Healthcare systems worldwide are desperate for doctors
Globally, healthcare was already known to be only hanging by a thread and running with band-aid. The COVID-19 pandemic did away with the tricks and revealed the gaping cracks in the medical world and no country seems to be spared by the ongoing crisis. From Norway to China, through Ghana and Canada, medical resources are lacking, and hospital coffers are empty. This is due to years of underfunding, which further crippled the already strained healthcare systems.
Doctors faced with uncertainty
Many patients in France will never forget their Christmas 2022. Although doctors had already been on strike on December 1 and 2, the "Médecins pour Demain" (Doctors for Tomorrow) group called for a similar action on December 26. It was renewed on January 8, 2023. On those particular dates, 50 to 70% of medical practices remained closed. Ever since, much tension has been going on, with demonstrations in February and strikes from March 3 to 9. French doctors are protesting against worsening working conditions which had already gone bad with COVID. Moreover, salaries no longer matched the workload.
In the United Kingdom, there is growing frustration among GPs who have to deviate from "normal procedures," as the British College of Physicians puts it. Since 2020, the College has been sending letters to its GPs to reassure them. COVID justified their moving away from "normal procedures" to treat patients as best as possible with their limited resources. However, at the end of 2022, physicians were still being asked to skirt these "normal procedures". The crisis has subsided, but there were still insufficient doctors and resources. The National Health Service (NHS) was bursting at the seams and was now paying a high toll for lean years when successive governments kept slashing funding. As a response, the Department of Health has pledged 204 billion euros this year to try to save the NHS.
'Medical deserts' around the world
Finding a general practitioner in Slovenia requires a lot of nerve. More than 100,000 inhabitants cannot consult a GP due to the impossibility of finding one. In this country of 2 million inhabitants, this is a hot issue, and the solutions proposed by the government, which is to consider medicine as a business, are far from satisfactory. The situation is quite alarming in Canada, too. By 2028, there will be a shortage of 44,000 doctors, most of whom will be General Practitioners, who are already becoming increasingly rare. In 2019, 4.6 million people were unable to find one. Today, they are 6 million, and the situation is even worse in rural areas.
Canada is not yet the worst performer among OECD countries, but it is getting close to it. The country has almost 3 general practitioners per 1000 inhabitants. Despite critical situations, the United Kingdom, France, and New Zealand are doing slightly better but are close to the OECD average of 3.5 doctors per 1000 inhabitants. Australia, Switzerland, Germany, Spain, Norway and Austria are above the average, with about 4 to 5.5 physicians per 1000 inhabitants. Austria has the highest average (5.5). Only two countries do slightly worse than Canada – the United States and Japan, with approximately 2.7 physicians per 1000 population.
However, the "best performers" of the OECD are not exempt from medical deserts. Spain, France, Germany and even Austria are under serious pressure. They all seem to be banking on the same solutions: call on foreign doctors and increase salaries.
Which countries offer the best opportunities and salaries for expat doctors?
Well, being a doctor in Germany is deemed great. According to a recent study by recruitment platform Stepstone, doctors were the best-paid professional category in 2022. They get a median annual salary of 93,800 euros, far ahead of consultants (54,000 euros), engineers (52,600 euros) and IT professionals (52,000 euros). Doctors in the US earn much more than in Germany (about 135,000 euros annually). On average, they earn slightly less in Switzerland (130,000 euros per year), Japan (100,000 euros per year) or South Africa (40,000 euros per year). In France, salaries can range from about 70,000 euros per year for a general practitioner to more than 130,000 euros for a specialist (surgeon, pediatrician, or ophthalmologist).
However, great disparities still exist between different medical professions and sectors of activity (public or private sector). Physicians' salaries depend on their status (salaried physicians, especially in hospitals, or independent physicians, with fixed or free fees). Salary also depends on the medical specialty pursued, the region where the practice is located, and the number of years of experience. Obviously, general practitioners generally earn less than specialists, like surgeons, cardiologists, ophthalmologists, and pediatricians, who earn the most. They are likely to earn even more when they further specialize, like a cardiovascular surgeon or neurosurgeon, to name a few. On the other hand, other health and paramedical professionals, like nurses, orderlies, stretcher-bearers, ambulance drivers, medical assistants, etc., are far less well paid.
One would almost be tempted to issue a "global notice" for expatriate candidates, as many countries are facing an acute shortage of GPs. Canadian authorities even fly directly to the countries they wish to recruit from. In late November 2022, Canada launched the first edition of its Mobility Forum in Morocco. A few days earlier, it had organized the same Forum in France, which is also suffering from a shortage of doctors.
Are we heading for a chronic doctors' exodus?
Governments are fighting merciless battles to attract foreign doctors. For the latter, it is the ideal opportunity to make professional progress, earn more, and build a career abroad. But what are the implications? In October 2022, the Spanish newspaper El País revealed that one Spanish doctor out of three was unsatisfied with their local working conditions. Low salaries and ever-increasing costs lead more and more doctors to leave Spain. This situation has been going on for years and has worsened with COVID. In 2021, there was a shortage of about 6,000 general practitioners and pediatricians. At the same time, Spanish doctors had left for the United Kingdom, France, Germany, Argentina and the United Arab Emirates.
France, Canada, Germany and the United Kingdom, for their part, are turning their attention to the African continent. Like Canada, which is recruiting directly in Morocco, France and Germany are recruiting in Ghana and Ivory Coast. The United Kingdom is banking on Zimbabwe. In September 2021, the country hired some 463 GPs, 807% more than the previous year. In 2022, it recruited 389. This is less than in 2021 but still more than in previous years.
The International Council of Nurses (ICN), the World Health Organization (WHO) and the African press have expressed great concern. While individuals may be happy to take advantage of the shortage of doctors to move abroad, the global imbalance in terms of the number of local GPs is clearly in disfavor of the less wealthy countries. The shortage of doctors experienced in Europe and Asia has now reached as far as Africa. About 80 percent of the qualified, experienced, and specialized nurses from African countries tend to immigrate to the United Kingdom, Canada, the United States, and a few other rich countries.
However, it is impossible to shift the burden of policy decisions onto the shoulders of professionals facing deteriorating working conditions. Some physicians leave by choice rather than by necessity. They know that they will make their hospital or health care center worse off, but they don't have a lot of choices either. Governments, on the other hand, do have real options, as pointed out by the WHO. Instead of playing the snake that bites its tail, it encourages countries not to aggravate the medical deserts of other countries but rather to think of real solutions to finally cure the medical world.
