EU accession will open new opportunities for Ukraine: access to institutional expertise, professional development, and investment. At the same time, it may intensify one of the healthcare system's greatest challenges — the migration of medical workers.
The question of healthcare worker migration is often framed as a threat to be stopped. In reality, it is more complex: the challenge is how to manage mobility in a way that keeps the healthcare system functional, accessible, and capable of development.
The problem of healthcare worker shortages predates the full-scale war. The system faces uneven distribution of staff, shortages of specialists in certain regions, and professional burnout among medical personnel. European integration risks making these problems even more pronounced.
Ukraine enters the EU integration period with pre-existing workforce imbalances. Physician density is close to the EU average, but nurse density is roughly half that figure. As a result, the nurse-to-physician ratio in Ukraine stands at 1.1, compared to an EU average of 2.3. This means that even without significant migration, the system is already operating with a less optimal workforce composition than most EU member states.
Nurses underpin the day-to-day operational capacity of any health system — providing continuous care, delivering services, and coordinating across teams. A rapid decline in nursing staff would gradually erode the system's ability to function reliably.
Why Migration Takes the Shape It Does
The analysis shows that migration patterns are shaped by the interplay of several independent but interconnected factors. Some examples:
Economic gaps. In 2025, the average physician salary in Ukraine was UAH 26,161 per month — approximately $8,000 per year in real terms. For cross-country comparison purposes, this is equivalent to around $26,700 in purchasing power parity (PPP) terms, while physicians in Bulgaria earn approximately $55,000, in Poland around $90,000, and the OECD average exceeds $93,000 (all in PPP). Even a gradual economic recovery will not close this gap in the near term.
The selective nature of outflows. Migration is most prevalent among young professionals, skilled specialists with language proficiency, staff in rural and frontline areas, and those who feel their career development is constrained. This means the system disproportionately loses some of its most competitive human capital.
An ageing workforce. Roughly a quarter of all physicians are at or approaching retirement age. More than half of family physicians are over 50, and nearly a third are over 60. In some rural and frontline communities, the retirement of these specialists within the next five years could leave residents without access to primary care — unless replacement pipelines are established well in advance.
A narrowing educational pipeline. Since the start of the full-scale invasion, the number of contract-based applicants to medical universities has fallen by 86.9%, largely due to a drop in international students. More than a third of medical school graduates do not proceed to internships. This means the system is already failing to replenish the next generation of specialists, even before they reach clinical practice.
Three Possible Trajectories
The report outlines three scenarios for how healthcare worker migration may evolve, depending on external conditions and domestic policy responses.
The baseline scenario reflects a continuation of current trends with no substantial policy or governance changes. Migration remains steady while workforce challenges gradually accumulate. This does not lead to a sharp deterioration, but it also does not enable the system to build greater resilience.
The worst-case scenario combines unfavourable structural conditions with weak post-accession policy. Staff reductions increase workloads, which in turn drives higher migration intent, leading to further staff reductions. Rural and frontline areas are particularly vulnerable, and the breakdown of primary care in these regions takes on a systemic character.
The mitigated scenario is not about eliminating migration, but about changing its nature. Under this trajectory, mobility becomes more temporary and reversible, and the system retains sufficient workforce capacity through coherent, coordinated policy across multiple domains simultaneously: financing, governance, regulation, facility-level management, and education.
Countries that joined the EU in earlier waves — including Croatia and Poland — demonstrate that healthcare worker migration increases following accession, but does not necessarily lead to systemic collapse. What proves decisive is whether a system prepares in advance or responds after the fact.
For Ukraine, the central question is not whether healthcare workers will move. The question is whether that mobility becomes a one-way outflow, or is transformed into a managed process compatible with a resilient health system.
For a fuller account of the drivers of migration, the connections between them, and examples of workforce retention policies that have failed or succeeded — see the report.
The report "Scenarios for Healthcare Worker Migration in the Context of EU Integration" was prepared by the Ukrainian Health Center (UHC) together with Maastricht University, with the support of the Government of the Netherlands.