Factors influencing emigration decisions among Bulgarian health professionals

Abstract Background Migration patterns of health professionals are influenced by a variety of factors, including personal, economic, social, political, and cultural ones. This study aims to investigate the factors that influence the emigration decisions of both Bulgarian health professionals who have been abroad and those without such experience. Methods A cross-sectional study was conducted in 2022 using an online questionnaire among 447 health workers in Bulgaria. The influence of factors on health professionals’ decision to migrate was measured on a 4-point scale (from “no influence” to “very strong influence”). The factors were grouped into three levels - macro (country and health system), meso (health facility) and micro (individual). Mann-Whitney U test was used to examine differences between the two groups of health professionals at a 0.05 significance level. Results At macro level, a higher standard of living in the destination country was the primary factor influencing the emigration decisions of the individuals who have been abroad (n = 109), with a mean value of 3.62 (p < 0.001). Conversely, the opportunity to work in a better-organized health system was the predominant motivator for those without such experience (3.36, p < 0.035). At meso level, remuneration received (3.70, p < 0.001) was the most significant driver for the individuals with a migration background, while better working conditions (3.31, p < 0.006) had the strongest influence for the other group. At micro level, both groups agreed on the importance of enhanced recognition of the medical profession abroad (3.69 vs. 3.49, p < 0.013) as a key determinant. Conclusions On the whole, health professionals with no migration experience exhibited lower mean values for the observed factors. Furthermore, economic drivers appeared to be more significant for respondents with a migration background, while the other group attached greater importance to the motives related to the health system and the profession. Key messages • Health workers migrate for a variety of reasons with economic motives playing a pivotal role in shaping migration decisions. • Recognizing the motives that predominantly impact migration attitudes is a crucial step in the development of appropriate retention policies.