Is migration to foreign lands worth it? In which country do doctors and nurses earn the most?

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Polish healthcare workers, such as nurses and midwives, as well as doctors, migrate to other countries to make a better life for themselves thanks to the higher salaries they can expect there. So in which country do nurses earn the most and what are the salaries of doctors abroad? Luxembourg, Turkey and Norway are at the forefront of OECD countries. But not only. We looked for lands flowing with milk and honey.

The Supreme Audit Office (NIK), on the occasion of the inspection of health care facilities, which resulted in the creation of the report "Medical staff resources in the health care system", published in 2023, which can be read at the following link: https://www.nik.gov.pl/plik/id,28020,vp,30841.pdf , conducted a survey among nearly 2,000 health care employees .

NIK asked the survey participants, in which nurses (52.3% of votes) and doctors (26.7%) were the most vocal, among other things about what motivates/demotivates them the most at work (multiple answers could be selected).

The respondents considered the main demotivating factor at work to be "high responsibility and daily stress" (51.8%). The top five reasons for discouragement also included salary issues . 37.9% of respondents believed that "low salary" was demotivating (2nd place), and 22.6% indicated “no raise” (5th place).

Source: NIK

The survey organizer also included the question: "Are you satisfied with your salary?" In response, 61.4% of people said no, including 29.5% who said "definitely not" and 31.9% who said "rather not".

Material factors came to the fore when NIK asked respondents what they thought would most affect their motivation at work. The first one was "the amount of remuneration" (57.7%) , followed by "the atmosphere at work" (52.5%), "bonus or reward" (30.1%) and "fair treatment of all employees" (29.5%).

Source: NIK

Many healthcare workers can boast above-average specialized education , and the experience gained during their professional career should additionally increase their "valuation" in the eyes of employers. It is worse when, although this should lead to this, nothing happens with it, which is influenced by many factors.

Some of those disappointed with their pay conditions start looking for places where they can earn more. Sometimes, this leads to situations that can turn their lives upside down. Some healthcare personnel decide to migrate in search of better bread.

"The problem of healthcare is the emigration of medical personnel. However, the Ministry of Health did not estimate its scale. The data comes from registers and the website of the European Commission. The register maintained by the Supreme Medical Chamber shows that in the years 2018-2022 (until the end of September) a total of 4,884 certificates confirming the acquisition of professional qualifications in Poland were issued (including to doctors, dentists and specialists)" - assessed NIK.

"However, the number of certificates issued by professional self-governments is not synonymous with the number of people who actually went abroad and took up work in the medical profession. From May 1, 2004, i.e. from Poland's accession to the European Union, to 2019, the number of certificates issued only to doctors (excluding medical specialists) amounted to approx. 16 thousand people, " the institution added.

In addition to reducing the number of Polish medical personnel caring for those in need, this also has a financial dimension. Many studies in Poland are free, but the costs of operating these universities are borne by the state, which in the end is basically every taxpayer.

"According to the estimates of the Ministry of Health, the cost of 6-year medical studies ranges from PLN 200,000 to PLN 250,000. Assuming that all doctors who received a certificate and completed free studies went to work in the EU, the cost to the state budget amounted to approx. PLN 4 billion (using the upper range of the range - editor's note)" - estimated NIK.

These calculations by institutions, if they accurately reflect reality, illustrate that the country is facing a difficult challenge, as brain drain is taking place. They may not accurately reflect the scale of the phenomenon, because they do not take into account, for example, that some people obtain multiple certificates for the needs of a single departure and migrate without obtaining a certificate (an example would be nurses taking up work as medical carers). Nevertheless, it cannot be disputed that we are observing migration processes carried out by medical staff to the detriment of Polish patients.

So on the one hand we have a brain drain, and on the other hand Poland incurs expenses for education that cannot be used in the interest of the good of domestic patients. Hence, in some circles there is discussion about a solution that is probably not very popular for many reasons. Namely, whether not to start signing universally with graduates of medical schools obligations under which they would have to work in Poland for several years before they could fly abroad. The idea is so multidimensional and controversial that it deserves a separate analysis.

Our country has serious shortages of medical and nursing staff. According to data for 2019, we had the lowest employment rates in these professions. In Poland, there were 2.4 doctors per 1,000 inhabitants (for the EU, the rate was 3.6) and 5.1 nurses (in the Community, it was 8.5). As a result , the level of population saturation with doctors and nurses lagged behind the EU average by 33% and 40%, respectively.

In addition, there are concerns that the situation may worsen, which results from poor generational replacement - the average age of a medical specialist is over 54, of a nurse over 53, and of a midwife over 50.

Another challenge for the national health service is excessive workload. Due to unsatisfactory salaries, over 60% of doctors and about 30-40% of nurses practice in more than one medical facility.

Source: Domagała et al. (2022)

There is no precise data on migration processes involving Polish specialists. Experts estimate that around 8% of practicing doctors and nurses applied for certificates in other EU countries after Poland joined the Community in 2004. Physiotherapists should also be added to this figure. In the case of pharmacists and laboratory diagnosticians, the size of migration was negligible.

You don't have to watch the series "Londoners", in which one of the main characters is a Polish nurse, to get the feeling that one of the popular migration destinations is the British Isles (Great Britain and Ireland). The next most popular migration routes lead to Germany, Sweden, Norway and Spain.

These are certainly not all the destinations that tempt Polish medspecs. Their attention is focused on the Old Continent, because wages in many countries are higher than in Poland, and it is not far from the homeland. Thanks to this, it is possible to maintain social ties with your loved ones who remain in the country, more or less.

It is not so obvious when we consider other continents – North America and Asia. Nevertheless, I know of cases where these distant lands were a landing place for migrants from our country.

To answer this question, I used the Organization for Economic Co-operation and Development (OECD) database. This economic organization brings together 38 countries, including Poland.

The infographics below include almost all the countries that are part of the OECD (except for Colombia and Costa Rica). The reference date is 2018 – it's a bit archaic, but I couldn't find better input data. All calculations are made to obtain a common denominator in euros, and we are talking about gross wages (before income tax) in each sector (public and private).

They do not include extraordinary remuneration components, which are sometimes uncertain in nature and often depend on the discretionary decision of the entity's manager (e.g. bonuses, additional cash benefits, including jubilee or occasional awards, share options or warrants convertible into shares granted under incentive programmes) – they may increase annual income, but there is no certainty that this will happen.

I made the calculations based on two variables concerning gross domestic product (GDP) and wages – in nominal terms per person and in terms weighted by purchasing power parity (PPP) per person.

The PPP indicator takes into account local conditions. This is easy to understand if we consider an employee who earns, for example, 10 euros in Germany and another who earns 10 euros in Turkey. 10 euros buys more goods and services in Turkey than in Germany. Simply put, life in Turkey is cheaper than in Germany.

To put it synthetically: nominal amounts show how much we get in salary, and PPP amounts show how much we can afford (in terms of consumption and investment) with the nominal salary.

The OECD database is valuable because, apart from its comprehensiveness, it is a source of data for the salaries of some medical professions on different continents. We have Europe, North America, Asia, Central America, South America and Oceania. Only Africa is missing.

The weakness of the OECD data is that it only applies to three medical professions: general practitioners, hospital nurses and emergency care physicians. But it's better than nothing, so let's not be fussy.

First, let's see what the basic parameters look like for the 20 leading out of 36 classified OECD economies (Poland was also included, even though it wasn't in the top twenty). This data set includes, among other things, average wages for all employees - regardless of what they do (medical and other professions).

The United States spent the most money on health (16.9% of GDP). The podium was also occupied by Switzerland (12.2%) and Germany and France (tied at 11.2%). Poland was much lower in this classification, with health spending corresponding to 6.3% of GDP.

The Swiss were the wealthiest nominally – the annual salary in all sectors of the economy exceeded 81 thousand euros. The next leading positions were occupied by Americans (74 thousand euros) and Icelanders (66 thousand euros). A Pole received annually about 15% of what a Swiss person received, although when the purchasing power parity between the two nations was taken into account, the gap was no longer as deep (53%).

Source: own study based on OECD

Now that we know what the key parameters look like at a general level, let's get to the heart of the matter. That is, let's answer the question of how much representatives of three healthcare professions in the top twenty OECD (plus Poland) can earn on average.

The two infographics below show this, with abbreviations used for pragmatic reasons to define the professions: general practitioners (GPs), nurses (P), emergency care physicians (ERPs). They include annual and monthly breakdowns.

The first one shows annual data ranked by gross nominal salary for primary care physicians. The composition of the leaders seems unsurprising. The podium is occupied by Luxembourg (275 thousand euros), the USA (218 thousand euros) and Switzerland (214 thousand euros). According to OECD estimates, Polish LPKs received 52 thousand euros per year. A paradise for nurses was Luxembourg (95 thousand euros), followed by Denmark (72 thousand euros) and Switzerland (72 thousand euros). This amount for Poland amounted to 13 thousand euros.

Earlier I mentioned data adjusted for purchasing power parity (PPP). Classifying individual countries according to this criterion gives us a surprise. Of course, Luxembourg still rules in first place for primary care physicians (EUR 230,000 in PPP), but Turkey came in second. In Turkey, the nominal annual salary for LPK is EUR 28,000, but converted to PPP it is already the equivalent of EUR 162,000.

Source: own study based on OECD (annual approach)

For the sake of statistical order of the narrative, it is also worth mentioning the monthly salaries of the three professional groups analyzed. The best, in terms of LPK, are of course the Luxembourgers (23 thousand euros). For Poland, this variable amounted to a little over 4 thousand euros.

Source: own study based on OECD (monthly)

The last parameter that I calculated based on OECD statistics is the index of the nominal salary gap between doctors (more precisely, the LPK group) and nurses. It corresponds to how many times the salary of a nurse is the salary of a primary care physician (LPK/P). As a result, we get a measure of the salary gap received in both professions.

The infographic below presents this indicator for the 10 least and most extreme generated results – the top ten (the smallest difference) and the last ten (the largest difference). The salaries of primary care physicians compared to nurses are the most flat in Spain, Turkey and Latvia (below twice the LPK salary). The greatest disproportion in this respect was in Slovakia, Hungary and Japan (over five times).

Source: own study based on OECD

The OECD also calculates the OECD Healthcare Salary Index, a collective measure that is intended to identify the most salary-friendly countries in the organization for the three health professions analyzed. The reference measure is the most friendly country (it gets 100 points), and the remaining jurisdictions are ranked on a scale from 100 to 0.

The benchmark was Luxembourg (100 points), followed by Turkey (94 points) and Norway (76 points). Poland was in the lower parts of this classification – We took 32nd place with a score of 38 points.