Abstract
Background. Emigration of healthcare professionals, particularly physicians, is an unresolved “pandemic”, influenced by various factors. In high-income countries, the training phase (fellowship) abroad is critical for career development, yet it poses challenges for the retention of these professionals upon their completion of training. This study aimed to identify the determinants influencing Israeli physicians' decisions to return to their home country after completing fellowship training abroad.
Methods. This cross-sectional study conducted in early 2024, surveyed Israeli physicians with post-graduate training who pursued a fellowship abroad between 2013-2024. An anonymous survey included questions on demographics, training experience, and professional challenges. Analytical methods included descriptive statistics and regression analysis to explore factors associated with the decision to return.
Results. Of the 323 individuals surveyed, 297 met the inclusion criteria. Among them, 141 (47.5%) have returned to Israel, while 156 (52.5%) currently reside in their fellowship country. Respondents identified several significant challenges, including a complex and demanding application process (47% of responders stated this as a major challenge), substantial financial burdens averaging 35,546 USD in direct out-of-pocket expenses, and job uncertainty, with only 55% having secured positions upon return. Of the 155 Israeli fellows still abroad, 107 (69%) reported medium to low confidence in returning. Factors associated with a higher likelihood of confidence in returning to Israel included a secured job position upon return (OR 8.6, 95% CI 3.1-28.9) and having an opportunity for a position that would utilize the skills gained during the fellowship (OR 3.5, 95% CI 1.3-10.2).
Conclusion. The decision to return to the origin country after a fellowship abroad involves a complex interplay of professional opportunities, personal circumstances, and geopolitical factors. Enhancing occupational certainty after fellowship can increase return rates, ensuring the sustainability of the healthcare system in Israel. These findings have implications for health care policy, suggesting the need for policies that support returning physicians and address the challenges they face.