2005 February 20 Sunday
Hungary And Romania Suffering Medical Brain Drain

Brain draining is happening all over the world. While medical brain draining of Africa is a tragedy that gets a lot of continuing press what is less remarked upon is the brain draining of Eastern Europe.

According to a recent survey of the Faculty of Medicine in Budapest, 66 percent of graduates in the European Union's new member said they plan to work abroad while 33 percent said they have already started searching for work in western Europe.

Some 430 young doctors have left the country for better paying jobs since Hungary joined the bloc on May 1 of last year, according to Ivan Golub, president of the Union of Hungarian Hospitals.

Anyone know how many doctors are in Hungary? The country has a total population of about 10 million people. The United States has about 190 physicians per 100,000 population (which is similar to Norway and a few other Western countries if memory serves - though socialist Canada is of course substantially lower). So we'd expect Hungary to have about 19,000 physicians if it had a ratio similar to that of the United States.

Hungary is turning around and brain-draining even poorer countries.

The job vacancies in Hungary are often filled by ethnic Hungarians who live in poor neighbouring countries, such as Romania, Ukraine or Serbia.

Up to one-third of the vacant medical positions in central Hungary are filled with doctors from these countries, MTI national news agency reported earlier this month.

When a country that has medical doctor salaries that are a tenth the Swiss level can turn around and brain drain its neighbors you just know that the neighbors have pathetically low salaries. What will happen to those pathetically poor countries in the future?

The Ukraine and Serbia are outside of the EU and hence it is harder for their nationals to get work in European Union countries. But think about Romania. It is now in the EU and while some labor movement restrictions are still in place it is so poor that even Hungary can brain drain it. That does not bode well for the future ability of Romania's people to get health care.

One factor that makes it easier for Hungary to brain drain Romania is that Romania contains ethnic Hungarians within its borders.

Perhaps the Romanian government could work out a deal whereby it trained many more doctors in exchange for those doctors taking on training cost debts that they could pay off by working in wealthier European countries. Might the Romanian government even strike a deal with some of those countries to guarantee collection of such debts from salaries paid in those countries? If the price for the training was set high enough then the Romanian medical schools could use the debt payback to fund the training of other doctors who would be obligated to work some number of years in Romania before leaving.

Share |      By Randall Parker at 2005 February 20 01:51 PM  Immigration Brain Drain

John S Bolton said at February 20, 2005 7:41 PM:

This is another reason why an all merit immigration policy is superior to one which responds to the skills needs of the moment. The credential driven recruitment of foreigners brings nations into conflict with other countries, including those which are scarcely worse than the places that their emigrants are heading, just a bit poorer today.

Stephen said at February 21, 2005 5:47 AM:

I agree that there's something immoral about the west cherry picking professionals from those poor countries that need the skills and have invested a lot of resource training them. That said, some poorer countries are taking active efforts to stop the professional classes leaving as soon as they receive a degree by requiring the student to agree to work in the country for x-years before migrating - kind of like paying off the debt.

I know this probably won't go down well here, but I think we should severely limit traditional immigration queues and instead welcome illegal immigrants. Basically, the idea is that legal immigrants are happy to stand in a queue and wait their turn, whereas illegals are entrepreneurial risk takers. In the long term, those illegals are going to invigorate a society more than a legal immigrant. Sure, its a bit darwinian, but it'd be interesting to try.

Hell, you could make a game show out of it - build lots of walls and traps etc so that crossing the border is really really hard - perhaps even dangerous. If the illegal is caught on the border they are expelled, but if they can make it through then they immediately become citizens.

...only half joking.

faeroe said at February 21, 2005 6:36 AM:

I used to correspond regularly with a Russian caridologist in Omsk. Her salary was, in 2001 and 2002, equivalent to $70/month. I tried to find her a fellowship in the US so that she could do additional study, but she couldn't afford the small additional expenses that were necessary.

On the other hand, I know that Hungarian dentists have set up numerous clinics near the Austrian border. It seems that the Austrians are able to get quality care at a steep discount by crossing the border. I also note that Montreal, due to certain Quebec-related freedoms not available in the rest of Canada apparently, is becoming the Canadian center of free-market medicine. Now Canadian doctors have a domestic avenue for greater reward.

The wave of the future is obvious: socialized systems will degrade and pay for service systems will continue to grow. Whether those providers are in Hungary or the US, it is foolish to try to stand in the way.

Randall Parker said at February 21, 2005 9:26 AM:


We already let in huge numbers of illegals. Entrepreneurialism? It is oversold as a simplistic panacea. Starting a lawn mowing business is far less productive to the economy than becoming an engineer in an existing industrial corporation.

See the chart on educational attainment by generation comparing Hispanics to others in the US. To compete against China, Japan, and South Korea we need more engineers and scientists, not more maid service operators or lawn care service operators.

Proborders said at February 21, 2005 12:53 PM:

Stephen, a plurality, if not majority, of illegal immigrants in the USA are Mexican illegal immigrants. There are about 22 million Mexican/Mexican Americans in the USA.

In the future Mexican/Mexican Americans might want their own Hispanic nation-state. By reducing immigration from Mexico the likelihood of the Southwest’s becoming a new Hispanic nation-state or becoming part of Mexico would in my opinion be reduced.

Some may say that Mexican Americans will not demand their own separate country. Even if Mexican Americans in the future, on average, do not favor a new Hispanic nation-state or a return of the Southwest to Mexico, Mexican Americans may turn the Southwest states into states with both Spanish and English as the official languages (I think that English and Spanish are currently the official languages of New Mexico). Public school students in these states may be required to learn both Spanish and English and demonstrate proficiency in both in order to graduate from high school. Various professionals (physicians, lawyers, dentists, etc.) may required to be proficient in Spanish in order to receive a license to practice in these states. In order to receive a driver’s license applicants may be required to prove a minimum level of Spanish language proficiency. Would not many whites, blacks, and Asians migrate from the Southwest if these possible requirements became law? If so, the Southwest’s population would become proportionately even more Hispanic.

Mexico has about 2% of the world’s population, yet about 1 in 3 immigrants in the US was born in Mexico (see http://www.cis.org/articles/2003/back1203.html). In fact there are more Mexican immigrants in the US than European immigrants in the US (see http://www.cis.org/articles/2003/back1203.html) even though Europe has several times the population of Mexico. Immigration from Mexico should be proportionately reduced. Reduce immigration from Mexico and increase immigration from Eastern Europe.

Perhaps many people prefer hearing Spanish than an Eastern European language (English, as a language, is closer to Spanish than to Eastern European languages). Perhaps many would rather have Catholic immigrants than Eastern Orthodox immigrants (some Slavic ethnic groups are predominately Catholic, however). Many like Mexican food.

There would be advantages to reducing immigration from Mexico and increasing immigration from Eastern Europe. First, if adult Eastern European immigrants were required to have the equivalent of a US high school diploma, they and their descendants would tend to perform better in terms of educational attainment than Mexican immigrants and their descendants. Two, Eastern European immigrants and their descendants would not be eligible for affirmative action (although laws could change; perhaps Gypsies might say that they are South Asian and should therefore receive affirmative action preferences) unlike Mexican/Mexican Americans who are eligible for affirmative action preferences. Third, by reducing immigration from Mexico the Southwest is more likely to remain as part of the USA.

John S Bolton said at February 21, 2005 6:55 PM:

It is indeed unfair that Mexico gets more than a dozen times its share of immigration places, that is, of those which are legal at the outset, or are legalized after the fact. They are not more worthy or compatible, but less meritorious and more hostile territorially and otherwise than the world in general. An all merit immigration policy using English language testing only, would take from the less successful societies a portion of the native talent which they are today unable to develop. The recruitment of those with graduate degrees in hypercredentialized professions, wipes out the investment in local ability which a relatively unsuccessful economy is able to develop to that point.

Andy said at March 1, 2005 8:28 AM:

Dear Sir,

Interesting to read your post and some of the above comments. Contrary to your post Romania is NOT yet an EU member country, but is certainly aspiring to be in the next round of those who do join, along with Croatia. One of the points that I feel wasn't investigated by your post was the fact that is is not western salaries alone that are attracting health professionals from Central Eastern Europe. In fact the trend is very much showing that, of those that do go, a large number are going in order to gain experience and language skills that they intend to reimport back into their home country. In the Magyar Orvos (Hungarian Doctor) there was an interesting article expressing the fears of the Hungarian medical establishment that they may be left behind by world medicine, due to their inability to speak medical English, and without access to some form of foreign experience, their knowledge and technical know-how could become obsolete.

In addition, those qualified health professionals who do decide to stay in their home country, are by no means staying in the medical professions and are instead looking to earn more by taking up jobs as disparate as sales executives to waiting staff (incidentally earning more than they did in their chosen profession).

It is sad that the pay rates are so low in the CEE countries that a waiter can earn more than a paramedic, and certainly these issues need to be addressed, but it is my hope that worker migration will draw attention and eventually government action to these issues rather than drain the local workforces completely.

Lastly, it is also a fact that if some of the richer countries who are doing most of the draining, actually invested the money in making their health systems a viable place to build a career, they may actually attract some local talent and render the need for imports irrelevant.

Somehow, I doubt this is the European market economy that Central Europe dreamed of - but they are proving to be quick learners and utilising their hard earned knowledge on the surrounding members to be.


Jakob Mauritz said at April 1, 2005 7:06 AM:

Just to be a smartass, I wanted to correct one of Mr. Parkers statements: Romania is not a member of the european union.

Randall Parker said at April 1, 2005 9:19 AM:

Jakob Mauritz,

You are quibbling. Romania is currently sorta in the waiting room. It is scheduled for full membership on Jan 1, 2007.

gina said at April 25, 2005 8:56 PM:

there is plenty of room for experienced doctors from hungary in australia ..i will help

dr.Ayuk Julius said at April 17, 2006 2:16 AM:

i am a medical doctor from Cameroon.i am interested in working in Hungary or Romania

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