trends [47]. Age and ...
... For instance, the emigration rate was set so that the number of emigrated physicians falls within likely boundaries. Likewise, the number of foreign doctors hired each year was approximated to a 10-year average growth rate, as calculated by Ribeiro et al [47]. This parameter is in fact a decision variable, although at this point it is not used as such, and thus it is assumed it just follows the historical trend (see Fig. 7). ...
... Health authorities in partnership with the Ministry of Education also keep track of information regarding the number of students enrolled in medical courses, vacancies to medical schools, average time required to complete the degree, In the private sector, the Medical Association keeps track of the stock of physicians. Unfortunately, their records do not provide information whether registered professionals are still active, retired, dead or have emigrated; the type of activity they perform; or if they practice in the private or in the public sector [47]. The OECD claims these numbers overestimate the workforce size by 30 % [41]. ...
Starting in the 50s, healthcare workforce planning became a major concern for researchers and policy makers, since an imbalance of health professionals may create a serious insufficiency in the health system, and eventually lead to avoidable patient deaths. As such, methodologies and techniques have evolved significantly throughout the years, and simulation, in particular system dynamics, has been used broadly. However, tools such as stochastic agent-based simulation offer additional advantages for conducting forecasts, making it straightforward to incorporate microeconomic foundations and behavior rules into the agents. Surprisingly, we found no application of agent-based simulation to healthcare workforce planning above the hospital level. In this paper we develop a stochastic agent-based simulation model to forecast the supply of physicians and apply it to the Portuguese physician workforce. Moreover, we study the effect of variability in key input parameters using Monte Carlo simulation, concluding that small deviations in emigration or dropout rates may originate disparate forecasts. We also present different scenarios reflecting opposing policy directions and quantify their effect using the model. Finally, we perform an analysis of the impact of existing demographic projections on the demand for healthcare services. Results suggest that despite a declining population there may not be enough physicians to deliver all the care an ageing population may require. Such conclusion challenges anecdotal evidence of a surplus of physicians, supported mainly by the observation that Portugal has more physicians than the EU average.
... Imbalances in the geographical distribution of qualified Human Resources for Health (HRH) in rural or poor areas are observed in almost all countries in the world [1][2][3][4][5][6][7], including Portugal in spite of its small dimension [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. Their impact is that access to health services is limited for segments of the population whose health needs may not be addressed adequately in a timely manner. ...
... No analysis other than forecasting the numbers of future graduates and future retirees has been found. There is no monitoring of outflows to the private sector, to other sectors other than health or to other countries; dual practice is not monitored either [12,23,39,41,42]. Emigration flows are estimated by proxy indicators such as cancellation or suspension of registration and requests of Certificates of Good Standing [43,44], which rose from 191 in 2009 to 650 requests in 2012 only in the South Regional Session of the Portuguese Medical Council [43]. ...
... The geographical maldistribution of physicians is acknowledged in Portugal; it is discussed in six scientific research documents, four political documents and nine policy analysis documents [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The distribution of physicians favours the three main urban areas of Oporto, Coimbra and Lisbon [8,11,22,47,48] (Fig. 2) where the most advanced technology and the oldest medical schools and teaching hospitals are found [10,48]. ...
Introduction: Portugal’s policy-makers face the challenge of attracting and retaining health professionals in remote, rural and underserviced areas. As a result, some segments of the population have a limited access to health services, which contradicts the stated policy objective of equitable access to all. There is an increasing amount of research evidence on how to improve the recruitment and retention of health workers in difficult regions. This raises the question of how this evidence can better inform policy development: which facilitators can be mobilized and how the impact of barriers can be mitigated.
The aim of this study is to understand the process by which health workforce policies that address the geographic distribution are informed or not by research evidence. We will document and analyze the efforts to link research evidence to policymaking and the factors that influence the use of research evidence.
Methods and materials: This case study builds on the analysis of policy and technical documents and of research reports and on semi-structured interviews with policy-makers, researchers and others stakeholders, such as representatives of professional associations, involved in the policymaking process.
Results: The review of published and gray literature has identified studies and unpublished research reports which document the imbalances in the geographical distribution of physicians and which identify probable causes and recommend strategies to address the problem. The analysis of government policy documents, such as national health plans and laws and decrees has identified specific interventions aiming at attracting sufficient numbers of physicians in areas with a deficit. The preliminary analysis shows weak links between research evidence and policy choices. The interviews, which will be completed by the end of 2015, explore the causes of this low utilization of research results as well as the views of producers and of potential users of evidence on how to increase the contribution of evidence to inform policy-making.
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... Portuguese nurses' main destination country is the UK (Pereira 2015), and recruitment by agencies plays a crucial role in their decision to move here. The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses (Ribeiro et al. 2014). Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Pereira 2015;Stoehr 2015). ...
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses (Ribeiro et al. 2014). Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Pereira 2015;Stoehr 2015). ...
Philippine and Indian nurses have been emigrating for many years, but Portuguese nurses and other South and East Europeans have recently started to replace them in the UK. This study focuses on the recent migration of Portuguese nurses – both as emigrants and immigrants – within the European area.
The research mixes extensive and intensive methodologies. Health agencies started to recruit heavily among Portuguese nurses after 2008, which often led to their decision to leave the country with a guaranteed job abroad. In turn, this dynamic of emigration being motived by institutional and recruitment networks was caused by a structural factor: the barriers erected in 2010 by UK immigration policies against the contracting of nurses from outside the EU, which led the job agencies to search for nurses inside Europe. The chapter’s main finding is that although the push factor of economic recession and increased unemployment that hit the European periphery after the 2008 financial crisis played a role in the outflow of Portuguese nurses, it was the pull factor that was more significant. The second finding is that this new mass emigration of nurses is not just a Portuguese phenomenon but rather is in keeping with other Southern and East European peripheral countries.
... S obzirom na to da su dosadašnje studije u svetu i u Srbiji pokazale veliku želju i tendenciju studenata da odu iz svojih zemalja nakon završenog medicinskog fakulteta da bi živeli i radili u struci u razvijenijim zemljama, značajno je istražiti i saznati razloge zbog kojih danas budući lekari žele da emigriraju iz Srbije i saznati njihove stavove o emigraciji (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Cilj ovog istraživanja bio je sagledavanje stavova (i želja studenata) završne godine Medicinskog fakulteta u Beogradu o emigraciji iz Srbije nakon završenog fakulteta. ...
... Zemlje Zapadnog Balkana -Bosna i Hercegovima, Makedonija, albanija, Hrvatska i Crna gora, respektivno, rangirane su na ovoj listi ispred Srbije (23). lekari su nakon završenih studija i staža često suočeni s vrlo zahtevnim radom, neznatnom perspektivom za dalje napredovanje u struci i malim platama, što je slučaj i u Srbiji (2,14). Svoje nezadovoljstvo navedenim činjenicama, ali i dugim i zahtevnim šestogodišnjim školovanjem za sticanje diplome doktora medicine, pokazalo je 69,5% ispitanika, izjasnivši se da im je izrazito neprihvatljivo da nakon završetka studija ne rade u struci. ...
... The international migration literature lists a significant number of "push" and "pull" factors that may act as stimuli to leave or attract one to other countries, respectively. In the particular case of human resources for health, several authors have identified critical factors (Clark et al. 2006;Ribeiro et al. 2014), for instance: inadequate compensation, when compared to other sectoral wages, but also to wages in other countries; remuneration system not related to performance; heavy workloads; poor working conditions; political instability; or unmet demand for medical education due to numerus clausus or lack of residency positions are reasons frequently provided for wishing to move abroad. Regardless of the working and living conditions in the home country, foreign countries may also offer fringe benefits that may attract physicians. ...
... We extend the typical definition by explicitly including the cost of being unemployed or unable to obtain a training place at a residency program, which we assume to be greater than the opportunity cost of not earning an income. The lack of vacancies at university hospitals is known to be one critical push factor in the health labour market, in particular mismatches between preferences and specialties (Ribeiro et al. 2014). Taken together, physicians emigrate according to the sign of the following index function: ...
Physician emigration can either function as an escape valve to help the health labour market clear from a supply surplus, or aggravate the problem further in case of a shortage. Either way, policy-makers should be particularly aware and devise policies to minimize the occurrence of an imbalance in the physician workforce, which may require physician retention policies if barriers to entry and other market rigidities can not be removed. To this purpose we have developed an agent-based computational economics model to analyse physician emigration, and have used it to study the impact of potential short- and long-term retention policies. As a real case study we have calibrated it with data from Portugal, which features a very particular health system with many rigidities. Results show that all policies are capable of increasing the workforce size, but not all reduce emigration. Also, the effect of return migration is non-negligible, and may substantially offset the impact on the workforce size. Furthermore, the welfare impact of the policies varies considerably. Whether policies to retain physicians should be enacted or whether policy makers should let physicians go will depend on the type of imbalance present in the health system.
... These measures have had a very significant impact on health workers who work in shifts and, often, overtime. During that period, there was a marked movement of professionals from the National Health Service for exclusive dedication to the practice of medicine in private hospitals and clinics [9,10], as well as an increase in medical emigration -184 (0.76%) in 2011 and 475 (1.92%) in 2015 -and in nursing -1,775 (4.43%) in 2011 and 2,727 (6.71%) in 2015, [11]. Human resources of hospitals belonging to the National Health Service and the Ministry of Health reached a total of 129,915 employees by the end of 2016. ...
... On average, the optimal scale regarding clinical staff is 65% of the observed (average) values; thus, a significant downsizing of hospitals is advisable. Results associated with the potential scale improvement of hospitals are provided in columns (11) and (12) of Table 1, as well as in Figure 2. Scale efficient hospitals, operating under constant returns to scale, exhibit a null potential improvement of both FTE doctors and nurses. On average, more than 20% of FTE doctors and nurses should be reallocated. ...
This study analyses the scale efficiency, optimal scale for hospital clinical staff, and the exogenous dimensions that can be associated with them. They offer useful insights for health policy design, particularly when human resources need to be reallocated across the country due to uneven distributions. Initial data considered a sample of 27 Portuguese general/acute-care public hospitals belonging to the National Health Service, observed between 2013 and 2016. This resulted into a sample of 108 hospitals-year. Data Envelopment Analysis was employed to assess scale efficiency and optimal scale associated with the workforce and at the overall hospital level. Quality and access to health care services adjusted the measures of scale efficiency and optimal size. A multiple regression analysis was carried out to associate optimal scale and scale efficiency to demographics. Optimal scale centred on 274 full-time equivalent (FTE) doctors and 475 FTE nurses. Overall, there is an excess of FTE doctors and FTE nurses, even after potential reallocations. There is an uneven distribution of health workforce, with excess of staff located in urban areas. Hospitals productivity would increase if they reduced their operational scale. Drivers of potential change include population size, childhood mortality rate, birth rate, and purchasing power parity. Health policies are required, not to hire more staff, but rather to promote the reallocation of employees to deprived regions.
... Portugal is another European country that has resorted to international recruitment of non-EU physicians through its Ministry of Health in response to the need for physicians in certain geographical areas and the lack of family doctors [5][6][7][8]. In 2015 there were 4.7 physicians per 1000 inhabitants in the country and the evolution of this indicator has increased in the last decade (Table 1). ...
... Finally, it is necessary to create spaces for the engagement and dialogue of stakeholders -such as the Ministry of Health, professional associations, unions of health professionals, representatives of usersto discuss the best strategies to address the need for physicians in some medical specialities and their geographical imbalances in the country. The growing trends, in recent years, in the emigration of Portuguese health professionals and in the outflows of Portuguese youngsters to study medicine abroad [7] should also be taken into consideration. This dialogue is essential for the creation of policy for the health professionals and health policies that are capable of ensuring an equitable access for the Portuguese population to health services. ...
The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources.
International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.
... The international migration literature lists a significant number of "push" and "pull" factors that may act as stimuli to leave or attract one to other countries, respectively. In the particular case of human resources for health, several authors have identified critical factors (Clark et al., 2006;Ribeiro et al., 2014), for instance: inadequate compensation, when compared to other sectoral wages, but also to wages in other countries; remuneration system not related to performance; heavy workloads; poor working conditions; political instability; or unmet demand for medical education due to numerus clausus or lack of residency positions; are reasons frequently provided for wishing to move abroad. Regardless of the working and living conditions in the home country, foreign countries may also offer fringe benefits that may attract physicians. ...
... We extend the typical definition by explicitly including the cost of being unemployed or unable to obtain a training place at a residency program, which we assume to be greater than the opportunity cost of not earning an income. The lack of vacancies at university hospitals is known to be one critical push factor in the health labour market, in particular mismatches between preferences and specialties (Ribeiro et al., 2014). Taken together, physicians emigrate according to the sign of the following index function: ...
... Unemployment and underemployment have e.g. led health professionals from Italy, Spain, Greece, Portugal and Romania to seek work elsewhere in the EU [24][25][26][27][28][29]. According to the European Federation of Nurses Associations [30], rising unemployment among nurses is a concern in the majority of 34 surveyed countries. ...
... When young health professionals leave -as is predominantly the case in e.g. Estonia, Hungary, Italy, Poland, Slovakia, Portugal and Romania [13,29] -they have had little time to 'give back' to the system and might be more likely to stay in the new system as they seem to adapt more easily to living and working abroad [39,43]. While migrants often intend on returning home at the moment of leaving, return to the home country is less likely once professional and personal ties are established in the destination. ...
The WHO Global Code of Practice on the International Recruitment of Health Personnel is a landmark in the health workforce migration debate. Yet its principles apply only partly within the European Union (EU) where freedom of movement prevails. The purpose of this article is to explore whether free mobility of health professionals contributes to "equitably strengthen health systems" in the EU. The article proposes an analytical tool (matrix), which looks at the effects of health professional mobility in terms of efficiency and equity implications at three levels: for the EU, for destination countries and for source countries. The findings show that destinations as well as sources experience positive and negative effects, and that the effects of mobility are complex because they change, overlap and are hard to pin down. The analysis suggests that there is a risk that free health workforce mobility disproportionally benefits wealthier Member States at the expense of less advantaged EU Member States, and that mobility may feed disparities as flows redistribute resources from poorer to wealthier EU countries. The article argues that the principles put forward by the WHO Code appear to be as relevant within the EU as they are globally.
Copyright © 2015. Published by Elsevier Ireland Ltd.
... While hospital budgets were diminished, large proportional salary cuts hit all civil servants, including all professionals at NHS hospitals, who also experienced higher income tax rates. Recent evidence shows that the worsening of economic circumstances have led professionals to migrate, leading to shortages in supply [20]. The motivation may have also been affected by the lower wages, and by the reduction in the prices of specific interventions paid by fee-for-service, such as some elective surgeries. ...
... Though, careful attention should be given to avoid reducing access to outof-hospital care, which the greater volume of in-patient care may signal. Although the State can do little to improve access to private care, the utilization of primary care has been threatened in Portugal due to the shortage of general practitioners, reinforced by the economic crisis [20,30]. The strengthening of primary care should be a priority, to guarantee the early treatment of diseases and a greater efficiency at the hospital level. ...
... The private sector is growing, and is becoming an important employer, with an undetermined number of professionals working in both the public and the private sectors. There is no monitoring of dual employment nor of mobility of health professionals [1,3]. In Spain there is also a NHS providing universal coverage, almost fully funded from taxes and predominantly within the public sector. ...
... Interviews conducted with informants from professional councils and trade unions in a separate study and statistical data on foreign health workers in Portugal suggest that the country evolved from receiving foreign health professionals , mainly from Spain and to a lesser extent from the Portuguese-speaking African Countries (PALOPs) and Brazil, to sending professionals to other countries [3,22]. Unemployment, precarious employment, and the difficulty to access specialty training were the main reasons for Spanish physicians to come to Portugal. ...
Context: Health workforce cross-border mobility has an impact not only on individual health workers, but also on how health services are organized, planned, and delivered. This paper presents the results of a study of current mobility trends of health professionals along the borders between Portugal and Spain. The objective was to describe the profile of mobile physicians and nurses; to elicit the opinions of employers on mobility factors; to describe incentive policies to retain or attract health professionals; and to collect and analyse employers' opinions on the impact of this mobility on their health services.
Phone interviews of key informants were used to collect relevant data. The interviews were conducted during December 2010 and January 2011 in health organizations along the border of the two countries. In Portugal and Spain, four and 13 organizations were selected, respectively. Interviews were obtained in all the Portuguese organizations and in four of the Spanish organizations.
Findings suggest that cross-border mobility between the two countries has decreased. From Spain to Portugal, mobility trends are mainly of physicians who seek professional development in the form of specialization, the availability of positions, better salaries, and the perceived good living conditions. The mobility of nurses lasted until 2008, when reforms improved working conditions in Spain and contributed to reversing the flow. Since then, there has been an increase of Portuguese nurses going to Spain seeking better working conditions or simply a job. Portuguese nurses as well as Spanish physicians are well considered in terms of professionalism and qualifications by their Spanish and Portuguese hosts, respectively.
There is a deficit of valid data on the health workforce in general. The present study allowed further exploration of the reality of the mobility trends between Portugal and Spain. At present, the mobility trends are mainly of Spanish physicians to Portugal and Portuguese nurses to Spain. There is a consensus on both sides of the border that the benefits of migratory flows are much greater than the limited problems (for example, language and salary differences) that they may bring.
... Comparing the research results with neighboring countries, this percentage is not too high, for example, 52.9% in Pakistan [7] and 62.1% in Poland [8]. Slightly lower percentages have been found in studies in Portugal, where 55% of respondents consider leaving [9], 53% in Croatia [10], Furthermore, a study from Serbia shows that 65% of medical students are considering leaving the country [11]. A recent study in Pakistan (2021) reported a slight decrease in intentions towards emigration, where 48.3% of students consider leaving the country. ...
Background and Purpose: Improper distribution of health workers is a worldwide problem, especially in developing countries. The shortage of health personnel has been intensified over the past two decades as a result of the emigration of health workers from developing countries to developed ones and disparities between urban and rural regions. Materials and Methods: This cross-sectional, quantitative, and descriptive study was conducted at the University of Sarajevo, Faculty of Health Studies, for two months. The study included 203 3rd-year and 4th-year undergraduate students of all study programs. The chi-square test was used to examine the difference between students’ attitudes about leaving according to gender, grade point, foreign language learning, and high school graduation, as well as different statements of intention to leave or stay. Results: Of 203 respondents, 49(24.1%) were male and 154(75.9%) were female. Thirty-four students (16.75%) stated their attitude towards the definitive departure. Also, 129 students (63.55%) were thinking about leaving after graduation, while 40 students (19.7%) wanted to continue their life in Bosnia and Herzegovina after their studies. Almost half of the female students (49.26%) and slightly more than half of the male students (14.28%) think about leaving after their studies, with a statistically significant difference between men and women who think about leaving and those who stay. The positive attitudes, which the students who are leaving, for the most part, agreed upon were the acquisition of life experience that their occupation profile was sought in other countries, and career development and professional development. The reasons why most students consider leaving the country after their studies are due to the attitude that their education and degree are more valued in other countries, higher living standards in other fields, and career development and professional development. Conclusion: To prevent the migration of health students, retention policies are needed that target immigrant staff. These policies can be extremely important in preventing the problem of a lack of quality health staff in the near future.
... Discussions about the advantages and drawbacks of migration of health workers have been taking place in both origin and destination countries [3][4][5]. The reasons for migration have been termed as push and pull factors -and include social, financial, political, academic, cultural, personal or religious reasons -which can trigger health professionals to leave their homelands [6][7][8]. To address this, in 2010, the World Health Organization Global Code of Practice for the International Recruitment of Health Personnel was published by the World Health Assembly [9]. ...
Introduction
Migration of medical professionals has been rapidly increasing in the past decades and it strongly affects origin and destination countries.
Objectives
We aimed to explore the extent and the reasons of migration among psychiatric trainees and early career psychiatrists in Iran.
Methods
Our semi-structured 61-items questionnaire inquired participants’ demographics, experiences of short-term mobility (from 3 months to 1 year), long-term migration (more than 1 year) and attitudes towards migration (current and future plans).
Results
A total of 184 responses were received. Most (73.4 %) participants were female, and within the age range of 25–65 (Mean: 34.9). Only 15.2 % had a short-term mobility experience, mostly due to academic reasons (35.7 %). Most (75 %) stated that this short-term mobility experience influenced them in favor of migration. The majority (83.7 %) had ‘ever’ considered leaving Iran, and more than half (57.3 %) stated they ‘strongly agree’ or ‘agree’ to leaving the country ‘now’ (at the time of the study). The main reason to migrate from Iran was first political, followed by work, financial, social, religious, academic, and cultural reasons, and the least ranked were personal reasons. In relation to their 5-year plans, 67.3 % saw themselves in the country they currently live in, Iran. The main features reported for an attractive job were ‘pleasant work environment’ (97.3 %), ‘good welfare and social security’ (96.7 %) and ‘high salary ‘(96.2 %).
Conclusions
This study calls for more support of psychiatric trainees and early career psychiatrists in Iran. Improvements in the political context, work conditions and finances might lower the rate of migratory intention and brain drain.
... Ribeiro et al., for example, cite poor future careers as a reason for elite students to emigrate; Therefore, creating suitable job opportunities, job security, teaching entrepreneurial skills by specialized professors in each field of study and creating a career counseling system in universities can make students' attitudes toward their future careers more positive. (25) From the students' opinions, it can be concluded that education and health managers at higher levels should pay attention to weaknesses, because most of the problems and stressors raised can be modified by management measures. It is hoped that by addressing issues such as environmental problems and lack of facilities, poor performance of instructors, the gap between theoretical and clinical education, lack of supportive counseling, the roots of the problems will be identified so that students can act competently in the clinical environments in the field of effective patient care. ...
Objectives:
The aim of this study is to explain the stressors of the clinical environment from the perspective of operating room undergraduate students.
Methods:
The present study is a qualitative study of contractual content analysis type that was conducted in 2019 at Hamadan University of Medical Sciences. In this study, 10 undergraduate operating room students were selected by purposive sampling. Semi-structured interviews were used to collect data.
Results:
From the analysis of interviews, 4 main categories were extracted as the stressors of operating room students of Hamadan Paramedical School in clinical learning environment: the need to receive support from the clinical environment (Insufficient students' skills in communicating with staff, Discrimination between paramedical students and residents, and Facilities available for training), lack of practical prerequisite skills (Contradiction between training and performance, and Lack of prerequisite knowledge for clinical practice), poor supportive and communication performance related to the instructor (Insufficient support of the instructor to the students against the medical staff, Evaluation criteria for instructors, and Treatment of instructor with students in presence of others), and psychological needs (Concerns about career prospects, Lack of motivational factors, and Lack of supportive counseling).
Conclusions:
The results of this study showed that Operating room students are faced with many stressors in the clinical learning environment. All stressors identified in this study affected the students' learning in the clinical setting. Lack of support for students in the clinical environment, poor practical skills training, poor support and communication performance related to the instructor, and poor psychological support of students are the factors that cause operating room student stress in the clinical environment.
... 'Mobile health care' can also be understood in some cases to refer to wireless communications solutions such as health care applications in mobile phones and other wireless interfaces (Khazbak et al., 2017;Mangu, 2017). The mobility of health care professionals on the other hand means the movement of doctors and other health care occupants to provide the demand of health care services (Ribeiro, 2014). ...
Societies are considering the accessibility of health services and its impact on environmental sustainability. The services are provided by both mobile and centralised solutions. This study compares the CO2 emissions of these strategies by applying a geographical information system (GIS)-based route allocation that is referred to qualitative data from focus groups with health care management professionals. The results show that in the sparsely populated case area, the CO2 emissions can be reduced 49% by applying a mobile health care facility model in primary health care. However, the presented model must be carefully considered to fit to the health service entity.
... Uma obra recente dedicou-se a este tipo de emigração para um país em particular -França (Lopes, 2014) e com um escopo mais abrangente foi analisada esta emigração com destino à Europa (Azevedo, 2014). Contudo, mais frequentes têm sido os estudos dedicados a um grupo profissional específico, como os profissionais de saúde (Pereira, Pinto & Pires, 2015;Ribeiro et al., 2013), professores e leitores de português (Pereira, 2007) Refira-se ainda, de novo, que a opção teórica e metodológica de separar os emigrantes "mais e menos qualificados" pela escolarização de nível superior é assumidamente redutora e incompleta: redutora, uma vez que reduz o conceito de qualificação a níveis escolares ou académicos; incompleta, pois não contempla qualquer indicador de qualificação profissional. ...
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
Portuguese emigration increased ever since its interruption by the 1974 revolution, especially since Portugal became a member of the then European Economic Community. This increase was underpinned by the regime of free movement of people within the European Union, which has helped transform Europe into the lead destination of Portuguese emigration. The effects of the 2008 financial crisis on this migratory dynamic have proven complex. In the first instance, the fact that this crisis was global prompted a downturn in emigration. However, in a second phase, there was new and very marked growth in the rate of Portuguese emigration coupled with changes to the hierarchy of destinations. The greatest of these alterations was the abrupt decline in the numbers departing for Spain, which was overtaken by the United Kingdom as the main destination for emigration. From a comparative perspective, the joint effects of the growth in emigration and the stagnation of immigration mean that Portugal is today among the least attractive countries in EU. As a consequence, international migratory patterns in Portugal today – as in the 1960s – are exacerbating rather than countering the population decline in the country with the lowest fertility rate in Europe.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
From the early 1980s to the mid-2000s, increased globalisation, development and modernization led to the return of numerous Portuguese migrant descendants back to Portugal. From the mid-2000s onwards, however, owing to the economic crisis that hit Portugal, many individuals once again become mobile, either re-returning to the countries they came from, or opting to twice migrate to a third country.
This article looks at the stories, experiences and expressed opinions of six migrant descendant returnees from Canada who re-returned or twice migrated from Portugal. Via the examination of narratives collected through in-depth interviews and casual conversations from 2008 to 2015, the article first sets out to observe the issues of attraction to and settlement in Portugal, and to discuss processes of integration into Portuguese society. Secondly, acts of re-return/twice migration will be examined, with discussion centering on the impacts of the recent economic crisis. Thirdly, the transnational resources possessed by participants when re-returning or moving to another country will be analysed.
The study’s results reveal that although initial acts of return were, above all, acts of self-discovery, emigrants integrated cautiously, always maintaining transnational links ready to be activated in case further mobility became necessary.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
I reflect on the overall contents of the book and highlight the key theoretical insights contributed therein. I draw on my own theoretical writings on the nature of migration trends in Southern Europe – the so-called ‘Southern European model’ of migration, with its various historical and geographical phases – and enrich this analysis through specific reference to the Portuguese case. Notions of cores and (semi-)peripheries are crucial to understanding both the political economy and evolving typologies of Portuguese migration trends over the long term and in recent years. Key here is the coexistence of Portugal’s status as the metropolitan core of a (post)colonial periphery and its (semi-)peripheral situation within Europe. This dual perspective helps to explain the complex geography and history of Portugal’s migration flows. Finally, I point to four areas which could have been given more emphasis: the within-Portugal regional patterning of emigration trends, the relative lack of attention given to return migration, the question of gender in ongoing Portuguese migration patterns and the overall impact of migration on Portuguese economic and social development.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
This chapter presents the results of a pioneering study on young, highly-qualified emigrants moving from Portugal to France. My analysis draws on a survey (of 113 individuals) distributed in 2012 to Portuguese emigrants in France aged between 20 and 35 who held at least one completed university degree. Its purpose was to map socio-demographic patterns. This was followed by fourteen semi-structured biographical interviews through which I could grasp a detailed understanding of the pathways leading to the interviewees’ decision to migrate. In this chapter I analyse some of the data collected through the questionnaire, focusing on (blocked) transitions to adulthood, and conclude that most of the respondents decided to migrate mainly because they wished to stop being sociologically young – that is, trapped in transition, waiting to get stable job, to get married and have children. Therefore, these emigrant trajectories result from a process of increasing reflexivity about structural constraints in the country of origin; they are individual and collective responses to the collapse of the standardised, linear life-course model.
... The emigration of Portuguese nurses only took on significant dimensions after 2010-2011; up to this point Portugal had principally been a receiving country, welcoming primarily Spanish nurses . Although recent, there are already studies on the departure of Portuguese nurses conducted in the sending country, Portugal (Gomes et al. 2014;Leal 2013;Leone et al. 2015;Reis 2016;Ribeiro et al. 2014), and some that complement this with the perspective of the receiving country Stoehr 2015). ...
This chapter formulates an approach to studying entrepreneurs abroad, using Portuguese nationals living in Luxembourg as a case study. Based on a survey of Portuguese entrepreneurs in Luxembourg, it analyses the determinants of entrepreneurial activity, the constraints entrepreneurs experienced, and the transnational economic links they established with their country of origin. It is argued that entrepreneurial initiatives are determined by the available resources and by certain incentives and pressures, and that decisions regarding the development of a business activity are complex, combining a diverse set of motivations. As shown throughout this chapter, Portuguese entrepreneurial activity results essentially from the identification of specific opportunities in the labour market and less from constraints imposed by the immigrant’s employment history. The identification of these opportunities and the low level of bureaucratic difficulties experienced in initiating independent business activity results from familiarity with the sector’s functioning. Data used also reveal that the construction and evolution of transnational relations is not an obvious or natural reality for all immigrant entrepreneurs. Spatial and temporal distance (between demand and supply of goods and services), the type of activity, and the nature of the product or marketed service all limit the development of transnational entrepreneurial relations with the origin country.
... Portugal represents a natural laboratory for investigation of migrations. It is a country with many centuries of contact with other cultures, and nowadays it is simultaneously and emigration and immigration country which is also reflected in the health professionals (Ribeiro et al., 2014;Rocha-Trindade, 2015). The immigrant population in this country is constituted by a diversity of ethnocultural groups. ...
EEG Gamma Oscillations key roles in brain function and altered states of consciousness
... Similarly, searching for better work condition and career progress are among the top factors for medical practitioners to choose a workplace (Ribeiro et al., 2014). In detail, medical practitioners, such as those from Africa and East Europe choose Portugal as a workplace due to the availability of new types of equipment, protective devices and diagnosis tools, low occupational risks such as viruses and epidermis and improved salaries. ...
SME Healthcare are at risk of sexual harassment in the workplace due to several barriers resulting in medical professionals leaving the workforce and reduced productivity. The paper attempts to bridge the
gap between the existing findings in general healthcare with medical tourism settings focusing on the medical tourists' behaviour in the destination country and the behaviour of medical practitioners in
healthcare SMEs, who may be exposed to sexual harassment at workplace.
Thus, this study urge for corrective actions in the medical tourism industry in ensuring the safety of medical tourists and practitioners in the rising demand for medical tourism.
... Similarly, searching for better work condition and career progress are among the top factors for medical practitioners to choose a workplace (Ribeiro et al., 2014). In detail, medical practitioners, such as those from Africa and East Europe choose Portugal as a workplace due to the availability of new types of equipment, protective devices and diagnosis tools, low occupational risks such as viruses and epidermis and improved salaries. ...
Healthcare SMEs are at risk of sexual harassment in the workplace due to several barriers resulting in medical professionals leaving the workforce and reduced productivity. The paper attempts to bridge the gap between the existing findings in general healthcare with medical tourism settings focusing on the medical tourists' behaviour in the destination country and the behaviour of medical practitioners in healthcare SMEs, who may be exposed to sexual harassment at workplace. Thus, this study urge for corrective actions in the medical tourism industry in ensuring the safety of medical tourists and practitioners in the rising demand for medical tourism.
... La entrada continua y creciente de estos/as profesionales a lo largo de las últimas dos décadas responde principalmente a una combinación de factores de expulsión y atracción, siendo la demanda de estos/as profesionales por parte del sistema sanitario, concretamente en determinadas especialidades médicas y regiones geográfi cas del país, un determinante signifi cativo entre los pull factors. La demanda de médicos/as está relacionada principalmente con las asimetrías en su distribución geográfi ca (Alentejo y Algarve son las regiones con una importante escasez en todas las especialidades), y con el défi cit de médicos/as en determinadas especialidades como Medicina General y Familiar, Obstetricia, Pediatría y Anestesia, siendo la mayor carencia en Medicina Familiar, así como el aumento de la demanda en el sector privado de la salud (Russo et al., 2012;Ribeiro et al., 2013). ...
From the experiences of Latin American doctors who practice their profession in Portugal and Spain, the article seeks to compare the international recruitment of doctors, recognition of qualifications for the practice of medicine and professional integration processes in the Portuguese and Spanish health system. For this, a qualitative methodology based on in-depth interviews was used. The results show similarities and differences in each of these three dimensions in these two national contexts.
... Italy and other southern European countries (Spain, Portugal, Greece), have become nurse emigrant countries more than nurse immigrant countries (Correia et al. 2013, Ribeiro et al. 2014). However, in the changing scenario, and in a context of a slowing down of nurse immigration to Italy because of the economic restraints suffered in the last years, the inflow to Italy of Indian nurses is steady,especially in large urban areas. ...
Aims and objectives:
This research aimed to investigate the lived subjective experiences of immigrant Indian nurses in Italy and specifically their professional and social integration BACKGROUND: To study the worldwide nursing flux is a health priority in the globalized world. The growth in migration trends among nurses, not only from Philippines or India, has proliferated in recent years. The research on nurses' mobility for Southern European countries is underexplored and in Italy the out-migration flows of Indian nurses were never analyzed DESIGN: Qualitative methodological approach.
Methods:
Semi-structured interviews (n = 20) were completed with Indian clinical nurses working in Italy for more than one year mainly in private organizations. A purposive sampling technique was used for recruitment. The data were then content-analysed using an inductive method.
Results:
The findings were categorised into four themes: (1) Aspects of professional integration and working experience, (2) Intra- and inter-professional relationships and perceptions of the IPASVI Regulatory Nursing Board, (3) Initial nursing education and continuous professional development, (4) Perceptions of social integration.
Conclusion:
The results show that for Indian nurses in Italy emigration is important to gain opportunities to expand economic and social privileges as well as escape from historical assumptions of stigma associated with nursing work, especially for women. However, these conclusions have to be seen in wider socio-cultural complexities that are at the basis of transnational fluxes (Prescott & Nichter 2014). This article is protected by copyright. All rights reserved.
... As migrações de profissionais de saúde não são uma realidade nova em Portugal, a diferença é que tem sido predominantemente um país de destino para enfermeiros estrangeiros (na sua maioria, espanhóis) e recentemente transformou-se simulta- neamente num país de partida dos enfermeiros portugueses (cf. Ribeiro et al. 2014). ...
O Gabriel estava efetivo num hospital, mas só quando foi trabalhar para Angola como enfermeiro conseguiu começar a passar mais tempo com a família, em Portugal. À Maria ofereceram-lhe emprego perto de Belfast antes de terminar a licenciatura. Vive agora numa casa em frente ao mar. O Eduardo conseguiu emprego em Portugal quando acabou o curso, mas não lhe davam possibilidade de progredir na carreira. Em Londres, o hospital paga-lhe formação profissional no horário de trabalho e o chefe discute com ele a sua progressão e o que o hospital irá beneficiar com os seus novos conhecimentos profissionais.
Ironicamente, são países com um maior número de enfermeiros por habitante, por comparação com Portugal, que vêm recrutar enfermeiros ao país. Os efeitos indirectos do número reduzido de enfermeiros no sistema de saúde já se sentem: Portugal é o país da OCDE onde mais se contraem infeções nos hospitais.
Conheça a nova vida dos enfermeiros que emigraram, através dos seus relatos em primeira mão.
Link: http://www.ordemenfermeiros.pt/publicacoes/Documents/Livro_VidasPartidas.pdf
... (2) Achieved (2) Achieved (3) Achieved and the recommendation to expand the network of Family Health Units, seen by the "Troika" as a measure to improve the accessibility and efficiency of services was largely ignored [24]. Since the beginning of the crisis, there has been an increase in the emigration of nurses and more recently of physicians, but this phenomenon has not attracted the attention of policymakers [31]. Data from the United Kingdom show that the number of Portuguese nurses admitted to their register increased from 20 in 2006/2007 to more than 550 in 2011/2012 [35]. ...
... As a result, emigration became the option for an increasing number of young nurses. The main destinations have been England, Germany, the Netherlands and Switzerland (Ribeiro et al. 2014). Positively, the demand from other countries who regularly recruit nurses from Portugal is evidence of the strong public system of nurses' education. ...
AimExamine metrics and policies regarding nurse workforce across four countries.Background
International comparisons informs health policy makers.Methods
Data from the OECD were used to compare expenditure, workforce and health in: Australia, Portugal, the United Kingdom (UK) and the United States (US). Workforce policy context was explored.ResultsPublic spending varied from less than 50% of gross domestic product in the US to over 80% in the UK. Australia had the highest life expectancy. Portugal has fewer nurses and more physicians. The Australian national health workforce planning agency has increased the scope for co-ordinated policy intervention. Portugal risks losing nurses through migration. In the UK, the economic crisis resulted in frozen pay, reduced employment, and reduced student nurses. In the US, there has been limited scope to develop a significant national nursing workforce policy approach, with a continuation of State based regulation adding to the complexity of the policy landscape. The US is the most developed in the use of nurses in advanced practice roles. Ageing of the workforce is likely to drive projected shortages in all countries.LimitationsThere are differences as well as variation in the overall impact of the global financial crisis in these countries.Conclusion
Future supply of nurses in all four countries is vulnerable.Implications for nursing and health policyWork force planning is absent or restricted in three of the countries. Scope for improved productivity through use of advanced nurse roles exists in all countries.
... These reasons are perhaps the reflection of the prominent resignation among students, but also in society as a whole. Moreover, medical professionals, after long and demanding studies (21), are often faced with low salaries, heavy workloads, remuneration not related to performance, and poor career prospects (22). ...
Aim
To investigate the emigration-related attitudes of final year medical students in Croatia at the dawn of the EU accession in 2013.
Methods
All final-year medical students at four Croatian medical schools (Zagreb, Rijeka, Split, and Osijek) were invited to participate in a cross-sectional survey on emigration attitudes.
Results
Among 260 respondents (response rate 61%), 90 students (35%) reported readiness for permanent emigration, expecting better quality of life (N = 22, 31%), better health care organization (N = 17, 24%), more professional challenges (N = 10, 14%), or simply to get a job (N = 8, 11%), while the least common expectation were greater earnings (N = 7, 10%). The most common target countries were Germany (N = 36, 40%), USA and Canada (N = 15, 17%), and UK (N = 10, 11%). In a multivariate analysis, readiness for permanent emigration was associated with an interest in undertaking a temporary training abroad (odds ratio [OR] 6.87; 95% confidence interval [CI] 2.83-16.72), while the belief that the preferred specialty could be obtained in Croatia appeared protective against emigration (OR 0.26; 95% CI 0.12-0.59).
Conclusion
Despite shortages of health care workers in Croatia, the percentage of students with emigration propensity was rather high. Prevalent negative perception of the Croatian health care and recent Croatian accession to the EU pose a threat of losing newly graduated physicians to EU countries.
Aim
To identify and systematically review current scholarship on talent management of international nurses in healthcare organizations.
Background
As nurse shortages persistently pose challenges for healthcare organizations globally, one of the primary strategies employed to address these shortages is employment of international nurses. To date little has been done to systematically review and collate contemporary research on talent management of this strategically important cohort. Talent management is a holistic construct that can support healthcare organizations to attract, develop, motivate, and retain talented employees to drive organizational performance. This systematic review isolates, appraises and collates available evidence on talent management practices for international nurses.
Study design
Systematic literature review.
Data sources
Searches of PubMed, EBSCO and Scopus were made covering literature from 2012–2022.
Review methods
This study followed Cochrane protocol for Systematic Reviews and key search terms were developed in consultation with University of Limerick library. As a key aim of the review was to provide evidence for the development of effective talent management practices, only peer-reviewed academic papers and empirical studies were included. Initial articles screening was conducted by two reviewers and full articles review was conducted by the entire research team. Findings were combined in a data extraction template for further analysis.
Results
This review includes 62 articles thematically analysed under the headings recruitment and selection, retention and turnover, career progression, professional development, discrimination and racism, culture and communication.
Conclusion
No articles were found that directly address talent management for international nurses. Although there are studies that address aspects of talent management independently, more research is required on talent management as a holistic process for international nurses to inform evidence-based practice.
Impact
This research emphasizes the importance of talent management for retention of international nurses in healthcare settings. It provides a knowledge base for healthcare organisations to enhance employee retention and ensure quality care for patients, as well as setting the foundation for future studies in this area.
Introduction: Nurses and midwives play an important role in society and are essential for each human being. In Slovakia, nurses and
midwives constitute the most significant group of employees in the health care institutions.
Methods: The data regarding the number of nurses and midwives in Slovakia were collected from 2000 to 2019. Chain indexes and/or
fixed-base indexes were used to follow the changes of the nursing workforce. The ageing of nurses and midwives was determined by mean
age and age structure. Correlation analysis was selected to detect the association between the living standard and number of nursing
workforce per 1,000 people in the EU.
Results: The total number of nurses and midwives in Slovakia decreased from 40,380 in 2000 to 33,041 in 2019. This decline of the
nursing workforce by 18.2% is a negative signal for the Slovak health care system. Ageing of the nursing workforce is the second negative
sign for health system in Slovakia. The age structure of nurses and midwives has changed significantly. The number of nurses over
60 years of age was more than 13 times higher in 2019 compared to the year 2000. The changed age structure resulted in an increase of
the mean age of the nursing workforce. The mean age of nurses increased from 37.2 in 2000 to 46.9 in 2019. In the case of midwives, the
average age increased from 40.9 to 47.4.
Conclusions: The decrease of the nursing workforce along with the ageing of nurses and midwives could result in a nursing shortage in
Slovakia. To stop this trend towards a nursing shortage, the Slovak government should more actively solve the problem of renumeration,
create a better work environment for the nursing workforce, and promote the importance and status of nurses and midwives in Slovakia.
Boundaries among social scientists continuously challenge the scope for obtaining broader reaching views. This constitutes the case for migration studies, generally perceived as interdisciplinary and correspondingly gathering contributions from many social scientists with diverse disciplinary background. For example, many practical and institutional boundaries separate those studying so-called voluntary and forced migration. The same sub-disciplinary division also applies to the study of highly skilled migration. Even when treated as part of overall migration, highly skilled migrants are viewed as so specific that their study must not be mixed in with other migrants. The main aim of this paper involves discussing the relevance of this divide between high and less skilled emigration, trying to understand which aspects place them in the same framework and which facets separate them out into isolated categories. Rather than discussing the issue in general, our purpose is to put forward evidence about sociodemographic profiles, migration strategies, and the integration processes of high and less skilled emigrants moving in the same context in order to systematically compare these groups. The context chosen for such a comparison is Portugal at the beginning of the new millennium: a country that witnessed a strong upsurge in emigration over recent decades in which high skilled and less skilled emigrants both coexisted. The data analysed in this article results from a large-scale survey applied to Portuguese individuals who left the country in the new century.
Introduction:
In the last few decades, the rates of international medical migration have continuously risen. In Psychiatry, there is great disparity in the workforce between high and low-income countries. Yet, little is known about the 'push' and 'pull' factors and the migratory intentions of trainees. This study aims to assess the factors impacting the decisions of psychiatric trainees in Portugal towards migration.
Material and methods:
A questionnaire was developed in the Brain Drain study and was distributed to psychiatric trainees in Portugal.
Results:
The sample consists of 104 psychiatric trainees (60.6% female). Overall, 40.4% of the trainees had prior experience of living abroad and the majority (96.9%) felt that this experience influenced their attitude towards migration in a positive way. About 75% of trainees had 'ever' considered leaving the country, but the majority (70.0%) had not taken any 'practical steps' towards migration. The main reasons to stay in Portugal were personal, while the main reason to leave was financial. The majority of the trainees (55.7%) were dissatisfied or very dissatisfied with their income, working conditions and academic opportunities.
Discussion:
Working conditions, salaries and academic opportunities are the main triggers for the migration of psychiatric trainees from Portugal.
Conclusion:
These results may inform the decisions of stakeholders in the health and education sectors and point out the necessary investments required and the impact it may have on the workforce.
Objective. Cigarette smoking represents an important factor for development of cardiovascular diseases. Both the amount and duration of cigarette consumption are in direct correlation to the increase in cardiovascular pathology. The aim of our research was to evaluate the influence of the cigarette smoking duration on the nitrate, nitrite, S-nitrosothiols and endothelin-1 levels in saliva of smokers.
Methods. For the purpose of this study, a total number of 60 subjects were recruited. They were divided into 4 groups based on the duration of cigarette consumption – non smokers
– control (n=15); group I (n=15) – consumption of cigarettes for 2 years; group II (n=15) – 4 years and group III (n=15) – 6 years. The blood pressure, weight and height of all subjects were measured. Body mass index was calculated. Determination of nitrate, nitrite, S-nitrosothiols and endothelin-1 was done in each salivary sample collected from 60 subjects.
Results. Both systolic and diastolic blood pressure did not differ between the control group and group I. These parameters were significantly greater in group II and group III subjects compared to controls. Smokers of all groups and nonsmokers had normal body mass index values. The levels of salivary nitrate, nitrite and S-nitrosothiols were significantly
lower in group II and group III compared to control group. Salivary endothelin-1 concentrations were significantly higher in subjects of group II and group III than controls.
Conclusion. In this study the substantial differences between smokers and non-smokers in levels of stable metabolites of NO and endothelin-1 are due to the causal effects of smoking.
Key words: cigarette smoking; saliva; nitrates; nitrites; Snitrosothiols;
endothelin-1; endothelium.
Nurses are the most representative professional group in several National Health Services (NHS). Being considered a welfare state profession, nursing is essential for meeting future challenges regarding health care (WHO 2000).
Health workers have been mobile for many decades. In the past, doctors from countries like Canada, Australia and New Zealand travelled to France, the US or the UK to acquire a specialty not available at home or which was more developed in the country of destination. From the 1950s on, doctors from newly independent countries started doing the same; some stayed and then others came, attracted by better working conditions or pushed by an insecure environment at home. The first ones to emigrate in significant numbers were from the Indian sub-continent, soon followed in the 1960s by others from Africa, both South and North of the Sahara and from the Caribbean. The direction of migratory flows was basically determined by language and historical links, and the vast majority of migrants were men, as medicine was little feminized at the time.
Health worker migration is causing profound health, safety, social, economic and political challenges to countries without special polices for health professional’ mobility. This study describes the prevalence of migration intentions among medical undergraduates, identifies underlying factors related to migration intention and describes subsequent actions in Serbia. Data were captured by survey of 938 medical students from Belgrade University (94% response rate), representing two thirds of matching students in Serbia stated their intentions, reasons and obstacles regarding work abroad. Statistical analyses included descriptive statistics and a sequential multivariate logistic regression. Based on descriptive and inferential statistics we were able to predict the profile of first and fifth year medical students who intend or have plans to work abroad. This study contributes to our understanding of the causes and correlates of intent to migrate and could serve to raise awareness and point to the valuable policy options to manage migration.
In a context of current and forecasted global health workforce shortages, attention around health professional mobility is mounting as observers and policy makers recognise its role in supplying health systems with the workforce they dependent on to function, or depleting these systems of their doctors and nurses. The paper proposes a typology of health professional mobility composed of six types of mobile health professionals and three types of borders. The framework draws attention to the individual's decision to migrate and to the role laws and borders play as determinants for mobility opportunities. In doing so, the typology is able to identify which types of mobile health professionals are likely to escape data collection, to highlight the distinction between free mobility within the EU and migration outside the EU's external borders, and to act as tool for designing policies adapted to the diversity of health professional mobility.
This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated.
Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants.
The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.
The debate over physicians’ distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what determines physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and foreign physicians across Portugal, with the objective to understand its determinants and identify suitable policies to influence it. Data from the Portuguese National Medical Association on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, as well as negative binomial and regression analysis models were adopted to determine: (a) the municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) the doctors’ characteristics increasing the probability of residing outside the country’s metropolitan areas.Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with Portuguese physicians’ location. For International physicians, the MDI did not result statistically significant, while municipalities’ proportion of foreign population appeared to be an additional positive factor in their location decisions. In general, being foreigner, male and under-35 resulted to be the physician characteristics increasing the probability of residing outside the metropolitan areas. However, among international doctors, the eldest were more likely to reside outside metropolitan areas, and sex was no longer a significant variable. Belonging to specific nationality groups (like Spanish or Brazilian) was found to increase the probability of being based outside the Lisbon and Oporto metropolitan areas. The present study showed the relevance of studying the impact of municipality and physicians characteristics on national and international doctors location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the unbalance of medical services across geographical areas.
Background
The debate over physicians’ geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it.
Methods
A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) doctors’ characteristics that could increase the odds of residing outside the country’s metropolitan areas.
Results
There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians’ location. For foreign physicians, the MDI was not statistically significant, while municipalities’ foreign population applying for residence appeared to be an additional positive factor in their location decisions. In general, being foreigner and male resulted to be the physician characteristics increasing the odds of residing outside the metropolitan areas. However, among the internationals, older doctors were more likely to reside outside metropolitan areas. Being Spanish or Brazilian (but not of African origin) was found to increase the odds of being based outside the Lisbon and Oporto metropolitan areas.
Conclusions
The present study showed the relevance of studying one country’s physician population to understand the factors driving national and international doctors’ location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the imbalance of medical services across geographical areas.
The Portuguese population enjoys good health and increasing life expectancy, though at lower levels than other western European countries. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Co-payments have been increasing over time, and the level of cost-sharing is highest for pharmaceutical products. Approximately one-fifth to a quarter of the population enjoys a second (or more) layer of health insurance coverage through health subsystems and voluntary health insurance (VHI). Health care delivery is based on both public and private providers. Public provision is predominant in primary care and hospital care, with a gatekeeping system in place for the former. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. The Portuguese health system has not undergone any major changes on the financing side since the early 1990s, despite the steady growth of public health expenditure. On the other hand, many measures have been adopted to improve the performance of the health system, including public private partnerships (PPPs) for new hospitals, a change in NHS hospital management structures, pharmaceutical reforms, the reorganization of primary care and the creation of long-term care networks. Some of these measures have faced opposition from the (local) population, namely those related to the closure of health care facilities. There is an overall awareness, and concern, about the rise in health care expenditure in Portugal. Most of the reforms that have come into effect have done so too recently to measure any effects at present (January 2011).
This paper discusses the state of the health workforce in Portugal's mainland during the past four decades. Healthcare workers represent 3.76% of the Portuguese workforce. All health professional groups significantly increased since 1960. Growth has been continuous for hospital physicians and nurses in general, as well as for primary care nurses. Primary care physicians are an exception, growing until the late 1970s but steadily decreasing afterwards. The density of physicians per 1000 inhabitants is above the European average. For nurses, Portugal is at the lowest European limit. However, the regional distribution of nurses, and also of pharmacists, across the country is more equitable than for physicians. The number of workers employed by the Health Ministry has grown by 44.6% between 1985 and 2004, with 127 013 employees registered in 2004. There has also been a marked increase in the number of female employees. Only 23.6% of healthcare workers employed by the Health Ministry, work at primary care level. Data on the private sector is insufficient in spite of its rising importance. The right number and mix of healthcare workers for an optimal healthcare system performance is a complex question and answering it requires an adequate information system. Portugal does not have such a system yet.
This chapter provides some interesting insights into foreign health professionals in Portugal from the viewpoint of migration and occupational integration. It focuses on the existence of both formal and informal barriers to the professional mobility of doctors and nurses, taking different factors into account: the formal recognition of professional status, the process of socialisation and the negotiation of a professional identity in a culturally different workplace. The empirical material is taken from an ongoing qualitative research project with foreign nurses and doctors — from Spain and from outside the European Union (EU). The discussion argues that the healthcare sector creates a number of specific barriers to mobility and integration.
This book on mobility of health professionals reviews, analyses and summarises published information and data as well as collected interview data from stake holders, including politicians, policy makers, health service managers and migrant health workers. It is based on the research carried out under the umbrella of the EU-funded project �Mobility of Health Professionals (MoHProf). The partners involved in the MoHProf project gathered evidence from 25 countries around basic questions and knowledge gaps relating to the international migration of health professionals, which involved an analysis of migration flows and evaluation of policies addressing migration. This book provides a comprehensive description and analysis of the mobility streams, the motives and driving forces behind them and the impact on and challenges for health systems and draws conclusions and provides recommendations for future strategic planning, monitoring and the management of mobility of health professionals as well as further research and policy development needs.
This paper reports on multiple employment among Portuguese health sector workers, using data obtained from six studies. The methodological aspects of these studies are briefly summarized. The prevalence among the study populations varies between 5 and 80%. When the first job is in the public sector, the site of additional employment is most frequently another public sector facility. Multiple employment is more prevalent among hospital workers; it is more frequent among those working shifts or part-time, and least frequent among professionals with a contract that requires exclusivity. Physicians with multiple jobs were more likely to have low expectations of getting promoted and to assess the rewards for their work as inadequate. For most nurses the salary increment resulting from multiple employment was less than their public sector salary. For both groups, improving income levels and higher job satisfaction were important reasons to seek additional employment. For physicians working in public services, access to more professional autonomy was an important reason for seeking additional employment in the private sector.
In Portugal, the healthcare sector demand for professionals has traditionally outweighed the supply for physicians, nurses and health technicians. However, the capacity of the National Health Service, the main healthcare sector employer, to absorb new professionals is apparently decreasing, and the demand for professionals in the private sector is unclear, but it seems to be growing. With regard to physicians, demand seems to persistently exceed supply, as many physicians work in several institutions or work overtime in the public sector, and the number of foreign physicians practicing in Portugal is increasing. In recent years, the number of medical schools and medical graduates increased, but it may not be sufficient to meet future needs. This paper is limited by the lack of comprehensive data on the private sector and on the number of professionals moving between the public and private sectors. These data are important for the planning and the decision-making process. Human resources policies, supported by an adequate health information system, are fundamental steps for the improvement of the performance of the healthcare system.
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