The Ethics of Importing Your Healthcare Workforce

1 January 2026

I covered an increasingly hot topic last year about the special pathways opening up for healthcare workers across the world. (Canada, IMGs)

Health workforce shortages are global, driven by aging populations and post-pandemic burnout. To cope, wealthy nations are aggressively recruiting from abroad. The number of foreign-born nurses in the OECD has more than doubled over the past 20 years, and 1 in 4 doctors in the OECD was born abroad.

The IOM Outlook states the number of foreign-born doctors in OECD countries jumped 86% between 2000 and 2020, with an even bigger surge for nurses (136% increase over the same period).

I'll do a full post on this later, but the US, UK, and Germany are the top destinations, hosting 58% of all foreign-trained doctors and 61% of foreign-trained nurses in the OECD. Some countries rely heavily on imported talent. In Israel, New Zealand, and Ireland, over 40% of doctors are foreign-born.

Asia is the major hub of origin, accounting for 40% of migrant doctors and 37% of migrant nurses in the OECD. Top exporters for doctors are India (100K in OECD), Germany, and China. Top exporters for nurses are the Philippines (undisputed leader with ~280K in OECD), followed by India and Poland.

The Ethics

~89K doctors and ~257K nurses in the OECD come from countries on the WHO's "Safeguard List." These are countries with fragile health systems like Nigeria, Pakistan, and Haiti. There are serious ethical questions raised when vulnerable countries see essential staff emigrate at this scale. The obvious one being: what does it mean for quality of care in source countries when destination countries extract critical healthcare workers?

I know this post is already riddled with numbers, but a bombshell stat: Small island nations like Jamaica and Grenada have expatriation rates >50%, meaning more of their doctors work in the OECD than at home.

You can't blame any of the workers themselves, obviously, as they're going to go where the higher salaries, better working conditions, more research opportunities, etc. are. Should host countries be obligated to backfill or train workforces in source countries? Or should they simply be directed to train their own population instead? Maybe one of you who works in the space can opine on this.