Brain Gain

Germany is one of the main beneficiaries of the brain drain from poorer countries, which are losing professionals trained at high costs.

BERLIN (Own report) - Germany is among those countries, which is benefiting most from the influx of highly qualified workers from poorer European regions, according to a recent study of the Vienna Institute for International Economic Studies (WIIW). The number of professionals coming from Eastern and Southeastern Europe is rapidly increasing, particularly in the health sector. This brain drain is creating huge problems in their countries of origins - also in view of the Covid-19 pandemic. For example, in Poland, the ratio of medical doctors and nurses per 100,000 inhabitants is about half as high as that in Germany, in Albania it is even lower. The German government, denying that this is having a negative impact on the countries of origin, speaks of an alleged win-win situation. However, resistance is growing at the European level against the drain of professionals. The countries of origin usually had to invest large sums for their training - investments from which the wealthy western and northern EU countries, particularly Germany, are profiting.

Go West

According to a recent study published by the Vienna Institute for International Economic Studies (WIIW) the German health sector is recording a considerable influx of foreign-trained doctors and nurses.[1] Between 2010 and 2017 the share of foreign-trained doctors increased from around 7 to 12.5 percent and that of nurses from around 6 to 8 percent. The German Medical Association's data for 2019 confirms this trend: Compared to the previous year, the number of doctors immigrating to Germany from EU countries increased by 2.7 percent and those immigrating from other European countries by even 10.4 percent.[2] According to the WIIW study by Isilda Mara, the balance is nevertheless slightly negative because, at the same time, many German doctors emigrated to take up better paid jobs in Switzerland or other countries. Sixty percent of the doctors, who chose to work in Germany, come from Romania, Hungary, Bulgaria, Poland and the Czech Republic. Many of the nurses also come from Eastern Europe and since some time increasingly from Southeastern Europe, such as Serbia, Albania or Bosnia-Herzegovina.

"Triple Win"

The German government is pursuing an active recruitment policy to attract foreign nurses. In 2012, in collaboration with the German Association for International Cooperation (GIZ) and the Federal Employment Agency's International Placement Services (ZAV), it established a "Triple Win" project, promising benefits for all those involved. Within this framework, it has entered cooperation agreements with Serbia, Bosnia-Herzegovina, Tunisia, Vietnam and the Philippines. Berlin often uses dubious methods for the acquisition of nurses. "In Bihać, agencies are trying to poach personnel for work in Germany. They are not squeamish, proceed very aggressively and bombard nurses with mails and telephone calls," Evresa Okanović, the director of a Bosnian hospital reports.[3] The private sector is also involved. For example, in Ukraine, Albania, Bosnia-Herzegovina and Northern Macedonia, the Dekra Academy prepares linguistically and professionally nurses considered suitable and willing to emigrate for their new jobs far from home. "Even in the Philippines, Mexico and Brazil, nursing professionals are participating in qualification programs," the enterprises announced.[4]


Between 2010 and 2018, approximately 40.000 medical doctors left their countries in Eastern and Southeastern Europe to go westward. In their countries of origin, this outflow is creating significant shortages of medical professionals with devastating effects, particularly in the course of the current pandemic. Whereas Germany has around 420 doctors and 1.200 nurses per 100.000 inhabitants, Poland has 270 doctors and 680 nurses, and Albania only 150 doctors and 515 nurses.[5]

The Countries are Reacting

Therefore, Romania has banned medical professionals and nurses for the elderly from leaving the country. Given the high costs of training, Gheorghe Borcean, President of Romania's Medical Association is demanding compensation payments from the countries of destination: "It is not right to lose such a large number of doctors without compensation."[6] Serbia has begun calling on its doctors practicing abroad to return and has temporarily suspended the "Triple Win" Agreement. "Mr. Spahn will not get my nurses," declared President Aleksandar Vucic.[7]

"Promoting Development"

In its response to a parliamentary interpellation submitted by the Left Party, the German government has denied that the program is having negative effects on the countries of origin and erroneously imagines it to be in line with the World Health Organization's (WHO) code of conduct for international recruitment of health-care professionals. "Many health-care professionals do not find work in their countries of origin and seek employment opportunities abroad, among other places, in Germany, the German government alleges. The countries of origin, for example, are benefiting from the relief on the labor market, from the recruited professionals' remittances to their family members and from the exchange of knowledge through circular migration."[8] In this context, the GIZ even speaks of "promoting development."[9]

Massive Consequences

Medical specialists are not the only professionals, migrating from Eastern and Southeastern Europe. Other highly qualified professionals are also migrating. According to the Competitive Index compiled by the Davos World Economic Forum, eastern and southern EU member countries are among those countries of the world, who have the most difficult time in holding onto their well-trained professionals.[10] This wreaks serious damage on their economies, as a 2016 study of the International Monetary Fund (IMF) has shown.[11] The migration of mainly younger professionals contributes to a large extent to the ageing of the society, which in turn, leads to higher social and health costs. The countries in question must also write off a portion of their investments in education. At the same time, salaries must be raised to provide a greater incentive for staying, even though productivity - and therefore competitiveness - is sinking due to the exodus of the labor force. According to the IMF, the exodus during the years 1995 - 2012 has cost the nations of East and Southeast Europe a loss of 7 percent to their economic growth. As the authors note, the brain drain, in turn, has reinforced the economic chasm within the European Union.

"Vicious Circle of Disintegration"

In its position statement on the migration of highly qualified citizens, published in February, the European Committee of the Regions (CoR), an association of representatives of regions within the EU agrees with this analysis.[12] According to the committee, the emigration of the talented is simultaneously both the cause and the effect of the "existing social and economic imbalances between the EU regions." The committee warns of a "vicious circle of disintegration." The committee sees this development placing the long-term "sustainability of the European project" at risk, and recommends that the EU Commission take counter-measures.

"The Battle is Becoming Stronger"

Croatia is one of those countries most urgently calling on Brussels to take action. Zagreb had not only successfully demanded the establishment of an EU "Demography and Democracy" Commission, it was also able to place a Croat in its leadership. At Croatia's initiative, the theme has been placed on the EU's "Strategic Agenda 2019 - 2024." However, it still appears unlikely that the east-to-west migration flow and with it the brain drain at the expense of the Eastern and Southeastern European countries will be halted. In the health-care sector, WIIW's author Isilda Mara, expects the situation to even get worse, as the rise in life expectancy and the ageing of the population are generating a greater need for health professionals and a large share of health professionals is going to retire. "This battle is going to become stronger" warns Mara: "It has already intensified over the past two decades, and a number of wealthier European countries have been benefiting at the expense of poorer ones."[13]


[1] Isilda Mara: Health Professionals Wanted: Chain Mobility across European Countries. Research Report 445.


[3] Philip Jokić, Robert Putzbach: Abwerbung und Ausverkauf. Der Freitag 20/2020.


[5] Isilda Mara: Health Professionals Wanted: Chain Mobility across European Countries. Research Report 445.

[6] Abösesumme für Ärzte aus Osteuropa verlangt. Frankfurter Allgemeine Zeitung 21.04.2020.

[7] Britta Beeger, Andreas Mihm: "Herr Spahn bekommt meine Pfleger nicht". 19.02.2020.

[8] Antwort der Bundesregierung auf die Kleine Anfrage der Abgeordneten Andrej Hunko, Harald Weinberg, Pia Zimmermann, weiterer Abgeordneter und der Fraktion Die Linke. Deutscher Bundestag, Drucksache 19/16732. 23.01.2020.

[9] Nachhaltig ausgerichtete Gewinnung von Pflegekräften (Triple Win).

[10] Abwanderung von Hochqualifizierten in der EU: Bewältigung der Herausforderung auf allen Ebenen.

[11] Emigration and Ist Economic Impact on Eastern Europe.

[12] Abwanderung von Hochqualifizierten in der EU: Bewältigung der Herausforderung auf allen Ebenen.

[13] Andreas Mihm: Europas brutaler Kampf um Ärzte. Frankfurter Allgemeine Zeitung 21.07.2020.