The past two decades have been marked by impressive growth in the migration of medical doctors. The medical profession is among the most mobile of highly skilled professions, particularly in Europe, ...and is also the sector that experiences the most serious labour shortages. However, surprisingly little is known about how medical doctors choose their destinations. In addition, the literature is scarce on the factors determining the sharp rise in the migration of doctors from Africa, Asia and Eastern and Southeastern Europe, and how the last economic crisis has shaped the migration flows of health professionals.
We use the new module on health worker migration provided by the Organisation for Economic Co-operation and Development (OECD) for 2000-2016 in order to examine the channels through which OECD countries attract foreign physicians from abroad. We estimate a gravity model using the Pseudo-Poisson Maximum Likelihood estimator.
Our results reveal that a lower unemployment rate, good remuneration of physicians, an aging population, and a high level of medical technology at the destination are among the main drivers of physicians' brain drain. Furthermore, an analysis of the mobility of medical doctors from a number of regions worldwide shows that individuals react differently on a country-wise basis to various determinants present in the destination countries. Physicians from African countries are particularly attracted to destination countries offering higher wages, and to those where the density of medical doctors is relatively low. Concurrently, a higher demand for healthcare services and better medical technology in the receiving country drives the inflow of medical doctors from Central and Eastern Europe, while Asian doctors seem to preferentially migrate to countries with better school systems.
This study contributes to a deeper understanding of the channels through which OECD countries attract foreign medical doctors from abroad. We find that, apart from dyadic factors, a lower unemployment rate, good remuneration of physicians, an aging population, and good medical infrastructure in the host country are among the main drivers of physicians' brain drain. Furthermore, we find that utility from migration to specific countries may be explained by the heterogeneity of origin countries.
While a large body of literature separately documents urban and rural resilience, little is known about how resilience evolves when communities experience an administrative reform that changes their ...judicial status from rural to urban. This paper explores the effects of the largest post-communist urbanization waves that took place in Romania in the early 2000s, when more communes were reclassified as towns. Using rich administrative data from 2000 to 2014, we employ a two-way fixed effect difference-in-differences research design to examine the impact of the reform on the resilience capacity of the affected communes. Our results reveal that the administrative reform had an initially positive impact on the physical resilience capacity. While the administrative reform did not have a significant effect on the overall resilience capacity of the newly declared towns, there are important differences across groups. The settlements situated in more developed counties and those with higher income levels were among the main beneficiaries. Negatively affected were mainly the poor communes and those that lack accessibility due to their mountain position and being far from big cities. In policy terms, this clearly emphasizes the need for place-sensitive policies complementing the administrative reform in order to help them escape from their rural uprootedness.
In recent years a considerable amount of attention has been directed to the migration of tertiary educated people. Social scientists are interested in the brain drain phenomenon, in order to ...understand the positive and negative effects of highlyskilled migration in the sending countries. This paper examines physician migration in Romania, a country which records in Europe one of the largest stocks of emigrated medical doctors in the last few decades. Using data from official statistics, a survey carried out among Romanian medical doctors who have migrated, as well as innovative data from LinkedIn, we provide detailed evidence on the emigration flows and trends of Romanian physicians in terms of destinations, specialties and time frame of emigration. In addition, our study sheds light on the underlying reasons for migration and on difficulties encountered in the destination country.
•I study how merely announcing austerity plans affects employees’ wellbeing.•I exploit the unexpected announcement of a drastic wage cut (25%) in Romania.•Unsurprisingly, results reveal an ...immediately drop in life satisfaction.•Men, married individuals, and employees with higher levels of education are most affected by the announcement.•The negative effect of the announcement is not persisting over time.
This study investigates the impact of austerity plan announcements on employees’ wellbeing. We exploit the unexpected announcement of a drastic wage cut (25%) related to public sector employees in Romania. Using data from the Eurobarometer Surveys and the European Quality of Life Survey, we employ a difference-in-difference research design combined with matching, based on entropy balancing, to identify the causal effects. Our results reveal that the mere announcement of austerity measures leads to an overall drop in life satisfaction among those working in the public sector. We also show that men, and especially married individuals, are most affected by the substantial wage cut announcement. Contrary to previous research, we find that public sector employees with higher levels of education are more likely to be affected by this policy communication compared to those with only secondary or primary levels of education. Our results also suggest that the negative effect of the announcement is not persisting over time.
Many children grow up with parents working abroad. Social scientists are interested in the scholastic achievement and health of these left‐behind children, in order to better understand the positive ...and negative aspects of migration for the families in the sending countries. This paper examines the causal effects of parents' migration on the education, physical, and mental health of left‐behind children aged 11 to 15 years in Romania, a country where increasingly more children have parents working abroad. Using data from a unique representative survey carried out in 2007, instrumental variable and bivariate probit estimates have been performed. The paper finds evidence for a significant positive effect of parental migration on children's school performance (reflected in higher grades) and a higher probability of suffering from depression and having health problems more frequently. The study furthermore demonstrates that living in transnational families is more harmful for girls and for those from rural areas.
•Using gravity models and 2001-2021 data, we study nurse migration drivers and the influence of health and economic shocks.•Health-related shocks in origin countries lead to a decline in nurse ...migration flows.•While economic crises in origin countries push more nurse migration, recessions at destination reduce the number of arrivals.•When health shocks are preceded by recessions origin countries struggle to cope with the increase in healthcare demand.•The study shows substantial heterogeneity across geographical regions in terms of the drivers of nurse migration.•Nurses are generally attracted to the OECD destinations by the better institutional and labour market conditions.
The COVID-19 pandemic has exacerbated the global shortage of nurses and doctors, highlighting the need for countries to aim for greater self-sufficiency in their health workforce rather than relying on foreign recruitment to meet excess demand. By using gravity models and taking advantage of rich data over the period 2001–2021, we examine the determinants of qualified nurse migration to OECD countries and investigate how macroeconomic imbalances impact nursing labour markets across time and place. We find evidence that economic recession in origin countries can lead to an increased loss of medical personnel, which could worsen the nurse deficit there. Source countries are particularly vulnerable to a nurse deficit if a recession is followed by a health shock that increases the demand for healthcare. However, a health shock temporarily reduces the number of nurses leaving and hence decreases the number of incoming nurses in destination countries. Recessions in destination countries reduce the number of arriving nurses there. Our study also captures the role of place in nurse migration by investigating heterogeneity in nurse migration across the main geographic source regions worldwide.
This paper examines the relationship between well-being inequality and the economic crisis for countries from Central and Eastern Europe. Using data from Life in Transition Surveys waves 2006 and ...2010, we assess the level of happiness gap by computing the instrument-effect-corrected standard deviation. Our results indicate that the dispersion in self-reported well-being levels increased after the economic crisis in all considered countries. We also show that the life satisfaction variation is not necessarily higher for those who report being poor compared to those from the upper part of the income hierarchy. Results also suggest that in general the gaps are higher in the case of those who report being not affected at all by the economic crisis compared to those who report being affected to a large extent by the crisis.
PurposeThis paper aims to extend the scope of previous studies on education-occupation mismatch to explicitly focus on the role high school track choices have on the risk of being mismatched in the ...labor market.Design/methodology/approachThe paper uses the most exhaustive available database regarding the early-career paths of university graduates in Romania. Using a novel matching technique, entropy balancing (EB), our study relies on multinomial logit models and logit regressions to estimate the effect of the completed high school track on the likelihood of being mismatched in the labor market. The empirical analysis focuses on two types of education-occupation mismatches: horizontal and vertical mismatches.FindingsWe show that studying a different field in college compared to the completed high school track increases the risk of being skill mismatched in the first job after graduation. Five years after college graduation, the influence of the high school track fades, while being skill mismatched in the first employment plays a more important role. In contrast, we find no evidence that pursuing a college major unrelated to the completed high school track increases the probability of being overeducated. However, being overeducated in the first job increases the risk of being overeducated five years later.Originality/valueThe study brings new reliable evidence on the extent to which high school track choices may contribute to the risk of being mismatched in the labor market.
Acute poisoning with drugs and nonpharmaceutical agents represents an important challenge in the emergency department (ED).The objective is to create and validate a risk-prediction nomogram for use ...in the ED to predict the risk of in-hospital mortality in adults from acute poisoning with drugs and nonpharmaceutical agents.This was a prospective cohort study involving adults with acute poisoning from drugs and nonpharmaceutical agents admitted to a tertiary referral center for toxicology between January and December 2015 (derivation cohort) and between January and June 2016 (validation cohort). We used a program to generate nomograms based on binary logistic regression predictive models. We included variables that had significant associations with death. Using regression coefficients, we calculated scores for each variable, and estimated the event probability. Model validation was performed using bootstrap to quantify our modeling strategy and using receiver operator characteristic (ROC) analysis. The nomogram was tested on a separate validation cohort using ROC analysis and goodness-of-fit tests.Data from 315 patients aged 18 to 91 years were analyzed (n = 180 in the derivation cohort; n = 135 in the validation cohort). In the final model, the following variables were significantly associated with mortality: age, laboratory test results (lactate, potassium, MB isoenzyme of creatine kinase), electrocardiogram parameters (QTc interval), and echocardiography findings (E wave velocity deceleration time). Sex was also included to use the same model for men and women. The resulting nomogram showed excellent survival/mortality discrimination (area under the curve AUC 0.976, 95% confidence interval CI 0.954-0.998, P < 0.0001 for the derivation cohort; AUC 0.957, 95% CI 0.892-1, P < 0.0001 for the validation cohort).This nomogram provides more precise, rapid, and simple risk-analysis information for individual patients acutely exposed to drugs and nonpharmaceutical agents, and accurately estimates the probability of in-hospital death, exclusively using the results of objective tests available in the ED.
This paper provides an analysis of the performance and efficiency of the public sector in the European Union (EU). Using composite indicators and data envelopment analysis, we focus on the new EU ...member countries, which were involved over the past decade in the accession and integration process. Results of the analysis indicate that, unlike "old" EU members, which invested more in sectors such as education or health, countries in Central and Eastern Europe, the "new" EU member states, have directed public resources mainly toward the performance of the government sectors. However, greater efficiency has been achieved precisely in those areas where they have invested less.
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