The United Kingdom's vote to leave the European Union (EU) was associated with major changes in health care worker migration and worsening physician shortages in England, according to a new study published in JAMA Health Forum.

Researchers found that the 2016 Brexit referendum led to an immediate decline in doctors and nurses arriving from EU countries. Although recruitment from non-EU countries increased in the following years, physician vacancies in England's National Health Service (NHS) continued to grow.

Like many high-income countries, the UK relies on internationally trained health professionals to meet workforce needs. Before Brexit, health care workers from EU countries could move relatively freely to the UK. Researchers examined how the 2016 Brexit referendum affected migration patterns and workforce shortages.

Researchers from the Harvard Pilgrim Health Care Institute, Massachusetts General Hospital, London South Bank University, and the WHO Europe Human Resources for Health Group analyzed health workforce data from 2008 to 2019, including more than 418,000 physicians and 358,000 nurses who migrated to Organization for Economic Co-operation and Development (OECD) countries. The study used quasi-experimental methods, such as a controlled interrupted time series design, to compare the UK with 32 high-income OECD countries from before to after the 2016 referendum.

The Brexit referendum was associated with an immediate drop of about 825 physicians and 2,771 nurses arriving from EU countries in 2016. In subsequent years, immigration from non-EU countries rose by an estimated 3,110 physicians and 1,437 nurses annually. Despite those gains, England's NHS physician vacancies increased by an estimated 383 positions, while overall nurse immigration declined.

The Brexit referendum changed where the United Kingdom recruited its health care workforce, with fewer clinicians arriving from Europe and more from countries in Africa and Asia. Our findings show that these shifts were not enough to prevent growing physician shortages within the National Health Service."

Tarun Ramesh, lead author and research fellow, Harvard Pilgrim Health Care Institute

The researchers also found that migration from EU countries began declining well before the UK's formal withdrawal from the European Union in 2020, with important implications for health care workforce planning.

"Health care workforce migration is highly sensitive to policy signals. Even before the UK formally left the European Union, uncertainty surrounding future immigration rules was associated with substantial changes in the flow of doctors and nurses into the country," said senior author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute.

The researchers say policymakers considering immigration restrictions should weigh the potential effects on health care staffing and access to care, as well as the risk of growing reliance on clinicians from countries that may already face their own workforce shortages.

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