Recruitment of Health Professionals from Abroad

Advantages and Disadvantages

Term Paper 2014 19 Pages

Sociology - Medical Care



Summary of Main Findings

1. Introduction

2. Immigration in the UK

3. Scarcity in UK Health sector

4. Cost of Immigration
4.1. Direct Cost of Recruitment
4.2. Higher Competition
4.3. Pressure on Labour market
4.4. GDP based outcome measurement not logical

5. Other Implications

6. Benefits
6.1. The opportunity cost
6.2. Demographic Factors
6.3. Cost Saving
6.4. Perfect Complements
6.5. Positive Societal Acceptance
6.6. International Friendship and Poverty Reduction

7. Situation in other industrialized countries

8. Ethical Issues

9. Conclusion




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Summary of Main Findings

1- Scarcity of Health Professionals is an international Phenomenon and is visible in developed countries.

2- Developing Countries face even more challenges because of growing population and high migration to developed countries.

3- The UK is a multi-cultural society with high number of migrants in all sectors especially healthcare and education

4- Without Immigration, there will be a negative impact in the UK economy as a whole.

5- The Royal College of Nursing Reports that there will be a scarcity of 20,000 Nurses in the NHS until 2020.

6- The Royal College of General Practitioners also report that by 2020 there will be a shortage of 16,000 GPs in UK.

7- In 2003, around 10% of Nurses were trained abroad and this trend was increasing

8- Direct Cost of recruiting from abroad is higher than hiring nationally.

Costs of Immigration

9- Recruiting international healthcare personnel will increase the competition for available vacancies in the UK

10- Higher competition might cause high quality British professional to immigrate to other countries

11- Spouses of Healthcare professionals who come to the UK also have a right of employment and might cause more pressure on other professions because they will enter the labour market as well.

12- The children of new healthcare immigrants also need investment for example in public schooling which should be borne by general taxation.

13- Gross Domestic Product ( GDP ) based benefit measurement might not be logical always because only total national output is calculated here and not the benefit per head. GDP per head would be more appropriate.

14- There might be negative impact on the environment or on public transportation or public services.

Benefits of Immigration

15- Skilled Workforces generate higher tax revenue and are less likely to be unemployed and claim social benefits.

16- The opportunity cost of not hiring from abroad can be higher because this might result in long waiting time for the patients which will result in medical tourism i.e. British people going abroad for treatment. This will cause the outflow of capital due to the cost related to it.

17- The UK is an ageing society and in the future there will be more aged people than young people. At the same time, the life expectancy is increasing as well. This also generates the increase of age related diseases like Alzheimer’s or Dementia. Hence, more medical professionals will be required and if they cannot be found in the UK, going abroad to recruit is necessary.

18- To train a doctor is very expensive in the UK. Currently, it takes about 400,000 Pounds for the tax payers to train one person. Bringing Doctors from Abroad means we have no investment but huge benefits.

19- Doctors and Nurses are perfect complements, hence more doctors from abroad will reduce the workloads of home nurses and more nurses from abroad will reduce the workload for home doctors hence improving the quality of care.

20- Overseas workers have been claimed to have better work ethics than the home grown ones. They work longer and also go to rural areas. Hence, they have a very positive image in the society. However, some form of discrimination and inter-cultural conflicts exist at workplace.

21- Hiring from abroad also increase international friendship and cultural exchange which can only enrich British society. The knowledge these Healthcare professionals gain in the UK can be used later in their home country. Moreover, the remittances they send might contribute to reduce poverty.

22- There are already many people living in the UK who are from other countries. Sometimes, due to lack of understanding, doctors and patient might misunderstand each other, that can have negative impact on health. Having a doctor from one’s own country might result in culturally sensitive treatment.

23- Ethical Aspects must not be ignored because developing countries have higher disease burden and at the same time less number of Healthcare professions in comparison to developed countries. Recruitment might cause brain drain and this can have negative consequences on the health of people living in poor countries especially in rural areas.

24- More research is required in this field and recruitment should only be undertaken if the benefit clearly outweighs the costs.

25- A sustainable approach to fight this scarcity should be adopted instead of short term solution to solve the problem.

1. Introduction

Scarcity of Healthcare professionals especially Doctors and Nurses is a worldwide phenomenon. On one hand demographic factors like population growth is bringing problems with it for example the demand of more healthcare, on the other hand the ageing population also comes up with age related diseases like Alzheimer’s and Dementia. If Health Technology fails to develop further, it is obvious that we will have to face difficult challenges in the future.

To meet the demand of more healthcare professionals, countries like the UK are very dependent on foreign countries that supply such people, like nurses from some East Asian countries. The scarcity of Healthcare Professionals is also a big problem for developing countries. Population growth and ageing not only generates the scarcity of health professionals but also brings the need to expand health infrastructures. For example, the healthcare institutions and health workforce that exist today were designed when the size of population was lower. So, today with higher growth of population, the expansion of health-infrastructures as well as health personnel is vital to meet the demand and to maintain the quality of healthcare.

To fulfil the demand in the future, in this Essay I will focus on recruitment of Healthcare-personnel especially doctors and nurses from abroad and the cost and benefit connected to it. I will start by analysing the scarcity in the United Kingdom today, followed by the cost and benefit of Immigration and then talk about some ethical issues and finally conclude the Essay with some recommendations to the labour minister.

2. Immigration in the UK

Immigration is highly significant to the UK economy: immigrants comprise 12% of the total workforce1. In the Health Sector, it is higher. Despite its highly advanced health sector and high immigration from A8 countries recently, scarcity of Doctors and Nurses is prevalent. The NHS is one of the largest recruiter of foreign workers. Labor Force Survey Data for 2006 suggest that the three most popular sectors for foreign born workers are public administration, education and health2. The Education sector has already realised that without immigration of high skilled professionals in the education system, the quality of education will deteriorate and on the other hand, the number of foreign students coming to the UK to study will be lower which will have negative impact on the economy as a whole.

3. Scarcity in UK Health sector

The Royal College of Nursing reports that there is a shortage of 20,000 Nurses in NHS3. In 2004, the UK needed about 10,000 additional doctors (Dobson 2004). This number will significantly increase. In an interview given to “Daily Mirror”, the chair of Royal College of General Practitioners highlights that by 2020, there will be a shortage of 16,000 GPs. Even today, the NHS is highly dependent on foreign trained doctors. The Table below shows that roughly one-quarter of Doctors were educated outside EEA in 2003.

Regarding Nurses, recruiting abroad is a long tradition. The Nursing and Midwifery Council (NMC) reported that around 10% of the Nurses were trained abroad in 2003. Nurses from former colonies prefer the UK as a potential destination because of the language, similar form of education in their home country and family ties. Numbers of Nurses working in NHS as % are shown in the following table.

Internationally, the issue looks similar for developed countries. Hence, every country is enacting policies so that trained Healthcare professionals do not immigrate. Based on our dependence on foreign workers, this would mean that we will face difficulties in recruiting workforce from abroad. This result in a scenario that developed countries will start recruiting workers in developing countries. The ethical issues behind this will be complicated to highlight.

4. Cost of Immigration

4.1. Direct Cost of Recruitment

The cost of international recruitment programmes are far higher than costs related to supporting overseaas-qualified healthcare professionals already in the UK. For example, the costs of recruiting dentists in India in 2004 included administrative costs; trips to organize the IQE A; hiring the dental institutes in India for the exams; examiners costs to travel to india; IQE B (£ 650) and C (£ 1550) costs for successful candidates; and dental nurse placements for successful candidates (an average dental nurse salary is between 15000-20000 pounds per annum)4

4.2. Higher Competition

The supply of Healthcare professionals will increase competition in the job market. Hence, there will be a downward pressure on wages. People from abroad, especially from lower and middle income countries are more likely to work for lower wages than UK locals. Consequently, UK trained Healthcare professionals might immigrate to other countries. The impact of this will be, those who were trained in a high-quality system and the ones who are familiar with the system and mentality of patients will go away and those who are less familiar with the system might remain. This will have negative impact as a whole.

4.3. Pressure on Labour market

When people immigrate to the UK, they come with family members who might or might not enter the labour market. If they do, there will be further pressure in labour market and their use of public services will over-crowd the system. The cost for putting a child in school should be paid by general taxation. Hence, the disadvantages in terms of cost might outweigh the advantages.

4.4. GDP based outcome measurement not logical

Policy makers tend to highlight the advantages of Immigration based on the incraease of GDP. GDP might be the best method to measure growth and output but it might not always measure societal well-being. The population increase has direct impacts on environment. Housing prices will go up at least in the short term and it will leave lower disposable income to those who do not own a house. There might be more pressure on other public services. Moreover, public transportation system may be over crowded or there will be more pressure on traffic. So, some economists argue that the advantages immigration will bring should be measured in terms of per capita GDP instead of total outcome.

The overall conclusion from existing evidence is also that immigration has very small impacts on GDP per capita, whether these impacts are positive or negative. This conclusion is in line with findings of studies of the economic impacts of immigration in other countries including the UK5. Hence, especially in the UK, more research is required in this field.

5. Other Implications

In the longer term, the main thrust of expanding the NHS nursing workforce will have to be on the training, recruitment and retention of UK nurses, for which international recruitment is not a sustainable substitute9. As of December 2013, number of job seekers in Scotland was still 113,800 people10. It is less costly and more socially acceptable to think about the possibility of providing training to the local job seekers especially as Nurses. However, this argument might not be logical for Doctors because of educational requirements and we can’t simply train the unemployed people to be doctors. It is unrealistic.

6. Benefits

Benefits from Immigration has been huge. The large number of vacancies depicts the scarcity of Health personnel and in its absence; people will fall short from getting adequate services. The services these skilled workforces provide are the most important benefit of this policy. Apart from that, the tax paid by them would have positive affect on government revenue. Evidence also shows that skilled manpower is less likely to receive any state support. Numerically, considering 1000 Nurses with an average gross salary of 25k/year and 200 Doctors with an average gross salary of 60k/year, with a mean age of 30 years, they will pay about 6 million pounds only as tax per year ( without National Insurance ). A large portion of their income might also be spent locally for example on consumption and transportation thereby helping the economy as a whole.

6.1. The opportunity cost

Of not providing care in the UK or long waiting time for care might be higher too. Due to long waiting time, more and more British Citizens are going abroad for treatment. This is again connected with costs related to treatment itself, travel and lodging costs and time lost. Based on the research done by London School of Hygiene published in The Guardian Magazine, yearly 63,000 British go abroad for treatment. Considering a fictional amount of £3000 a patient lose for treatment, travel cost and for lodging and fooding abroad, this would mean that it would cost total amount of 189 million pounds. A substantial number of medical tourists this could be reduced and millions of pounds will remain in the presence of required medical workforce in the UK.



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Institution / College
University of Aberdeen – College of Life Sciences and Medicine
Brain Drain Immigration in Health Sector Health Management Cost and Benefits of Immigration in Health Sector



Title: Recruitment of Health Professionals from Abroad