BOSTON, MA — Britain’s decision to leave the European Union was followed by a rapid transformation in the way the country recruited doctors and nurses from abroad, according to a new study published in JAMA Health Forum. Researchers report that the 2016 Brexit referendum was associated with an immediate decline in the number of physicians and nurses arriving in the United Kingdom from European Union countries. Although recruitment from non-European countries increased in the years that followed, the additional inflow did not prevent physician vacancies from continuing to rise across England’s National Health Service. The findings suggest that immigration policy can reshape a national health workforce long before new rules formally take effect, with uncertainty itself acting as a powerful influence on where internationally trained clinicians choose to work.
The United Kingdom has long depended on internationally educated health professionals to supplement domestic medical and nursing graduates. Before Brexit, citizens of EU member states generally had the right to move to the UK and seek employment without the visa requirements imposed on workers from outside the bloc. This relatively open system helped hospitals and clinics recruit staff from across Europe, particularly in specialties and regions where local supply was insufficient. The referendum introduced uncertainty over future residence rights, professional recognition, employment conditions, and access to the British labor market. Even though the UK did not formally leave the EU until 2020, the study indicates that migration patterns began changing soon after the 2016 vote, revealing how political signals can affect health systems years before legislation is fully implemented.
To investigate the change, researchers from the Harvard Pilgrim Health Care Institute, Massachusetts General Hospital, London South Bank University, and the World Health Organization Europe Human Resources for Health Group analyzed international health workforce data covering the years 2008 through 2019. Their dataset included more than 418,000 physicians and 358,000 nurses who migrated to countries belonging to the Organization for Economic Co-operation and Development. The investigators compared migration to the UK with migration to 32 other high-income OECD countries. This comparison allowed them to estimate what might have happened in Britain if the referendum had not occurred, while accounting for broader international trends affecting the movement of health professionals.
The study used quasi-experimental statistical methods, including a controlled interrupted time series design. In this type of analysis, researchers examine whether a measurable event is followed by a sudden change in an outcome, while using a comparison group to distinguish the event’s effects from unrelated trends. Here, the referendum served as the interruption, and the other OECD countries provided a control for global fluctuations in health worker migration. The approach cannot establish causation with the certainty of a randomized trial, but it can identify whether the timing and magnitude of changes in the UK were substantially different from patterns observed elsewhere. The researchers also separated migrants by whether they originated in EU or non-EU countries, making it possible to track the geographic redirection of Britain’s recruitment strategy.
The estimated effects were striking. In 2016, the number of physicians arriving in the UK from EU countries fell by approximately 825 compared with the expected level based on previous patterns and comparison countries. The decline was even larger among nurses, with an estimated reduction of about 2,771 EU-trained nurses. These figures represent changes in annual migration flows rather than the total number of EU-trained clinicians already working in Britain. Nevertheless, even a single-year reduction can have substantial consequences in a health system operating with limited staffing reserves. Hospitals rely on a continuing flow of new workers to replace retirees, compensate for career changes, cover population growth, and maintain services during periods of increased demand.
In the years after the referendum, recruitment from outside the EU increased. The researchers estimate that immigration from non-EU countries rose by approximately 3,110 physicians and 1,437 nurses annually. This shift moved the UK’s recruitment base toward countries in Africa and Asia, where many clinicians have historically trained in systems influenced by British medical education. The increase demonstrates that governments can redirect international recruitment through policy, licensing pathways, and employer demand. However, replacing one source of health workers with another is not a simple numerical exchange. Doctors and nurses arriving from different countries may require separate credentialing procedures, language assessments, adaptation periods, and immigration sponsorship. The availability of workers abroad also depends on the staffing conditions of the countries from which they are recruited.
The expanded non-EU physician recruitment did not resolve shortages within England’s NHS. During the study period, physician vacancies increased by an estimated 383 positions, while overall nurse immigration declined despite the rise in recruitment from some non-EU nations. A vacancy is not necessarily identical to a permanently unfilled post; it can reflect an approved position that remains open while an employer searches for a suitable candidate. Persistent vacancies, however, can increase workloads for existing staff, lengthen waiting times, restrict service capacity, and contribute to burnout. The results therefore point to a mismatch between the number of clinicians entering the country and the workforce needs of the health service. Immigration can expand supply, but it cannot by itself correct shortages caused by training bottlenecks, retention problems, uneven regional distribution, or rising demand for care.
The researchers emphasize that migration began shifting before the UK’s formal withdrawal from the European Union. That timing is important because it shows that health worker mobility responds not only to enacted regulations but also to expectations about future policy. Clinicians deciding where to study, work, or settle may consider whether they will need a visa, whether their qualifications will continue to be recognized, whether family members can accompany them, and whether political debates signal a less welcoming environment. In economic terms, uncertainty can raise the perceived cost of migration even when the immediate legal framework remains unchanged. For health systems, this creates a planning challenge: workforce strategies based on current rules may fail if potential recruits respond to anticipated changes before those changes become official.
“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,” said lead author Tarun Ramesh, a research fellow at the Harvard Pilgrim Health Care Institute. “Our findings show that these shifts were not enough to prevent growing physician shortages within the National Health Service.” Senior author Hao Yu, an associate professor of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, said the findings demonstrate that health care workforce migration is highly sensitive to policy signals. The authors argue that governments considering immigration restrictions should evaluate effects on staffing and access to care, while also considering the ethical risks of increasing dependence on clinicians from countries that may face their own shortages. The study presents Brexit as a case study in how political change can rapidly reconfigure the global circulation of medical expertise, with consequences that persist well beyond the original vote.
Subject of Research: The effects of Brexit on international migration of physicians and nurses and on physician shortages in England’s National Health Service
Article Title: Health Care Workforce Immigration to the UK After Its European Union Membership Referendum
News Publication Date: 21 August 2026
Web References: https://doi.org/10.1001/jamahealthforum.2026.2868
References: Ramesh T, Leary A, Zhang F, Yu H. Health Workforce Immigration to the United Kingdom after the Brexit Referendum. JAMA Health Forum. Published online 21 August 2026. DOI: 10.1001/jamahealthforum.2026.2868.
Keywords: Brexit, United Kingdom, health workforce migration, physician shortages, nurses, NHS, international medical graduates, EU migration, immigration policy, health care staffing, workforce planning, population health
