The International Mobility of the Highly-Skilled; Why has Sweden so many foreign-trained medical doctors and the Netherlands so few?


Abstract. This paper discusses the role of pull factors in the international mobility of medical doctors by comparing the experiences of two host countries. Over 27% of doctors active in Sweden have been trained abroad. Their share is increasing. In the Netherlands foreign-trained doctors make up barely 2% of the total. How can this difference be explained? The Netherlands has long aimed for self-sufficiency.  Sweden educates and trains fewer doctors than it needs- not because candidates are lacking but because of a lack of places in medical school (some 25% of the foreign-trained are Swedish citizens). To provide context and to find other factors that may have played a role the paper highlights key differences between the healthcare systems of the two countries. Doctors in Sweden are typically employees. Doctors in the Netherlands are mainly self-employed. Health workforce planning in Sweden is highly decentralised and takes place within the public sector; in the Netherlands it is a more inclusive exercise that is organized at central level. In contrast to the Netherlands, few Swedes have their ‘own’ family doctor; this facilitates the acceptance of foreign-trained doctors. The re-registration requirement and strictness in the testing of language skills may also have played a role. The paper is based on official documents and other publications, in addition to interviews with practitioners and experts in the medical field in Sweden and the Netherlands

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