Medical brain drain: How many, where and why?

We build a new database documenting the evolution of physician migration over a period of 25 years (1990-2014), and use it to empirically shed light on its determinants. In relative terms, the highest emigration rates are observed in small island nations and low-income countries, where needs-based deficits of healthcare workers are often estimated to be most severe. Over time, we identify rising trends in Caribbean islands, Central Asia and Eastern Europe. On the contrary, despite increasing migration flows to Western Europe, physician migration rates from sub-Saharan Africa have been stable or even decreasing. Our empirical analysis reveals that physician migration is a complex phenomenon that results from a myriad of push, pull, and dyadic factors. It is strongly affected by the economic characteristics of origin and destination countries. The sensitivity to these push and pull factors is governed by linguistic and geographic ties between countries. Interestingly, we find that the evolution of medical brain drain is affected by immigration policies aimed at attracting high-skilled workers. In particular, physician migration is sensitive to visa restrictions, diploma recognition, points-based system, tax breaks towards migrants, and the option of obtaining a permanent resident status. (C) 2020 Elsevier B.V. All rights reserved.