The European Union is in need of healthcare professionals. Although this isn't publicized within European institutions, a behind-the-scenes battle is clearly underway among various European countries. These countries are treading carefully, balancing more restrictive immigration policies with chronic labor shortages. What does this mean for medical professionals from around the globe?
Persistent doctor shortages within the EU
The end of the crisis is not in sight. The European Union (EU) continues to suffer from a lack of doctors. According to a 2022 report by the World Health Organization (WHO), 30% of European doctors are aged 55 years or more. Working conditions are deteriorating, and salaries are not keeping up. Currently, nearly 80,000 German doctors are over 60 years old. Other European countries face similar situations. Some specialties, like general medicine, are more affected than others. This phenomenon is not new but has worsened since the health crisis. Medical deserts, already prevalent in rural areas, are now spreading to cities.
Consequently, EU countries are turning to non-EU nations to find doctors. Italy is recruiting practitioners from Argentina and Cuba. As France hires doctors from Algeria, Tunisia, and Senegal, Germany recruits talent from all over the world. However, EU countries are not united in their approach and sometimes hinder each other's efforts. For instance, Germany welcomes those disillusioned with the French health system, while Belgium attracts French cross-border workers who can't find medical jobs.
According to Eurostat, Austria has the highest number of practicing doctors (540 per 100,000 inhabitants), followed by Norway and Cyprus (516 and 490 doctors per 100,000 inhabitants, respectively). Germany, close behind (452 doctors per 100,000 inhabitants), fares better than Romania and Slovenia (350 and 334 doctors per 100,000 inhabitants, respectively). With 318 and 302 doctors per 100,000 inhabitants, France and Serbia are the lowest-ranked European states. However, these countries are not leaning towards a European-level solution, as immigration remains a highly politicized issue, especially in the context of European elections.
The most attractive European countries to non-European healthcare workers
Germany is leading the race among the top recruiters of non-European doctors worldwide. The German healthcare system would not survive without them. In 2021, independent experts reported that over one in five doctors practicing in Germany were non-German. Germany recruits healthcare workers from the Philippines, Vietnam, Brazil, Syria, Nigeria, Algeria, and other European countries like Romania and France.
Germany's attractiveness stems from its relatively straightforward recognition of non-European qualifications compared to other countries. In Germany, there is no need to retake exams to validate one's degree. Non-European professionals undergo a simple knowledge assessment according to their specialty, unlike France, which is faced with its own contradictions. The recent reform of the conditions for practicing for non-EU diploma holders (Padhue) is still confusing. It takes a lot of effort for non-European practitioners to be able to practice in France.
France and Italy need to improve their conditions
In France, Padhue doctors work as much as other doctors. However, they often settle for precarious contracts and insufficient salaries. To be fully recognized as doctors, they must pass knowledge verification tests (EVC), undergo an internship of one to three years, and finally appear before a Commission for Authorization to Practice (CAE). If they pass this last step, they can register with the medical board. This is a long journey for recognition that, according to non-European doctors, needs to be improved. The days of global applause from balconies are over. Non-European practitioners in Italy face similar difficulties. To protect local healthcare workers, successive governments have continuously tightened the rules for recognizing non-EU diplomas. The lengthy process takes more than a year, which is too long for expatriates, who prefer to leave.
In Austria, however, the recognition process follows the German system. Non-European doctors do not take exams but undergo a "random test" in German (with a dictionary allowed). They also fill out a form detailing their education. In France, Padhue doctors advocate for a German-style system that considers each candidate's experience and background. The government denies subjecting them to a "hidden medical exam." Earlier this year, President Macron acknowledged the difficulties faced by Padhue doctors, who are essential to healthcare services but surviving in great precariousness. But although he promised to regularize the situation of "many foreign doctors", nothing has been done yet.
EU strategy to combat doctor shortages
According to the WHO, solving shortage problems by exacerbating shortages in other countries is not a solution. The non-EU countries providing foreign talent also lack healthcare workers. Germany, which launched a major recruitment drive in 2023 (notably in South America and Africa) claims to be sensitive to the concerns of "talent-supplying" countries. The government points out that it only targets countries where the number of healthcare workers exceeds market needs.
Western European countries are also stepping up efforts to retain their practitioners. However, wages remain a real challenge. Their governments speak of a drain benefiting the wealthiest European countries. Moreover, working conditions vary significantly from one European country to another. These conditions are even more difficult for non-European practitioners who do not have any recognition. The WHO believes European states must devise a solution that is in everyone's favor.
Ireland, for instance, is attempting to innovate with its "Enhanced Community Care" program. This system eases the burden on hospital doctors by increasing community care services for seniors. The EU still has much to do to address labor shortages. The aging population will necessitate strong measures to make the profession more attractive.
