Health Policy 118 (2014) 173–183 Contents lists available at ScienceDirect Health Policy journa l h om epa ge: www.elsevier.com/locate/healthpol First- and fifth-year medical students’ intention for emigration and practice abroad: A case study of Serbia Milena M. Santric-Milicevic a,b,* , Zorica J. Terzic-Supic a,b , Bojana R. Matejic a,b , Vladimir Vasic c , Thomas C. Ricketts III d a Institute of Social Medicine, Faculty of Medicine University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia b Centre – School of Public Health, Faculty of Medicine University of Belgrade, Pasterova 2, 11000 Belgrade, Serbia c Department of Statistics and Mathematics, Faculty of Economics University of Belgrade, Kamenicka 6, 11000 Belgrade, Serbia d Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 M.L. King Blvd CB 7590, Chapel Hill, NC 27599-7590, USA a r t i c l e i n f o Article history: Received 7 August 2013 Received in revised form 29 September 2014 Accepted 30 September 2014 Keywords: Human resources Emigration Intention Medical students Motivation Salaries and fringe benefits Serbia a b s t r a c t Health worker migration is causing profound health, safety, social, economic and political challenges to countries without special polices for health professional’ mobility. This study describes the prevalence of migration intentions among medical undergraduates, identi- fies underlying factors related to migration intention and describes subsequent actions in Serbia. Data were captured by survey of 938 medical students from Belgrade University (94% response rate), representing two thirds of matching students in Serbia stated their inten- tions, reasons and obstacles regarding work abroad. Statistical analyses included descriptive statistics and a sequential multivariate logistic regression. Based on descriptive and infer- ential statistics we were able to predict the profile of first and fifth year medical students who intend or have plans to work abroad. This study contributes to our understanding of the causes and correlates of intent to migrate and could serve to raise awareness and point to the valuable policy options to manage migration. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Health worker emigration due to professional, social, economic, political, individual and other reasons is caus- ing profound health system challenges to some countries, in particular to those lacking the special polices for health professional’ mobility [1]. Out-migration of physicians con- tributes to workforce shortages or maldistribution, which may, in turn, create inequity in healthcare access between * Corresponding author at: Institute of Social Medicine, Faculty of Medicine University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia. Tel.: +381 11 2643 830; fax: +381 11 2659 533. E-mail addresses: msantric@med.bg.ac.rs, msantric@yahoo.com (M.M. Santric-Milicevic). regions and restrict the improvement of health system performance [1,2]. The appearance of physician shortages [3] and rapidly growing demand for health care, induced waves of health worker migration after 2000; this move- ment was mostly from low to high income countries and from rural to urban areas [4,5]. China and some countries in Africa, Central and Eastern Europe and Oceania are becom- ing important sources of health workers for other countries [6]. In the recipient countries, foreign-trained physician ranged from below 1% of the total in Poland, to 20–30% in USA, UK, Canada and Australia and up to 39% in New Zealand [7,8]. Key migration motivators are professional development opportunities, better salaries, and higher safety and quality standards of living and working conditions, which are usu- ally included in the incentives offered by those who recruit http://dx.doi.org/10.1016/j.healthpol.2014.09.018 0168-8510/© 2014 Elsevier Ireland Ltd. All rights reserved.