Why do Polish healthworkers want to work abroad?

INTER DI ARY IPLIN CONF SC EIIC Electronic International Interdisciplinary Conference September, 2. - 6. 2013 ENCE ER Why do Polish healthworkers want to work abroad? Agnieszka Wyrozębska Paweł Wyrozębski Ewa Dmoch- Gajzlerska Institute of Obstretrics and Gineacology Medical University of Warsaw Warsaw, Poland [email protected] Department of Project Management, Warsaw School of Economics (SGH) [email protected] Institute of Obstretrics and Gineacology Medical University of Warsaw Warsaw, Poland [email protected] Abstract — The goal of the research was to analyze the factors affecting the desire to find a job abroad among young Polish health care workers on the basis of determining the emigration plans of students and trainees of Medical University of Warsaw. Empirical studies were based on a survey distributed among undergraduate students and graduates of MUW. The biggest impact on the willingness to seek employment in another country are higher wages, better working conditions, greater opportunity for professional development, positive feedback from health professionals and a lack of job stability in Poland. The strength of individual factors for emigration varies between representatives of different faculties (students of medicine, nursing, midwifery, dietetics, public health, physiotherapy and pharmacy). The percentage of people who consider leaving is higher among people from better-off families. Keywords- emigration, migration from Poland, healthcare worker, brain drain I. INTRODUCTION Investigation into the causes and effects of human territorial mobility was subject of interest for researchers for many decades. The first subject was taken already in 1885 by Ernest Ravenstein. He saw the relationship between decision to migrate with other factors, such as nuisance law in his country, high taxes, an unattractive climate or even inappropriate social environment [1, 2, 3]. Since the publication of Ravenstein's work, many researchers undertook attempts to analyze the causes of population mobility. Particular attention was paid to migration movements of high-skilled workers (including, in particular, health care workers). Factors that influence the decision to migrate and the choice of destination country migration are varied. Many reports and publications published around the world present the subject of the causes of migration of health workers with regard to different systems of classification. The research in causes of migration movements of medical staff is currently undertaken by many organizations related to the health sector in the world, including the World Health Organization (WHO). According to WHO the factors related to work organization include heavy workload, unsatisfactory pay, high risk work, poor personnel management practices (authoritative decision making, favoritism of particular employees), inadequate and limited access to medical equipment, lack of opportunities for professional development (i.a. access to and exchange of expertise) and social respect for the medical professionals. The reason for the decision to leave their home country is also irresponsible human resource management policy (including lack of migration policy aimed at retaining health professionals in the country) or its weak implementation. Environmental factors consist of: bad condition of the national economy (high inflation), relatively lower growth opportunities compared with those of the host country, a sense of security in their home country (war, violence) and climate. Determinants that may affect the decision of going abroad are also the young age and marital status (singles). The WHO defines individual and family reasons for the migration of health professionals as: a higher level of education, transfer of knowledge and skills, knowledge of the target language country of emigration, positive reference from friends and relatives who live abroad. The scale of emigration of health professionals is influenced as well by other factors that are not included in the previous groups, such as the activity of headhunting companies, labor legislation, immigration policy and the system of recognition of professional qualifications in the host countries [4, 5]. Factor that has significant impact on the direction of migration is the geographical and language proximity of countries. For example, the Austrian doctors frequently work in Germany, and the increasing number of German students plans to start education in Austria. The interest in studying medicine at Austrian universities become so large that the Austrian authorities posed restrictions on the number of foreigners admitted to college, reserving 75% of the Austrians, 20% of EU citizens and 5% for third-country nationals [5]. A different concept for classification of people’s motives to leave their home country was established in the theory of Everett Lee in 1966. The theory is known as the “push-pull action” takes into account two group of factors: one that pushes outside the country (push factors) and the second one that attracts people to settle down (pull factors). The push factors include factors relating to the place/country of origin. This group may include: economic conditions, high unemployment in the country of origin, as well as the necessity of the repayment of the debt. Pull factors, on the other hand, refer to the place/country of destination, and provide incentives to settle immigrant. Lee’s model presupposes the existence of another factor, the so-called indirect barriers (interfering obstacles) called frictional factors. These include those arising from cultural differences, distance and associated costs of The 2nd Electronic International Interdisciplinary Conference SECTION http://www.eiic.cz/ 6. Psychology, Sociology and Pedagogy, Social Science, Families, Work, Activism, Lifestyle Choices - 270 - INTER DI ARY IPLIN CONF SC EIIC Electronic International Interdisciplinary Conference September, 2. - 6. 2013 ENCE ER moving, as well as instruments immigration policy in the host country [3,9]. Valuing the push and pull factors is subjective in nature and often differs from reality. While the place of residence and his environment is well known, the perception of target place of emigration is often based on incomplete information and with great uncertainty [6]. B. Push-pull theory explains the phenomenon of migration as the sum of pushing and pulling factors that can be related to migration of health workers [7,8,9]. Undoubtedly the key incentive to leave (pull factor) is the remuneration of employees, which significantly differs between individual states. Occupational migration to developed countries, in addition to the possibility of obtaining a higher income also allows the moving person to develop their professional skills. [10] Next to the unsatisfactory earnings important push factor which drives Polish doctors to seek work abroad, is difficulty in making medical specialties [11, 12]. Once verified, there were finally 2007 fully completed, valid questionnaires, which amounts to 68% of the targeted population. The variety of factors that influence the decision to leave the homeland is determined as well by the features of the country of ones origin. In 2003, the WHO Regional Office for African States published a report on the migration of health professionals in six countries of the continent. The study involved 2,364 workers in the health sector at various levels - from the nurses to specialist doctors. The conclusions of the research showed that apart from determinants of individual workers the causes of emigration exhibit characteristics typical for the each country [13]. For example, in Cameroon obstacles to career development, low standard of living and a desire to acquire new skills were the factors that often influenced the decision to emigrate in more extensive way than higher wages offered by the host country [14, 15]. Meanwhile, among the medical staff of Uganda and Zimbabwe better financial condition were the most important motives to work in another country [16, 17]. Higher wages and a desire to improve the living conditions are factors, which very often determine the emigration of health professionals. This factor positively correlates with the difference in wages between home country and the host country. The analysis of the research conducted by Vujicic shows that the income a doctor or nurse in Africa may be several times lower than in Europe or the United States, even when taking into account differences in the cost of living among the countries [2]. The reasons underlying the decision on permanent migration and labor are diverse and often difficult to grasp. Motives for emigration of health professionals often merge into each other, connect, but sometimes camouflage. It is therefore very difficult to select one reason that leads health care workers to look for a work outside the country. A. Aim of the study The goal of the research was to analyze the factors affecting the desire to find a job abroad among young Polish health care workers on the basis of determining the emigration plans of students and trainees of Medical University of Warsaw. Materials and methods The survey was addressed to a group of 3,026 last year students and alumni of the Medical University of Warsaw throughout the 4 academic years of 2007/2008, 2009/2010 and 2010/2011. For statistical data analysis researchers used specialist statistical software package SPSS 17 and Statistica 9.0. II. RESULTS The key research issue of the study was to explore the determinants of willingness to seek work abroad. Respondents were asked to indicate the importance of given factors: better remuneration, better working conditions, greater opportunity for professional development, positive reference from other health workers, better interpersonal relationships in the workplace, lack of job stability in Poland, family reasons, etc. Factors were assessed in a five-point ordinal scale (Table I). TABLE I. TABLE I. DESCRIPTIVE STATISTICS AND AVERAGE RANK OF VARIABLE: FACTORS INFLUENCING SEEKING WORK ABROAD Factors influencing seeking work abroad n better remuneration 1 993 4,80 0,553 5,90 1 993 4,51 0,754 5,38 1 980 3,99 0,992 4,44 1 977 3,62 0,972 3,75 1 982 3,07 1,094 2,84 1 983 3,47 1,231 3,62 1 980 2,31 1,269 2,07 16 4,50 1,095 better working conditions professional development positive reference from other health workers better interpersonal relationships in the workplace lack of job stability in Poland family reasons other Mean Standard deviation Average rank Source: own study Analysis conducted with Friedman test showed that the average rank assigned to each factor differ significantly (Chi2 = 5623.73, df = 6, p = 0.0001). According to the respondents higher remuneration has the greatest impact on the willingness to look for work in another country (average rank of 5.9). Other factors followed in order of importance were: better working conditions (average rank 5.38), greater opportunity for professional development (average rank 4.44); positive reference from other health professionals (average rank 3.75), lack of job stability in Poland (average rank of 3.62.) Far less important for respondents in the decision to seek a work abroad are such factors as: interpersonal relationships in the workplace (average rank 2.84) and family reasons (average rank of 2.07.) The 2nd Electronic International Interdisciplinary Conference SECTION http://www.eiic.cz/ 6. Psychology, Sociology and Pedagogy, Social Science, Families, Work, Activism, Lifestyle Choices - 271 - INTER DI ARY IPLIN CONF SC EIIC Electronic International Interdisciplinary Conference September, 2. - 6. 2013 ENCE ER Students of midwifery found unsatisfactory interpersonal relationships and lack of job stability in Poland as the strongest factors that determine abroad job search. For future dietitians major determinant of migration were greater opportunity for professional development in a foreign country. For future managers of public health (public health faculty) and physiotherapists the strongest factor were the lack of stability in the Polish labor market. Trainees for the pharmaceutical industry pointed to greater opportunity for professional development as the most important factor influencing their desire to look for a job abroad. TABLE III. AVERAGE RANK OF FACTORS AFFECTING THE WILLINGNESS TO SEEK WORK ABROAD VS. FIELD OF STUDY l a t i o n medical nursing midwifery dietetics public health physiotherapy pharmaceutics total medical nursing midwifery dietetics public health physiotherapy pharmaceutics total medical nursing midwifery dietetics public health physiotherapy pharmaceutics total medical nursing midwifery dietetics public health physiotherapy pharmaceutics total medical 680 375 101 87 335 83 332 1 993 680 376 101 87 335 83 331 1 993 676 373 101 86 333 83 328 1 980 671 375 100 87 335 81 328 1977 675 Average rank 1007,72 1067,09 1023,12 1062,60 905,92 1058,64 947,23 Chi2 (α = 0,001) 50,619 n nursing midwifery dietetics public health physiotherapy pharmaceutics total medical nursing midwifery dietetics public health physiotherapy pharmaceutics total medical nursing midwifery dietetics public health physiotherapy pharmaceutics total 375 101 87 335 81 328 1 982 673 375 101 87 335 83 329 1 983 676 374 100 87 334 82 327 1 980 Chi2 (α = 0,001) 1138,84 1176,17 1037,28 853,29 845,79 926,40 921,72 994,51 1152,14 1199,19 1047,72 1084,19 948,96 890,73 1170,75 1116,89 1052,37 1012,10 984,95 914,82 38,759 75,336 The analysis showed that the percentage of people who are thinking about leaving is higher among people who do not receive any form of financial assistance (Chi2=4,17; df=1; p=0,04). (Table III). TABLE III. GETTING SOCIAL SCHOLARSHIP VS. LOOKING FOR A JOB IN ONES PROFESSION ABROAD 1045,90 1060,62 1093,44 1067,10 834,21 1025,49 934,03 972,74 955,44 965,84 1212,53 895,82 1074,72 1091,16 974,14 1112,70 1112,03 1011,37 877,81 909,72 967,66 993,82 Chi2=4,17; df=1; p=0,04 61,570 40,351 41,300 Yes n No Field of study Average rank Field of study One of the research issues was the importance of the financial situation of the family of the respondents as one of the factors determining migration plans for students and trainees of the Medical University of Warsaw. Therefore one of the analysis examined whether the desire to find a job abroad is higher among students and trainees who receive any scholarship or other forms of financial aid and benefits from the University. Social scholarship positive reference from other health workers professional development better working conditions better remuneration TABLE II. family reasons The analysis shows that the specific fields of study differentiate factors affecting the strength of the desire to seek work abroad (Table II). For medical students of the most important factors were the favorable conditions of work and the opinions of health professionals employed abroad. The greatest impact on the desire to seek employment abroad among nursing students have financial benefits and interpersonal relationships in the workplace. lack of job stability in Poland The next step was to examine whether the strength of individual factors for emigration vary between representatives of different fields of study (students of medicine, nursing, midwifery, dietetics, public health, physiotherapy and pharmacy). Willingness to emigrate Total Yes No n 269 225 494 % of social scholarship 54,5% 45,5% 100,0% % of willingness to emigrate 23,2% 27,2% 24,9% % of total 13,5% 11,3% 24,9% n 891 602 1493 % of social scholarship 59,7% 40,3% 100,0% % of willingness to emigrate 76,8% 72,8% 75,1% 70,997 The 2nd Electronic International Interdisciplinary Conference SECTION http://www.eiic.cz/ 6. Psychology, Sociology and Pedagogy, Social Science, Families, Work, Activism, Lifestyle Choices - 272 - INTER DI ARY IPLIN CONF SC EIIC Electronic International Interdisciplinary Conference September, 2. - 6. 2013 ENCE ER % of total 44,8% 30,3% 75,1% Source: own study Another aspect of the study of factors affecting the desire to find a job abroad was their variability over time (Fig. 1). Kruskal-Wallis test showed that in only three cases, there were significant differences in the average ranks the intensity of factors depending on the year of the study:  1040 1020 998,34 1013,43 1039,44 1060 1050,94 1080 970,43 1000 942,15 948,67 980 960 941,88  better interpersonal relationships in the workplace (Chi2 = 11.579, df = 2, p = 0.003), lack of job stability in Poland (Chi2 = 10.807, df = 2, p = 0.005) and family reasons (Chi2 = 19.293, df = 2, p = 0.0001). 1066  940 920 900 880 better lackpoczucia of job lepsze relacje brak interpersonalne stabilności interpersonal stability pracy in wrelationships miejscu pracy w Polsce Poland in the 2010/2011 2009/2010 2007/2008 2010/2011 2009/2010 2007/2008 2010/2011 2009/2010 2007/2008 860 family względy rodzinne reasons Figure 1. Average rank of factors affecting the willingness to seek work abroad vs. academic year of research Source: own study III. DISCUSSION According to the research results the main factor influencing desire to look for a job abroad among the students and trainees of Medical University of Warsaw is better remuneration. Interestingly, despite some discrepancies in terms of the scale of interest in traveling abroad observed in other Polish studies in this topic, when considering the causes of this phenomenon results from other studies are very similar [18,19,20,21,22]. In each of the cited studies economic factor was a key determinant of departure, acting from 73-100% of all the factors affecting the decision to emigrate. The results of these studies confirm the discontent aroused by the financial situation in the Polish healthcare sector, particularly in relation to remuneration. The level of remuneration of Polish health workers in public health care is in fact not only disproportionately low compared to the salaries received by doctors overseas, but also in comparison with salaries in other sectors of the national economy. Research conducted by M. Vujicic, suggest however that the differences in pay between health workers in developing countries and highly developed are so big that even an increase in salaries in the home country is unable to stem the tide of emigration of doctors and nurses. Therefore only focus on other determinants of decision of leaving their home country, such as working conditions, career opportunities can have significant impact on reducing the scale of emigration [23]. Labor migration is not merely focused on meeting the daily financial needs but also is a way to increase ones human capital, which in the future would help to increase their social status. Decisions are taken also due to the desire to improve their qualifications and work experience, language learning, learn a new culture etc. [24,25]. Although emigration refers mainly to increased income in the household, it is simultaneously a kind of non-economic calculation of profit, which may carry up job abroad. This fact is also confirmed by the analysis of this research, which shows that the desire to find a job abroad is reported more frequently by people who did not receive in the course of studying the material support (maintenance grants) than the students who received such assistance. It can therefore be concluded that migration potential among young health care workers is not a result of the financial situation of the family. Similar observations can be drawn from the analysis of foreign studies, which show that, for the students of medical universities apart from higher wages very important migration factors are working conditions, career prospects and working arrangements offered by foreign labor markets. It is also important that the reasons for which young health workers decide to look for work abroad are different for representatives of various professions. A study shows that for future physicians the most important factor is the favorable conditions of work abroad but among nursing students alongside economic conditions, interpersonal relationships in the workplace are as well very important. Different reasons for the decision to emigrate give pharmacy trainees (greater opportunity for professional development), and physiotherapists (lack of stability in the Polish labor market). This inhomogeneity should be particularly taken into account by the authorities when considering design of future laws and strategy for restructuration of Polish health care. The main finding is the fact that the reasons for which representatives of various medical professions prefer to seek work abroad are different. All activities aimed at stopping excessive emigration among young health professionals should therefore consider these differences and respond to the needs of particular groups. The 2nd Electronic International Interdisciplinary Conference SECTION http://www.eiic.cz/ 6. Psychology, Sociology and Pedagogy, Social Science, Families, Work, Activism, Lifestyle Choices - 273 - INTER DI ARY IPLIN CONF SC EIIC Electronic International Interdisciplinary Conference September, 2. - 6. 2013 ENCE ER Increasing demand for medical staff, technology and demographic changes make the shortage of health workers a global problem [26]. The problem of excessive outflow of health workers, until recently affecting only sub-Saharan Africa, has become a serious threat to the sustainability of health care systems in all European countries. Therefore, Member States of the European Union face the need to take appropriate steps not only to train and develop, but also to prevent from leaving an adequate number of their own healthcare professionals. Otherwise, the passive approach of EU foreign policy will increase the negative effects of migration in both developed and developing countries. IV. CONCLUSION: The main factors influencing the willingness to look for work outside Polish borders are: more favorable financial terms offered by foreign markets, better working conditions and greater opportunity for professional development. Preventing migration of Polish medical workers therefore requires not only increase the salaries in the health sector but also to upgrade the working environment of young health workers in Poland. 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[26] Wyrozębska A, Matysiak A, Tatara T: Polish health care system workers emigration, especially complying Great Britain, Zdrowie Publiczne 2009; 119(2): 171-174 The 2nd Electronic International Interdisciplinary Conference SECTION http://www.eiic.cz/ 6. Psychology, Sociology and Pedagogy, Social Science, Families, Work, Activism, Lifestyle Choices - 274 -