WMA Statement on Ethical Guidelines for the International Migration of Physicians

Adopted by the 54^th WMA General Assembly, Helsinki, Finland, September 2003
Revised by the 65^th WMA General Assembly, Durban, South Africa, October 2014
and by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

The medical workforce is essential to global health care systems. Population growth in some parts of the world, combined with ageing populations in other regions have contributed to shortages in the health personnel workforce. While comprehensive and extensive workforce planning at a national and international level is required, this hasn’t always been a priority, leaving a global shortage of physicians, even in the wealthiest countries. A major reason for the shortage is a failure to educate and train enough physicians to meet the needs of the country. Other reasons for the net loss of physicians are the recruitment of physicians to other professions, early retirement and emigration, illness (including mental health problems), and the problems of combining professional and family responsibilities, all of which are often due to poor working conditions for physicians.

Physicians do have valid reasons for migrating, for example, to seek better career opportunities and to escape poor working and living conditions, which may include the pursuit of more political and personal freedoms and other benefits. The WMA acknowledges that temporary stays of physicians in other countries where they can work and train in other healthcare systems help both the receiving and the sending countries to exchange medical knowledge, skills and attitudes. The exchange of medical professionals is therefore beneficial for the development of medicine and healthcare systems and in general deserves the support of Constituent Members as well as governments.

The WMA Resolution on the Medical Workforce (2023) has stressed the need for comprehensive and gender equal measures to guarantee physicians’ well-being and safety via an adequate working environment, including in emergency contexts, with a strong emphasis made to the employer’s responsibility in ensuring this. The WMA also reaffirms its policies on WMA Statement on Non-Discrimination In Professional Membership and Activities of Physicians, WMA Resolution on Task Shifting from the Medical Profession, and WMA Resolution of Criminalisation of Medical Practice.

The WMA emphasizes the WHO Global Code of Practice on the International Recruitment of Health Personnel, established to promote voluntary principles and practices for the ethical international recruitment of health personnel and to facilitate the strengthening of health systems and that takes into account the “rights, obligations and expectations of source countries, destination countries and migrant health personnel”.

The Global health and care worker compact[1] provides Member States, stakeholders and other organizations with technical guidance on how to “protect health and care workers and safeguard their rights, and to promote and ensure decent work, free from racial and all other forms of discrimination and a safe and enabling practice environment”, in line with the WHO Global Code of Practice on the International Recruitment of Health Personnel.

RECOMMENDATIONS

The WMA makes the following recommendations to ensure physicians’ well-being and safety via an adequate working environment in the source and destination countries:

1. Constituent Members, governments and employers should exercise diligence in collecting global health workforce data. This data can be used to establish, strengthen and maintain a health personnel information system; ideally it should be available in real time, for better reactivity. The setting up of observatories on medical demography should be encouraged.
2. Every country should do its utmost to educate and train an adequate number of physicians, taking into account its needs and resources. A country should not rely on immigration from other countries to meet its need for physicians. Countries should explore strategies to mitigate negative effects of physician migration on “source” countries.
3. Every country should put resources into retaining its physicians in the profession as well as in the country (including those nationals who have studied medicine elsewhere) by providing them with the support they need to meet their personal and professional goals, taking into account the country’s priorities. This includes providing comprehensive induction to those new to the country and the system of working. All countries need to ensure adequate working conditions for physicians, including, but not limited to safe working conditions, manageable working hours, access to essential resources, including well-being support, and opportunities for professional advancement.
4. Physicians should not be prevented from leaving their home or adopted country to pursue career opportunities in another country.
5. Countries that recruit or receive physicians from other countries should ensure that recruiters provide timely, comprehensive and accurate information to potential recruits on the nature and requirements of the position to be filled on immigration, administrative and contractual requirements, and on the legal and regulatory conditions for the practice of medicine in the recruiting country, including language skills.
6. Physicians who are working, either permanently or temporarily, in a country other than their country of birth, adopted country or country of education, should be treated fairly and without discrimination in all aspects of the recruitment and employment process in relation to other physicians in that country (for example, equal access to career development and equal payment for the same work); grievance mechanisms should be considered.
7. Fair and equitable remuneration for physicians and all health and care personnel should be ensured as an important element of providing them with safe, healthy, supportive and dignified conditions of work.
8. Countries that wish to recruit physicians from another country should only do so in terms of and in accordance with the provisions of a Memorandum of Understanding entered between the countries. Further the international recruitment should be “conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health systems in developing countries”[2].
9. Nothing should prevent countries or medical institutions from entering into fair bilateral agreements and agreements of understanding, as provided for in international law and with due cognizance of international human rights law, so as to effect meaningful co-operation on health care delivery, including the exchange of physicians.
10. The monitoring and information-sharing system established by the WHO should be robustly supported with the goal of international cooperation. Stakeholders should regularly collate and share data, which should be monitored and analyzed by the WHO. The WHO should provide substantive critical feedback to governments. Information should be shared about how to overcome challenges encountered.

[1] Friedman EA, Bickford R, Bjork C, et al
The global health and care worker compact: evidence base and policy considerations
BMJ Global Health 2023;8:e012337.
[2] Para. 3.5 of WHO Global Code of Practice on the International Recruitment of health Personnel