THE INFLUENCE OF PERSONAL AND PROFESSIONAL VARIABLES UPON THE NATURE OF IMMIGRATION OF ROMANIAN DOCTORS TO FRANCE: THE MODERATING EFFECT OF GENDER.

• Author: Saghin, Despina

1. Introduction

   This paper aims to analyze the particularities that underline the phenomenon of Romanian doctors' migration, given that the doctors' tendency to permanently live outside the country has a negative impact on healthcare services in Romania. The migration of healthcare personnel is crucial to the comprehension of the 'brain drain phenomenon', all the more since doctors play an important part in the accomplishment of good quality of life in the country of origin.

   Our interest in the study of Romanian doctors' migration resides in the unprecedented dynamics of this phenomenon, which was the result of the EU-wide recognition of the medical degree obtained in Romania, starting on January 1st 2007. For Romanian healthcare personnel, their country's accession to the European Union (EU) implied the opening of 'a royal gateway to migration' (Tandonnet, 2003, p. 109), heralding an intensification of the intra-community migratory phenomenon because of the newly created opportunities of free circulation, settlement and work opportunities in this enlarged area (Mouhoud, 2007; Stanica, 2007; Ionescu, 2008; Michalon and Nedelcu, 2010).

   The international migration of Romanian doctors represents a response to the particular problems that, on the one hand, the developed countries in the EU and, on the other hand, Romania, are confronted with. Specifically, the economic decline Romania recorded during the most recent financial-economic crisis (2008-2011) has had negative long term impacts on the Romanian healthcare system. The austerity measures and structural reforms adopted by the Government in response to the crisis (Law no. 118/2010) were considered among the most severe in Europe (e.g. Stoiciu, 2012), and enforced a cut of 25% of the wages of public employees, doctors included, and a structural reorganization of the health-care system, with the shutting down of 67 hospitals. Prior to the onset of the crisis and in the following years, the average wage of a Romanian physician represented only a 10th of the average wage of a French physician (Romanian Medical Council, undated), which, coupled with other economic and personal factors related to superior living conditions in the destination country and the prospects of professional advancement, basically provided the background for migration. Added to this, other drivers such as corruption, distrust in the state institutions and the state's inability to ensure optimal conditions for the exercise of the medical profession (e.g. European Commission, 2012), further explain the sharp rise in the migration of physicians.

   The recruitment of highly qualified human capital in the healthcare area constitutes a convergence point of the migratory policy led by the developed states (Skeldon, 2009). The demographic situation of these countries calls for an increase in medical staff to allow them to be able to cope with the specific problems of the time. The ageing population and the growing number of seniors call for the creation of new jobs in healthcare and social fields, given the fact that the elderly need special care. The ageing of the population and the increasing number of the elderly is simultaneous, in certain developed countries of Europe, with the ageing of medical staff, while the shortage of healthcare personnel cannot be filled by indigenous labor (Vasilcu and Sechet, 2010). Parallel with a life expectancy increase, the French population is getting older. In 2012, people aged 60 or more, represented 30.03% from the total population, and the elderly, aged 75 or more, were around 27% of the total number of the elderly (French National Institute of Statistics and Economic Studies, undated). This trend will likely trigger an increase of expenses in the health sector, and as a result the need to incorporate migrant specialists into the system will become stronger.

   Furthermore, France is also facing an aging of medical staff, given that in 2014 the average age of French doctors was relatively high, despite generational renewal: 53 years for men and 49 years for women. In 2015, 26.4% of the practitioners which were members of the Medical Order of France, were over 60 years old and 23% of physicians in activity were retired (Conseil National de l'Ordre des Medecins, 2014, 2015).

2. Romanian 'medical brain drain'

   The sharp increase in the migration of Romanian healthcare personnel can be seen as a direct consequence of the social and spatial inequalities in Romania and of the legitimate needs of human beings (Simon, 2008). The decision to emigrate is the result of an array of both external factors--pertaining to economic, social and political areas --and internal or personal reasons, consisting of the aspirations of the people who make the decision to move from one place to another. In the case of many Romanian doctors, emigration appears the result of an individual or family project, in which the personal and professional sides are inseparable; thus the general tendency leans in favor of settling down in the destination country (Guillaume, 2009).

   The periods of economic decline had a negative impact on the healthcare system in Romania and on the standard of living in general (Beine, Docquier and Rapoport, 2009; Stoiciu, 2012). Consequently, the underfunding of the healthcare system appears as one of the major causes leading to the brain drain. As opposed to the fact that in Romania the average allocations to the healthcare budget in the last 20 years represents 3.2% of the gross domestic product, Central and Eastern European countries have allotted 7.3%, while the states of the Organization for Economic Cooperation and Development have allotted between 10 and 12%. Despite the World Health Organization's recommendations regarding the increase in funding allotted to the field and the cover of minimal healthcare costs, Romania has been unable to fulfill these indicators (e.g. World Health Organization, 2010).

   The lack of involvement on the part of the political stakeholders and the incapacity of the Romanian government to promote effective policies to keep healthcare personnel in the national system, correlated with the austerity measures taken in recent years, have generated a wave of general discontent.

   More specifically, in 2011, on the background of an already visible migration of physicians, the austerity measures introduced by the Government to reform the healthcare system, resulted in the closing down of 67 of the total 435 hospitals, with the cutting of 5,700 hospital beds, of medical staff licensing and wages (e.g. Stoiciu, 2012). Such measures have drastically limited the access of a large part of the population to healthcare services. In addition, the Romanian health system is also vulnerable owing to the additional costs of medications.

   The structures of social, economic and political life in Romania reflect themselves on the life of its citizens and act as repulsive factors, encouraging the migration phenomenon. On this vulnerable terrain, the active recruitment policy led by the agencies in the developed countries has been fruitful: we are currently witnessing a real drain of the 'white coats'. For instance, since 2007 to the present day, more than 15,000 specialist doctors out of the 40,000 doctors licensed to practice medicine, i.e. over 37% of the licensed doctors, have left Romania (Curentul, 2014). According to the rules imposed by the WHO, if 2% of the doctors that are practicing in a country emigrate, the powers-that-be must give a 'red alert'. As such, this dramatic situation in the Romanian health system calls for urgent stimulating measures, directed towards limiting the migration phenomenon, taking into consideration the fact that in Romania, the lack of doctors alarmingly increased to 40-42% in 2014 (Romanian Medical Council, undated).

   According to The Romanian Medical Council the emigration potential of Romanian doctors is very high, and so is the projected increase of the share of emigrant Romanian doctors in the next three years (Mediafax, 2016). Moreover, as a result of European inter-university exchange programs, an increasing number of medical students opt to complete their degree in European universities, which enables them a quicker integration into the destination society. Under these circumstances, as they do not need the certificate of conformity delivered by the Romanian ministry, these students are not registered in any Romanian statistics.

   The research in the field shows that 'the skill and brain exchanges' (Fall, 2010, p. 223) normally enable both the country of origin and the country of destination to benefit from the professional experience acquired by the expatriated medical personnel. But can we really speak about a 'brain gain' in the case of the Romanian doctors' migration, as long as most of them appear to have the firm intention of settling down in France? How could they readjust to the living conditions in Romania after their life experience in a developed country? Furthermore, from the professional angle, the return to Romania of specialist doctors who practiced in France is at one point virtually impossible, since there are certain top specialties that require advanced medical technology that cannot be found in Romania.

   Even though at first the difficulties of adjustment to a new society make many immigrants contemplate the idea of going back to their country of origin, the time spent in the developed country plays a major part in respect to the representations about and sense of belonging to that particular society (Rachedi, 2009). The longer the period of practice and the greater the investments in the country of destination, the stronger the feeling of alienation of the Romanian doctors towards their native country and the less envisaged the idea of returning to Romania. The professional integration and the recognition by the medical body and by the social environment are the keys to integration in the...