December 2025: Across Europe, health systems are increasingly shaped by the cross-border movement of doctors. In many European countries, physicians who obtained their primary medical qualification abroad now account for a substantial share of the medical workforce, reflecting long-standing shortages, ageing populations and gaps between domestic training capacity and demand. While the scale of reliance varies from country to country, the overall trend is clear: medical migration has become a structural feature of European healthcare rather than a temporary response to crisis.

 

According to the World Health Organisation (WHO), between 2014 and 2023, the number of foreign-trained doctors working in Europe grew by 58 per cent, based on data reported by national health authorities, and foreign-trained nurses by 67 per cent. In the same period, annual inflows — new entries into the health labour market — of doctors nearly tripled, while inflows of nurses increased fivefold. Strikingly, around 60 per cent of doctors and 72 per cent of nurses arriving in 2023 were trained outside Europe.

 

Reliance on foreign-trained doctors varies widely across Europe. In some countries, such as Switzerland, Norway and Ireland, foreign-trained doctors make up more than four in ten of all practising physicians; in others, the share is considerably smaller. This broad pattern reflects a combination of demographic pressures, workforce shortfalls and differing national approaches to medical training, recruitment and retention.

 

These trends are part of a broader shift in the European health workforce. Across the European Union (EU), the number of doctors trained abroad has risen faster than the number trained domestically, even as countries have sought to expand local medical education. Annual inflows of foreign-trained doctors have grown in most destination countries, shaped by migration policies, qualification recognition practices and labour market demand.

 

In this study, The Immigrant Times examines how this pan-European picture plays out at the national level. The report begins with Germany, a major destination where foreign-trained doctors make up a substantial share of the workforce and where the country also exports its own graduates. In the United Kingdom, the National Health Service (NHS) has become deeply dependent on internationally trained clinicians, while in France a more tightly regulated system has been cautious, but increasingly reliant.

 

Italy illustrates a tax-funded but highly decentralised health system that has shifted from exporting doctors to emergency-driven international recruitment. The research also examines the Netherlands and Sweden, smaller countries that nonetheless rely significantly on foreign-trained doctors. Finally, the report reviews Poland, a so-called ‘sending country’ whose medical graduates have moved in significant numbers to other European health systems.

 

Editor’s note: Data sources differ in how countries classify ‘foreign’ and ‘foreign-trained’ doctors, and comparability between countries is imperfect. Definitions based on where a doctor was trained or where they were born can produce different figures. In this article, The Immigrant Times generally uses figures based on place of training and explains exact methodologies in the methodology note at the end of the article. The current version of our study has been updated to include Italy. Additional country sections will be added throughout 2026.

 

BACK TO TOP

 

Foreign doctors in Germany

In Germany, foreign-trained doctors, understood here as doctors who obtained their primary medical qualification abroad, play a crucial role in the healthcare system. They now make up close to 16 per cent of all practising physicians, and are particularly important in undersupplied rural areas and in a number of shortage specialities.

 

By late 2024, more than 68,000 foreign-trained doctors were working in German hospitals and doctors’ surgeries, according to the German Medical Association. This represents roughly 16 per cent of the country’s approximately 437,000 licensed doctors. The number of foreign-trained doctors has more than quintupled since the 1990s, reflecting both long-term demographic pressures and changes in migration patterns.

 

Of these doctors, around 48,000 were trained outside the EU. While doctors from other EU member states, particularly those from Eastern Europe, continue to make up a significant share, the past decade has seen a sharp rise in doctors trained outside the EU.

 

Germany faces a growing shortage of doctors, especially in rural regions and in specialities such as anaesthesiology, internal medicine, paediatrics and psychiatry. In some hospitals and regions, particularly outside major cities, foreign-trained doctors account for between 50 and 80 per cent of medical staff, helping to keep clinics and practices operational as the population ages and more German doctors retire.

 

Foreign-trained doctors working in Germany

From Syria: 6,600

From Romania: 4,300

From Turkey: 2,900

From Russia: 2,800

From Austria: 2,700

From Greece: 2,600

From Ukraine: 2,300

From Poland: 1,900

From Azerbaijan: 1,900

From Egypt: 1,800

From Iran: 1,600

From Jordan: 1,300

(Source: Deutsche Ärztekammer, 2024)

 

Germany operates a predominantly insurance-based healthcare system. Most hospitals and medical practices are privately run, but care is financed mainly through statutory health insurance (Gesetzliche Krankenkassen), alongside a smaller private insurance sector (Private Krankenversicherung). Workforce decisions are decentralised, with hospitals, clinics and regional authorities playing a major role. This structure has made it comparatively easier for providers facing shortages to recruit foreign-trained doctors directly, without a single national employer controlling hiring.

 

Foreign-trained doctors must undergo a formal recognition process (Anerkennung), which typically includes language requirements, equivalency assessments and, in some cases, additional examinations. While the process can be lengthy and demanding, Germany has expanded recognition pathways and support programmes in recent years, reflecting both the scale and persistence of workforce shortages.

 

One of the most notable developments since 2015 has been the arrival and integration of doctors from Syria. Several thousand Syrian doctors are now working in Germany, making them one of the largest non-EU groups within the medical profession. Many arrived initially as refugees and later sought recognition of their qualifications.

 

For these doctors, the question of permanence remains unresolved. Some have established long-term careers and personal lives in Germany, while others face a dilemma: whether to remain in a stable, well-resourced health system or consider returning to Syria should political and security conditions allow. From a German perspective, their presence has become structurally important; from a Syrian perspective, their absence represents a significant loss of trained human capital.

 

Germany is not only a major destination for foreign-trained doctors; it is also a significant exporter of its own domestically trained medical workforce. Each year, thousands of German-trained doctors leave to work in neighbouring countries, particularly Austria and Switzerland.

 

The reasons are largely structural. Austria and Switzerland often offer lighter workloads, more predictable working hours and, in the case of Switzerland, substantially higher pay. This outward migration highlights a central tension within Germany’s healthcare system: while foreign-trained doctors help fill gaps at home, domestic working conditions continue to push some German doctors abroad. The result is a circular pattern of medical migration, rather than a simple one-way flow into Germany.

 

BACK TO TOP

 

Foreign doctors in the United Kingdom

The United Kingdom’s National Health Service (NHS) is a tax-funded, state-run system and the dominant employer of doctors. Workforce planning, pay structures and recruitment are highly centralised. Persistent gaps between the number of doctors trained domestically and the needs of the system have made overseas recruitment a structural feature rather than a temporary solution.

 

The UK has one of the largest medical workforces in Europe, with well over 350,000 doctors licensed to practise. Within this workforce, doctors who obtained their primary medical qualification outside the UK play a central role.

 

Approximately 42 per cent (some 138,500) of doctors currently working in the UK qualified outside of the UK, with the majority intending a long-term move, but recent data shows an increasing number of international medical graduates leaving the UK workforce. A 2024 General Medical Council (GMC) survey of doctors who chose or were considering UK practice found that a third (33%) were looking for a permanent move, while more than a fifth (21%) planned to stay for less than five years. This indicates a significant portion of the international workforce is temporary or plans for a shorter stay.

 

The number of non-UK qualified doctors leaving the UK workforce has increased significantly. In 2024, 4,880 foreign-trained doctors relinquished their medical licences, a 26 per cent increase compared to 2023 figures (3,869). This growing trend is a concern for the stability of NHS staffing.

 

Reliance on overseas-trained doctors has intensified as patient demand has risen faster than domestic training capacity. Vacancies persist across multiple specialities, including general practice, emergency medicine and psychiatry, and in many regions internationally trained doctors have become indispensable to service delivery.

 

Unlike Germany, where refugee pathways have played a significant role, the UK’s medical migration is dominated by labour recruitment. Doctors trained in India now form the single largest group of foreign-trained physicians in the UK. They are joined by substantial numbers from Pakistan, Nigeria, Sri Lanka and, increasingly, countries in the Middle East and Africa.

 

Policy changes in recent years, including adjustments to immigration rules, recognition procedures and visa pathways, have facilitated this inflow. Recruitment has been actively encouraged by NHS employers seeking to stabilise staffing levels.

 

While the UK continues to attract large numbers of overseas doctors, retention has emerged as a growing concern. High workloads, long waiting lists and prolonged industrial disputes have contributed to dissatisfaction among both domestically trained and immigrant doctors.

 

Recent data suggest rising numbers of doctors leaving the UK medical register or signalling an intention to work abroad. This raises questions about the long-term sustainability of a recruitment-led workforce strategy, particularly if outflows increasingly offset inflows.

 

Recent data suggest rising numbers of doctors leaving the UK medical register or signalling an intention to work abroad. This raises questions about the long-term sustainability of a recruitment-led workforce strategy, particularly if outflows increasingly offset inflows. A 2024 General Medical Council (GMC) survey of doctors who chose or were considering UK practice found that a third (33%) were looking for a permanent move, while more than a fifth (21%) planned to stay for less than five years. This indicates a significant portion of the international workforce is temporary or plans for a shorter stay.

 

The number of non-UK qualified doctors leaving the UK workforce has increased significantly. In 2024, 4,880 foreign-trained doctors relinquished their medical licences, a 26 per cent increase compared to 2023 figures (3,869). This growing trend is a concern for the stability of NHS staffing.

 

The UK demonstrates how a highly centralised, publicly funded health system can become deeply dependent on international medical labour. It also illustrates the limits of recruitment alone: without sustained improvements in working conditions, pay and career progression, reliance on overseas doctors may fail to resolve underlying workforce pressures.

 

BACK TO TOP

 

Foreign doctors in France

France operates a predominantly public, state-regulated healthcare system combining public hospitals with a large network of self-employed doctors working under national agreements. Healthcare is financed mainly through compulsory social health insurance, with the state playing a central role in regulation, pricing and workforce planning. Historically, this highly regulated system has been cautious about admitting foreign-trained doctors, particularly from outside the EU.

 

France has one of the largest medical workforces in Europe, with around 230,000–240,000 practising doctors. Compared with Germany or the UK, the share of foreign-trained doctors has traditionally been lower, reflecting restrictive recognition rules and a strong emphasis on national training pathways.

 

That situation has begun to change. In recent years, tens of thousands of doctors practising in France obtained their primary medical qualification abroad, accounting for roughly 10 to 12 per cent of the medical workforce. Growth has been driven by persistent shortages, especially outside major cities and in hospital-based specialities.

 

France faces pronounced geographic inequalities in access to healthcare. Large rural areas and some outer urban districts are designated déserts médicaux  (medical deserts) where shortages of general practitioners and specialists are acute. Ageing among the medical workforce has intensified these pressures, as many doctors trained during earlier expansion phases approach retirement.

 

In this context, foreign-trained doctors have become increasingly important in maintaining hospital services, emergency care and long-term care facilities, particularly in underserved regions.

 

France’s foreign-trained doctors come from a mix of EU and non-EU countries. Within the EU, Romania has been a major source country, alongside other Central and Eastern European states. From outside the EU, doctors from North Africa, notably Algeria, Morocco and Tunisia, form a significant group, reflecting historical, linguistic and professional ties.

 

Many non-EU doctors entered the French system through hospital-based roles with limited status or temporary contracts, a pathway that has long attracted criticism from professional bodies and unions.

 

For decades, France maintained a restrictive recognition regime for non-EU doctors, often confining them to junior or temporary positions despite years of experience. In recent years, reforms have sought to regularise the status of these doctors and facilitate fuller recognition, partly in response to staffing crises exposed during the COVID pandemic.

 

These changes remain politically sensitive. While policymakers acknowledge the system’s growing reliance on foreign-trained doctors, debates continue over training capacity, working conditions and the perceived impact on domestic medical graduates.

 

France illustrates a model of reluctant but increasing reliance on immigrant doctors. Strong state regulation has slowed inflows compared with Germany or the UK, but it has not prevented dependence from growing. As shortages persist and territorial inequalities widen, France faces a choice between expanding domestic training, further opening its system to foreign-trained doctors, or continuing with a hybrid approach that satisfies neither fully.

 

BACK TO TOP

 

Foreign doctors in Italy

Italy’s healthcare system, the Servizio Sanitario Nazionale (SSN), is a tax-funded, universal system providing healthcare free at the point of use. In this respect, it resembles the United Kingdom’s National Health Service more closely than the insurance-based systems found in countries such as Germany or France. However, its decentralised structure and long-standing workforce constraints have produced a distinctive pattern of reliance on foreign-trained doctors.

 

The SSN is funded primarily through general taxation rather than earmarked health insurance contributions. National funding is supplemented by regional taxes, including a levy on productive activities (IRAP) and regional income tax surcharges. While access to care is largely free, patients are often required to pay modest co-payments, known as ticket, for specialist consultations, diagnostic tests and some prescriptions, with exemptions for low-income groups, older people and those with chronic conditions.

 

A defining feature of the Italian system is its high degree of regional decentralisation. Responsibility for healthcare delivery lies with Italy’s 20 regions, while the central government sets minimum standards through the Livelli Essenziali di Assistenza (LEA). In practice, this has resulted in stark territorial disparities. Northern regions such as Lombardy and Emilia-Romagna tend to have better-funded hospitals and shorter waiting times, while parts of southern Italy face chronic shortages, debt and service disruption.

 

Historically, Italy has been a net exporter of doctors. Each year, an estimated 1,000 to 1,500 Italian-trained doctors leave the country, attracted by higher pay, lighter workloads and better career prospects in countries such as Germany, the United Kingdom and Switzerland. Strict limits on medical school places (numero chiuso) have further constrained domestic supply, even as demand has grown.

 

In recent years, however, Italy has increasingly turned to foreign-trained doctors to plug widening gaps. By 2024–2025, it is estimated that more than 20,000 doctors trained abroad were working in Italy. Many are employed in hospital emergency departments, rural facilities and hard-to-staff specialities, where shortages have become acute.

 

Despite this growing reliance, foreign-trained doctors are often not fully integrated into the public system. Permanent public-sector positions typically require Italian citizenship and success in competitive national or regional examinations (concorsi), leaving many foreign doctors on temporary or exceptional contracts.

 

Italy’s most striking recruitment strategy has emerged in regions facing near-collapse of hospital services. In Calabria, one of the country’s most under-resourced regions, authorities signed a bilateral agreement with the Cuban government to recruit doctors directly.

 

Since 2023, nearly 500 Cuban doctors have been deployed across Calabria under this arrangement, helping to keep hospitals and emergency departments operational. Local officials have described the initiative as essential to preventing service closures, and similar recruitment discussions have since taken place in other regions, including Lombardy and Sardinia, with a view to attracting doctors from South America and India.

 

This model is unusual in Western Europe and reflects the severity of Italy’s regional staffing crisis. It also highlights how decentralisation allows regions to pursue highly pragmatic, and sometimes controversial, solutions in the absence of sufficient national supply.

 

The main obstacle facing foreign-trained doctors in Italy is the recognition of qualifications. Degree equivalency procedures are often lengthy and inconsistent, varying by region and employer. During the COVID pandemic, Italy temporarily relaxed rules to allow foreign doctors to practise without Italian citizenship or full recognition, a measure introduced under emergency legislation known as Cura Italia.

 

Although initially conceived as a short-term response, these emergency provisions have been repeatedly extended and remain in place into 2026. The result is a growing cohort of doctors working in what has been described as a state of ‘permanent emergency’: essential to service delivery, yet lacking the security, pay progression and professional status of their Italian-trained colleagues.

 

Unlike countries such as Sweden or the Netherlands, Italy has no comprehensive, state-funded national language and integration programme for medical professionals. Responsibility for linguistic and professional adaptation is often left to individual hospitals or regional authorities, adding to uneven experiences across the country.

 

Italy’s reliance on foreign-trained doctors is no longer a temporary fix but a structural necessity. The SSN is slowly shifting from a rigid, nationally focused recruitment model towards a more pragmatic engagement with international medical labour. At the same time, continued emigration of Italian doctors to northern Europe and Switzerland means that foreign recruitment is often compensating for losses rather than expanding capacity.

 

BACK TO TOP

​

Foreign doctors in the Netherlands

The Netherlands operates a highly regulated, insurance-based healthcare system with universal coverage. All residents are required to take out basic health insurance from private insurers, which operate under strict state regulation. Healthcare providers are largely private or non-profit, while workforce planning and professional standards are tightly controlled. This combination has produced a system that is open to foreign-trained doctors, but only under selective and carefully managed conditions.

 

Compared with Germany, the UK or France, the Netherlands has a smaller medical workforce, with roughly 90,000 to 100,000 practising doctors. The proportion of foreign-trained doctors is lower than in many larger European countries, reflecting strict language requirements, controlled training numbers and a strong emphasis on domestic workforce planning.

 

Even so, several thousand doctors practising in the Netherlands obtained their primary medical qualification abroad, accounting for an estimated 8–10 per cent of the medical workforce. While modest in absolute terms, these numbers are significant in a system that traditionally aims to be self-sufficient.

 

Like other European countries, the Netherlands faces demographic pressures from an ageing population and a rising burden of chronic disease. Shortages are particularly evident in general practice, elderly care and certain hospital specialities. Part-time working patterns, which are common among Dutch doctors, further intensify staffing pressures.

 

Foreign-trained doctors have been used to alleviate these gaps, especially in underserved regions and specialities where domestic supply has struggled to keep pace with demand.

 

The Netherlands’ foreign-trained doctors come primarily from other EU countries, benefiting from mutual recognition of qualifications. Doctors from neighbouring countries such as Germany and Belgium form a visible group, alongside doctors from Southern and Eastern Europe.

 

Recruitment from outside the EU exists but is limited. High language proficiency requirements, strict recognition procedures and the relatively small size of the market have constrained large-scale inflows from non-European countries.

 

Foreign-trained doctors must undergo a rigorous recognition process, including Dutch language tests and professional competency assessments. While this ensures high standards of care, it also acts as a significant barrier to entry.

 

As a result, the Netherlands tends to attract foreign doctors who are already highly skilled, mobile and able to invest time and resources in meeting regulatory requirements.

 

The Netherlands illustrates a model of selective openness. Strong regulation and workforce planning have limited reliance on foreign-trained doctors compared with larger European countries, but they have not eliminated it. Even a well-resourced, tightly managed system continues to depend on international medical mobility to address specific shortages, underscoring how difficult complete self-sufficiency has become in European healthcare.

 

BACK TO TOP

 

Foreign doctors in Sweden

Sweden operates a tax-funded, universal healthcare system in which responsibility for delivery and staffing lies largely with regional authorities. While overall policy is set nationally, regions have significant autonomy over recruitment, pay supplements and working conditions. This decentralised model has made Sweden increasingly reliant on foreign-trained doctors to address uneven regional shortages.

 

Sweden has a comparatively small medical workforce, with approximately 50,000 to 55,000 practising doctors. Within this workforce, foreign-trained doctors represent a substantial and growing share, estimated at 20 per cent or more in recent years, one of the higher proportions in Northern Europe.

 

The share has risen steadily as domestic training has failed to keep pace with demand, particularly in primary care and hospital services outside major cities.

 

Doctor shortages in Sweden are most acute in northern and sparsely populated regions, as well as in primary care. Regional authorities have increasingly turned to international recruitment to maintain services, particularly for general practitioners, psychiatrists and emergency medicine specialists.

 

Foreign-trained doctors are therefore not marginal additions but a structural component of service provision in several regions.

 

Sweden’s foreign-trained doctors come from a mix of EU and non-EU countries. Within the EU, doctors from neighbouring Nordic countries and from Eastern Europe form an important group. From outside the EU, countries such as Syria, Iraq and Iran have become significant sources, reflecting both refugee flows and labour migration pathways.

 

Foreign-trained doctors must complete a structured recognition process, including Swedish language proficiency and supervised practice. While the system is demanding, Sweden has invested in bridging programmes to integrate foreign-trained doctors more effectively, particularly those with refugee backgrounds.

 

Sweden illustrates how even a well-funded, egalitarian welfare state has become dependent on foreign-trained doctors to sustain universal access. Decentralisation at the regional level has encouraged pragmatic recruitment, while raising questions about long-term workforce planning and integration capacity.

 

BACK TO TOP

 

Poland, an exporter of doctors

Poland’s healthcare system is predominantly publicly financed through a national health insurance fund, with services delivered by a mix of public and private providers. While access is universal, the system has long struggled with underfunding, staffing shortages and relatively low pay compared with Western Europe.

 

Unlike Germany, the UK or Sweden, Poland is best understood primarily as a sending country within Europe’s medical migration system. For decades, Polish-trained doctors have moved abroad in significant numbers, particularly to wealthier neighbouring countries offering better pay and working conditions.

 

Poland has approximately 140,000 to 150,000 licensed doctors, but a substantial proportion of Polish medical graduates seek employment abroad at some point in their careers. Germany, the UK, Sweden and other Nordic countries have all been major destinations.

 

While precise numbers are difficult to capture, professional bodies and migration data consistently show that Poland is among the largest exporters of doctors within the EU, especially relative to its population size.

 

The primary drivers of outward migration are economic and professional. Polish doctors frequently cite low wages, heavy workloads, limited career progression and resource constraints as reasons for leaving. EU free movement has made such migration comparatively easy, particularly to Germany and Scandinavia.

 

Outward migration has contributed to persistent shortages within Poland itself, especially in rural areas and in hospital-based specialities. Poland has one of the lowest doctor-to-population ratios in the EU, exacerbating access problems and waiting times.

 

In response, Polish authorities have taken steps to increase training numbers and, more recently, to attract foreign-trained doctors, particularly from Ukraine and Belarus, though these inflows have so far been insufficient to offset losses.

 

Poland highlights the asymmetries at the heart of European medical mobility. Doctors trained in a middle-income EU country help sustain healthcare systems elsewhere, while shortages persist at home. As a sending country, Poland brings into sharp focus the ethical and policy questions surrounding free movement, workforce planning and the uneven distribution of medical talent across Europe.

 

This study focuses on scale, systems and mobility. It does not address in detail the working conditions, career progression or professional experiences of foreign-trained doctors themselves. A future article by The Immigrant Times will examine how migrant doctors experience European health systems — and whether reliance on international recruitment is matched by sustainable and equitable working environments.

 

BACK TO TOP

 

Methodology

This study by The Immigrant Times examines the role of foreign-trained doctors in selected European health systems using a combination of international datasets and national-level sources. The primary comparative framework is based on data from the World Health Organisation (WHO), which compiles figures reported by national health authorities on the number and inflow of doctors trained abroad.

 

At the country level, the analysis draws on data from medical associations, health ministries, workforce registries and official statistics agencies in Germany, the United Kingdom, France, the Netherlands, Sweden and Poland. Where available, the most recent comprehensive figures were used. In some cases, data refers to practising physicians; in others, to licensed doctors, reflecting differences in national reporting systems.

 

Countries differ in how they define and record ‘foreign’, ‘foreign-trained’, or ‘international’ doctors. Some statistics are based on place of medical training, others on nationality or country of birth. In this article, The Immigrant Times generally prioritises definitions based on place of primary medical qualification, as this most directly reflects cross-border training and recruitment patterns. Where national methodologies differ, this is indicated in the relevant country sections.

 

Because of these variations, figures are not strictly comparable across countries. The analysis, therefore, focuses on broad trends, relative reliance and structural patterns rather than exact rankings.

 

Sources

• World Health Organisation (WHO), Global Health Workforce Statistics and Health Labour Market Analysis reports

• National medical associations and licensing bodies (including Germany’s Bundesärztekammer; UK General Medical Council; Ordre des Médecins, France)

• National health ministries and statistical offices

• OECD Health Statistics (used selectively for contextual comparison)

• Peer-reviewed research on medical migration in Europe

 

Further reading: Teaching and training for refugees in Europe || Immigrants create wealth || Immigrants in German states and cities ||

​​

BACK TO TOP

​​

COMMENT

Praise. Criticise. Write.

​

FOLLOW

Instagram || TikTok || X(Twitter) || Thread || Facebook || BlueSky || Mastodon || LinkedIn ||

​​​