The anatomy of a decision: exploring the push, pull, and personal factors of emigration intent among Turkish medical students

Abstract

Background

The migration intentions of medical students, often referred to as “brain drain,” pose a significant challenge to healthcare systems worldwide. This study aims to investigate the motivations for emigration, career preferences, and preparatory actions among medical students in Türkiye, a country experiencing significant physician outflow.

Methods

A cross-sectional online survey was distributed to medical students across Türkiye. The final sample included 1134 participants from 20 different medical faculties. Data were collected on demographics, motivations for studying medicine, specialty preferences, language proficiency, international experience, and intentions and preparations for working abroad or domestically.

Results

Motivations for studying medicine and specialty preferences differed significantly by gender. Female students were more driven by altruism and preferred nonsurgical specialties, whereas male students prioritized financial prospects, prestige, and surgical fields. The key predictors for intending to work abroad included higher parental education, advanced foreign language proficiency (especially English), and prior international experience. A third of the students (33%) expressed a desire to work abroad after graduation, with Germany, the UK, and the US being the top destinations. The primary push factors for emigration were demanding working conditions (70.8%), violence against healthcare professionals (64.1%), and systemic problems within the healthcare system (55.8%). A striking finding was 74.2% of the students who planned to stay in Türkiye were also making preparations to leave, indicating a deep-seated lack of confidence in the domestic healthcare environment.

Conclusion

A significant proportion of Turkish medical students intend to practice abroad, driven primarily by push factors related to working conditions and safety. The widespread preparatory activities, even among those stating an intention to stay, suggest that brain drain is a tangible risk. Retaining this future physician workforce requires urgent, systemic interventions addressing working conditions, safety from violence, and career opportunities, particularly in research and academic medicine.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-08500-0.

Background

The global healthcare landscape is grappling with a critical and worsening shortage of physicians, a crisis most acutely felt in low- and middle-income countries (LMICs) and underserving rural regions worldwide [1]. The World Health Organization (WHO) estimates a deficit of millions of physicians, with projections indicating that significant gaps will persist beyond 2030, particularly in the African and Eastern Mediterranean regions [2]. This shortage is exacerbated not only by demographic pressures such as population growth and aging but also by a deeply interconnected phenomenon: the brain drain of medical professionals. Brain drain, or human capital flight, refers to the large-scale emigration of highly skilled individuals from source countries to destination countries, driven by a combination of push factors (e.g., poor working conditions, low pay, political instability) and pull factors (e.g., better opportunities, higher salaries, stable environments) [3]. This migration does not occur in a vacuum; it directly intensifies the shortages that undermine healthcare systems globally.

The emigration of physicians from LMICs creates a vicious cycle that deepens existing healthcare crises. When doctors leave, source countries are not merely losing several workers but also depleting their most critical human capital [4]. This exodus leads to a catastrophic rise in patient-to-physician ratios, overwhelming the remaining staff and leading to longer wait times, reduced access to care, and ultimately, poorer health outcomes, including increased maternal and child mortality [5]. The loss is both a social and an economic catastrophe: source countries lose substantial investment in training these professionals, whereas destination countries gain a ready-trained workforce without incurring the educational costs [6]. Furthermore, the departure of experienced clinicians undermines mentorship and knowledge transfer, eroding the quality of training for the next generation of doctors and further diminishing the system’s long-term capacity and resilience [5]. Thus, brain drain fuels physician shortages, creating a feedback loop where understaffed and overburdened systems push more health workers to leave.

Türkiye’s situation presents a nuanced case study within this global paradigm. On the surface, the country has proactively addressed the quantitative aspects of the shortage. Through policy measures such as establishing new medical schools and increasing student intake [7], Türkiye now produces more medical graduates per capita (15.7 per 100,000 people) than the OECD average (14.2) [8]. However, a failure to retain this valuable workforce critically undermines this promising output. The physician-to-population ratio remains critically low, at 2.6 per 1,000 in metropolitan areas and 1.7 in rural regions, far below the OECD averages of 4.5 and 3.2, respectively [8]. This stark disparity highlights that training more doctors is a necessary but insufficient solution; without addressing the powerful drivers of emigration, the brain drain will continue to perpetuate a severe de facto shortage.

The determining factor in the migration of healthcare workers in Türkiye stems from a number of push factors. Economic hardship is a consistently cited top reason, primarily due to low salaries and inadequate remuneration [9]. This is compounded by profoundly challenging working conditions characterized by long hours, excessive workloads, insufficient resources, and dangerously short consultation times. A negative and unsupportive work environment, including a lack of management support, further erodes professional satisfaction [10]. A particularly alarming push factor is pervasive violence in healthcare settings, which generates legitimate fears for personal safety among health workers [11, 12]. Combined with broader political instability and anxiety about the future, these conditions create a strong sense of insecurity. Finally, a perceived devaluation of the profession, a lack of societal respect, and limited opportunities for career advancement and specialized training complete the picture, making emigration an increasingly attractive option for both practicing physicians and medical students [9, 11].

Therefore, mitigating brain drain is not a separate issue from solving physician shortages; it is its fundamental prerequisite. This study aims to investigate the emigration intentions of medical students in Türkiye, to illuminate the reasons and motivating factors behind their consideration of working abroad. To achieve this aim, our research is guided by the following specific questions:

1. What are the primary motivations for studying medicine and specialty preferences among Turkish medical students, and how do they differ by gender?

2. What are the key demographic, educational, and experiential factors (e.g., foreign language proficiency, international experience) that predict the intention to work abroad?

3. To what extent do students’ stated migration intentions align with their concrete preparatory actions, and what does this reveal about the underlying drivers of brain drain?

By systematically addressing these questions, this research will provide critical evidence on the decision-making processes of future physicians, thereby informing targeted retention strategies and national policy interventions. Ultimately, reversing brain drain is essential for translating Türkiye’s investment in medical education into a stronger, more resilient, and equitable healthcare system for its entire population.

Methods

Study design and population

This study was designed as a cross-sectional, descriptive, and quantitative research project. The study population consisted of medical students enrolled across 20 universities strategically selected from diverse geographical regions of Türkiye (including the Marmara, Western, Central, and Eastern Anatolia regions) during the 2023 academic year. To ensure diversity and representation, the study included institutions from both metropolitan and non-metropolitan areas, encompassing students from all academic years. The study was conducted in accordance with the principles outlined in the Declaration of Helsinki and received ethical approval from the Ethical Committee of Bursa Uludag University Faculty of Medicine on May 11, 2022 (2022-10/30).

Survey design and development

The survey instrument was a researcher-developed questionnaire created for this study through a multi-stage process to ensure content validity and relevance. First, an initial pool of questions was generated based on a comprehensive review of the literature on physician migration and work-related expectations. To further ground the questionnaire in the specific context of Turkish medical students, key themes and concerns were identified through non-structured in-depth interviews and focus group discussions with students. The transcripts from these sessions were reviewed and discussed by the research team to identify recurring themes that directly informed the wording and content of the questions.

Additionally, some questions were conceptually adapted from previously surveyed instruments that address physician migration, working conditions, and professional expectations. Only those questions that were clearly aligned with our research questions were included, and none of these instruments were administered as full multi-item scales.

A panel of three senior clinicians and medical education experts with international experience reviewed the preliminary questionnaire in terms of clarity, relevance, comprehensiveness, and potential bias. Their feedback led to refinements in item wording and the removal of redundant questions.

The revised questionnaire was then pilot-tested with a group of 15 medical students who were not included in the main study. The pilot study aimed to assess average completion time, identify ambiguous wording, and ensure the technical functionality of the online platform. Minor refinements were made to the phrasing of several questions based on feedback from the pilot.

The final questionnaire primarily consisted of categorical questions and captured a wide range of variables, including the following:

• Demographic characteristics.

• Socioeconomic expectations.

• Career intentions (domestic vs. abroad).

• Academic motivation levels.

• Foreign language proficiency.

• Previous international experience.

• Specialty preferences.

Data collection

Data were collected via an online survey instrument administered anonymously. The survey questions are provided in the supplementary file (Supplementary File 1).

Data analysis

Data analysis was performed using the IBM SPSS 29.0.2.0 (IBM Corp. Released 2023. IBM SPSS Statistics for Windows, Version 29.0.2.0 Armonk, NY: IBM Corp.). The data were first summarized using descriptive statistics, namely frequencies and percentages. Categorical variables, such as demographic variables and career choices, were compared using Pearson’s chi-square, Fisher’s exact, and Fisher-Freeman-Halton tests between groups. The Bonferroni test was used as a multiple comparison test. To identify factors associated with medical school graduates’ intentions to work abroad, a binary logistic regression analysis was performed. Variables that were statistically significant in the univariate analyses were included in the multivariate logistic regression model. The results were reported as odds ratios (OR) with corresponding 95% confidence intervals (CI). Statistically, the significance level was accepted as α = 0.05. To ensure the robustness and clarity of the data collection instrument, a pilot test (pretest) of the survey was administered prior to the main study, which contributed to improved question phrasing and overall data reliability.

Results

Sociodemographic characteristics

A total of 1134 medical students from 20 universities responded to the survey. The survey cohort included medical school students, with a gender distribution of 58.7% female, 40.5% male, and 0.8% who preferred not to specify. The participants were distributed across academic years as follows: Year 1: 19.1%, Year 2: 15.1%, Year 3: 16.3%, Year 4: 15.0%, Year 5: 23.6%, and Year 6: 10.9%. In terms of institutional representation, most respondents (54.2%) were from the Bursa Uludağ University Faculty of Medicine, followed by Ege University (15.1%), Manisa Celal Bayar University (6.5%), Süleyman Demirel University (4.8%), and Sakarya University (4.2%), with the remainder originating from other medical schools.

To evaluate the relationship between the education and financial status of their families and the students’ tendency to work abroad, the students were asked about their parents’ education and income. With respect to parental education, more than half of the students’ mothers were high school or university graduates (23.1% and 32.8%, respectively). Paternal educational attainment was higher, with approximately three-quarters holding a university or postgraduate degree (Master’s/PhD). Specifically, 54% of fathers had a postgraduate degree. Concerning socioeconomic status, the majority of students (59.5%) reported their family’s income as middle income. A very small proportion characterized it as very low (0.8%) or very high (1.9%) (Table 1).

Table 1.

Sociodemographic characteristics of participants

		n	%
Gender	Female	664	58.7
	Male	459	40.5
	I don’t want to specify	9	0.8
Institution	Bursa Uludağ University	614	54.2
	Ege University	171	15.1
	Manisa Celal Bayar University	74	6.5
	Süleyman Demirel University	54	4.8
	Sakarya University	47	4.2
	Van Yüzüncü Yıl University	41	3.6
	Çanakkale Onsekiz Mart University	40	3.5
	Afyonkarahisar Health Sciences University	26	2.3
	Balıkesir University	19	1.7
	Kafkas University	16	1.4
	Recep Tayyip Erdogan University	6	0.5
	Dokuz Eylül University	5	0.4
	Inönü University	5	0.4
	Health Sciences University Bursa Faculty of Medicine	5	0.4
	Kütahya Health Sciences University	3	0.3
	Erciyes University	2	0.2
	Harran University	1	0.1
	Istanbul University	1	0.1
	Marmara University	1	0.1
	Tekirdag Namık Kemal University	1	0.1
Year of study	1	216	19.1
	2	171	15.1
	3	185	16.3
	4	170	15.0
	5	267	23.6
	6	123	10.9
Mother’s education level	Primary Education (Primary/Middle school graduate)	374	33
	Secondary Education (High school graduate)	262	23.1
	Tertiary Education (Bachelor’s degree)	371	32.8
	Postgraduate Education (Master’s degree, Doctorate)	70	6.2
	Other	55	4.9
Father’s education level	Primary Education (Primary/Middle school graduate)	63	5.6
	Secondary Education (High school graduate)	133	11.7
	Tertiary Education (Bachelor’s degree)	242	21.4
	Postgraduate Education (Master’s degree, Doctorate)	611	54
	Other	83	7.3
Family economic status	Very low	9	0.8
	Low	112	9.9
	Middle	673	59.5
	High	316	27.9
	Very high	22	1.9

Motivation, career plans, and language proficiency

When questioned about their motivation for choosing to study medicine, the most frequently selected reason among female students was “the desire to help people” (58.6%), followed by “job security” (48.9%) and “not finding other professions suitable for me” (48.0%). In contrast, the most prevalent reasons among male students were “job security” (56.0%) and “social status/prestige” (54.9%), followed by “financial prospects/earning potential” (52.7%). In contrast to their female peers, only 25.5% of the male students selected “not finding other professions suitable for me.” Overall, the most cited motivation for all participants was “the desire to help people” (52.3%), followed by “job security” (51.8%). With respect to specialty choice after medical school, many female students (46.1%) expressed a preference for a nonsurgical specialty (e.g., cardiology, neurology, or pediatrics). Conversely, a plurality of male students (44.4%) indicated a desire to pursue a surgical specialty (e.g., general surgery, orthopedics, or neurosurgery).

To examine the relationship between having been abroad before and the tendency to work abroad, the students were asked whether they had been abroad before and in what way. Concerning international travel experience, a significant majority of all the students (69.8%) reported never having been abroad. While 22.4% had traveled abroad for tourism, only 3.3% had done so for educational purposes (3.6% of females vs. 2.8% of males).

When assessing foreign language proficiency, most of the students (58.8%) self-rated their English skills as intermediate (B1-B2 level). This proportion was greater among female students (61.1%) than among male students (55.3%). In contrast, most students (54.2%) reported no knowledge of German, with 41.9% indicating beginner-level (A1-A2) proficiency. Advanced-level proficiency was reported by 13.5% of the students for English, whereas for German, this figure was only 0.7%.

Regarding the intended place of work after graduation, 67% of the students stated a preference to work in Türkiye, whereas 33% expressed a desire to work abroad. This distribution was similar across genders, with 33.1% of female and 34.6% of male students intending to work abroad. Conversely, among the nine students who preferred not to specify their gender, this trend was inverted, with 66.7% indicating a desire to work abroad. Due to the very small sample size (n = 9), the analysis of the non-binary gender group should be interpreted with caution. The findings presented here are best regarded as preliminary observations rather than robust statistical inferences (Table 2).

Table 2.

Motivations, career plans, and Language proficiency of medical students by gender

	Female		Male		I do not want to specify		Total
	n	%	n	%	n	%	n	%
What was your primary reason for choosing to study at a Medical School? (Please select up to three options that best apply to you)
To conduct scientific research	154	23.2	126	27.5	4	44.4	284	25.1
I did not find other professions suitable for me	319	48.0	117	25.5	5	55.6	441	39.0
The desire to help people	389	58.6	200	43.6	3	33.3	592	52.3
Job security	325	48.9	257	56.0	4	44.4	586	51.8
It was not my own choice / I was influenced by others	28	4.2	43	9.4	1	11.1	72	6.4
Financial prospects / earning potential	247	37.2	242	52.7	4	44.4	493	43.6
Social status / prestige	318	47.9	252	54.9	3	33.3	573	50.6
What are your career plans after graduating from Medical School?
No specific career goal	34	5.1	34	7.4	2	22.2	70	6.2
A surgical specialty (e.g., general surgery, orthopedics, neurosurgery)	261	39.3	204	44.4	2	22.2	467	41.3
A non-surgical (internal medicine) specialty (e.g., cardiology, neurology, pediatrics)	306	46.1	171	37.3	2	22.2	479	42.3
A basic medical science field (e.g., anatomy, pharmacology, physiology)	35	5.3	13	2.8	1	11.1	49	4.3
An academic career / professorship	28	4.2	37	8.1	2	22.2	67	5.9
Have you ever been abroad?
No, I have never been abroad.	462	69.6	324	70.6	4	44.4	790	69.8
Yes, through a student exchange program (e.g., Erasmus, etc.).	13	2.0	9	2.0	0	0.0	22	1.9
Yes, for educational purposes using my own means (e.g., language course, summer school).	24	3.6	13	2.8	0	0.0	37	3.3
Yes, for tourism using my own means.	145	21.8	104	22.7	5	55.6	254	22.4
Yes, as a participant in an international social project (e.g., volunteer work, NGO activity).	20	3.0	9	2.0	0	0.0	29	2.6
Please indicate your proficiency level and any certificates held for the following foreign languages: [German]
I do not speak this language	349	52.6	260	56.6	5	55.6	614	54.2
Beginner (A1-A2)	290	43.7	180	39.2	4	44.4	474	41.9
Intermediate (B1-B2)	22	3.3	14	3.1	0	0.0	36	3.2
Advanced (C1-C2)	3	0.5	5	1.1	0	0.0	8	0.7
Please indicate your proficiency level and any certificates held for the following foreign languages: [English]
I do not speak this language	13	2.0	20	4.4	0	0.0	33	2.9
Beginner (A1-A2)	164	24.7	116	25.3	0	0.0	280	24.7
Intermediate (B1-B2)	406	61.1	254	55.3	6	66.7	666	58.8
Advanced (C1-C2)	81	12.2	69	15.0	3	33.3	153	13.5
Please indicate your proficiency level and any certificates held for the following foreign languages: [Other]
I do not speak this language.	575	86.6	389	84.7	6	66.7	970	85.7
Beginner (A1-A2)	69	10.4	37	8.1	1	11.1	107	9.5
Intermediate (B1-B2)	13	2.0	20	4.4	1	11.1	34	3.0
Advanced (C1-C2)	7	1.1	13	2.8	1	11.1	21	1.9
Where do you plan to work after graduating from Medical School?
Türkiye	456	68.7	300	65.4	3	33.3	759	67.0
Abroad	208	31.3	159	34.6	6	66.7	373	33.0

Motivations for working in Türkiye or abroad

When students who preferred to work in Türkiye were asked for their reasons, the most selected reason for both genders—although it was more common among males (41.3%) than females (31.4%)—was “patriotism/sense of belonging to the country.” This was followed by “familial reasons” (25.9% of females vs. 22.3% of males). Regarding what could change their decision to work in Türkiye, a majority of all the students (59.8%) selected “deterioration of my employment rights and benefits (both financial and administrative).” This was followed by “if I am subjected to violence in the healthcare setting” (50.1%) and “if working conditions deteriorate (increased working hours and workload)” (49.0%). The top three rankings were consistent across genders. Only 9.6% of the students reported that they “would not consider living abroad under any circumstances” (Table 3).

Table 3.

Factors influencing the decision to work in Türkiye or abroad

	Female		Male		I do not want to specify		Total
	n	%	n	%	n	%	n	%
Why do you want to work in Türkiye? (Please select the single most important reason)
Language barriers in academic/foreign settings	51	11.2	29	9.7	1	33.3	81	10.7
Patriotism/sense of belonging to the country	143	31.4	124	41.3	1	33.3	268	35.3
Family reasons	118	25.9	67	22.3	0	0.0	185	24.4
Socio-cultural factors (e.g., familiarity, comfort with social norms, being close to one’s own culture	68	14.9	27	9.0	1	33.3	96	12.6
Insufficient financial means to go abroad	22	4.8	14	4.7	0	0.0	36	4.7
Familiarity with the Turkish healthcare system	20	4.4	13	4.3	0	0.0	33	4.3
The positions I will hold will be better in my home country (e.g., better job title, more responsibility, faster career progression)	31	6.8	26	8.7	0	0.0	57	7.5
Other	3	0.7	0	0.0	0	0.0	3	0.4
What would make you reconsider your decision to work in Türkiye? (What would make you consider moving abroad permanently? ) (Please select up to three options that best apply to you)
If my employment rights and benefits deteriorate (both financial and administrative)	270	59.2	183	61.0	1	33.3	454	59.8
If I am subjected to violence in the healthcare setting	252	55.3	128	42.7	0	0.0	380	50.1
If I experience mobbing (workplace harassment/bullying)	104	22.8	69	23.0	0	0.0	173	22.8
If working conditions deteriorate (increased working hours and workload)	228	50.0	144	48.0	0	0.0	372	49.0
If I achieve sufficient academic qualifications	56	12.3	34	11.3	0	0.0	90	11.9
If I achieve sufficient foreign language proficiency	94	20.6	53	17.7	0	0.0	147	19.4
If I acquire the financial means to go abroad	70	15.4	39	13.0	0	0.0	109	14.4
If the country’s sociopolitical conditions change significantly	104	22.8	91	30.3	0	0.0	195	25.7
I would not consider living abroad under any circumstances	35	7.7	37	12.3	1	33.3	73	9.6
Why do you not want to work in Türkiye? (Please select up to three options that best apply to you)
Inadequate academic meritocracy	51	23.8	43	27.6	2	66.7	96	25.7
Prevalence of mobbing (workplace bullying)	79	36.9	53	34.0	2	66.7	134	35.9
Insufficient research opportunities	56	26.2	51	32.7	2	66.7	109	29.2
Demanding working conditions (increased working hours and workload)	152	71.0	110	70.5	2	66.7	264	70.8
Inadequate financial compensation	105	49.1	77	49.4	2	66.7	184	49.3
Systemic problems within the healthcare system	120	56.1	86	55.1	2	66.7	208	55.8
Increasing violence against healthcare professionals	148	69.2	89	57.1	2	66.7	239	64.1
The current socioeconomic situation in the country	108	50.5	85	54.5	3	100.0*	196	52.5
The current sociopolitical situation in the country	99	46.3	75	48.1	3	100.0*	177	47.5
Insufficient opportunities for postgraduate education	26	12.1	21	13.5	1	33.3	48	12.9
All of the above reasons	3	1.4	2	1.3	0	0.0	5	1.3
Other	5	2.3	1	0.6	0	0.0	6	1.6
What are your primary sources of information on international career opportunities? (You may select multiple options)
Academicians with international experience	46	21.5	37	23.7	0	0.0	83	22.3
Physicians with international experience	115	53.7	81	51.9	2	66.7	198	53.1
Friends or acquaintances with relevant knowledge or experience	102	47.7	80	51.3	1	33.3	183	49.1
Official websites and online portals	119	55.6	74	47.4	2	66.7	195	52.3
Social media platforms (e.g., WhatsApp, Telegram, X/Twitter, Instagram, YouTube)	140	65.4	115	73.7	1	33.3	256	68.6
The career office/center of my faculty or university	8	3.7	8	5.1	1	33.3	17	4.6
Events organized by student clubs	41	19.2	30	19.2	0	0.0	71	19.0
What would make you reconsider your decision to move abroad? (Please select up to three options)
If working conditions improve (e.g., hours and intensity)	139	65.0	104	66.7	1	33.3	244	65.4
If my employment rights and benefits improve (e.g., financial, administrative)	144	67.3	105	67.3	1	33.3	250	67.0
If the sociopolitical situation in the country changes	120	56.1	92	59.0	0	0.0	212	56.8
If satisfactory regulations are implemented to address violence in healthcare	122	57.0	95	60.9	1	33.3	218	58.4
If the quality of education and training improves	45	21.0	26	16.7	0	0.0	71	19.0
I would not consider working in this country under any circumstances	28	13.1	20	12.8	2	66.7	50	13.4
Other	3	1.4	5	3.2	0	0.0	8	2.1
What preparations have you made for an international career? (You may select multiple options)
Participating in research and/or projects to build academic qualifications	36	16.8	32	20.5	2	66.7	70	18.8
Learning a foreign language	143	66.8	115	73.7	2	66.7	260	69.7
Preparing for the licensing/equivalency exam of the target country	40	18.7	27	17.3	0	0.0	67	18.0
Not undertaking any specific preparations	58	27.1	33	21.2	0	0.0	91	24.4
Other	1	0.5	0	0.0	0	0.0	1	0.3

*Three out of six students who did not want to specify their gender and preferred to work abroad answered the questions

Conversely, for students planning to work abroad, the primary reason, selected by 70.8% of respondents, was “demanding working conditions (increased working hours and workload).” This was followed by “increasing violence against healthcare professionals” (64.1%), a reason selected by 69.2% of female students compared with 57.1% of male students. The third most cited reason was “systemic problems within the healthcare system” (55.8%). When asked in which country they planned to work, the most frequently selected destinations were Germany (39.2%), followed by the United Kingdom (21.8%), the United States (13.2%), Canada (5.6%), and Switzerland (5.1%) (see Supplementary Table 1). In preparation for working abroad, 69.7% of these students reported “learning a foreign language,” whereas 24.4% had not undertaken any preparation. The primary sources of information on international career opportunities were social media platforms (68.6%), physicians with international experience (53.1%), official websites and online portals (52.3%), and friends or acquaintances with relevant knowledge (49.1%). The career office/center of their faculty or university was the least utilized resource, cited by only 4.6% of the students. When asked under what circumstances they would reconsider their decision to work abroad, the leading factor was “if my employment rights and benefits improve (e.g., financial, administrative)” (67.0%). This was followed by “if working conditions improve (e.g., hours and intensity)” (65.4%) and “if satisfactory regulations are implemented to address violence in healthcare” (58.4%). However, 13.4% of the students stated that they would not reconsider their decision under any circumstances. When presented with a hypothetical immediate opportunity to work abroad, nearly half (47.5%) of the respondents reported that they would leave their medical studies or current position, while 52.5% stated that they would not (Table 3).

Associations between categorical variables

The relationships between the intention to work domestically or abroad and various demographic and academic variables were analyzed; the results are summarized in Table 4. Although a borderline significance was observed between gender and the desire to work abroad (p = 0.049), post-hoc pairwise comparisons revealed no significant differences, a finding attributed to the small subgroup of students who preferred not to specify their gender and who demonstrated a high propensity for working abroad. A significant association was found between parental education level and the intention to work abroad, for both mothers and fathers (p < 0.001 and p = 0.001, respectively). In contrast, no significant relationship was identified between family income level and the desire to work abroad.

Table 4.

The relationships between the intention to work domestically or abroad and various demographic and academic variables

		Where do you plan to work after graduating from Medical School?				p
		Türkiye		Abroad
		n	%	n	%
Gender	Female	456	68.7	208	31.3	0.049
	Male	300	65.4	159	34.6
	I do not want to specify	3	33.3	6	66.7
What is your mother’s level of education?	Primary Education (Primary/Middle school graduate)	276	73.8	98	26.2	< 0.001
	Secondary Education (High school graduate)	189	72.1	73	27.9
	Tertiary Education (Bachelor’s degree)	216	58.2	155	41.8
	Postgraduate Education (Master’s degree, Doctorate)	36	51.4	34	48.6
	Other	42	76.4	13	23.6
What is your father’s level of education?	Primary Education (Primary/Middle school graduate)	168	72.4	64	27.6	0.001
	Secondary Education (High school graduate)	182	75.2	60	24.8
	Tertiary Education (Bachelor’s degree)	326	63.7	186	36.3
	Postgraduate Education (Master’s degree, Doctorate)	72	57.1	54	42.9
	Other	11	55.0	9	45.0
How would you rate your family’s socioeconomic status on a scale of very low to very high?	Very low	9	100.0	0	0.0	0.145
	Low	68	60.7	44	39.3
	Middle	454	67.5	219	32.5
	High	212	67.1	104	32.9
	Very high	16	72.7	6	27.3
What was your primary reason for choosing to study at a Medical School?	Other options	598	70.5	250	29.5	< 0.001
	To conduct scientific research	161	56.7	123	43.3
What are your career plans after graduating from Medical School?	No specific career goal	51	72.9	19	27.1	0.026
	A surgical specialty (e.g., general surgery, orthopedics, neurosurgery)	300	64.2	167	35.8
	A non-surgical (internal medicine) specialty (e.g., cardiology, neurology, pediatrics)	340	71.0	139	29.0
	A basic medical science field (e.g., anatomy, pharmacology, physiology)	26	53.1	23	46.9
	An academic career / professorship	42	62.7	25	37.3
Have you ever been abroad?	No, I have never been abroad.	564	71.4	226	28.6	< 0.001
	Yes, through a student exchange program (e.g., Erasmus, etc.).	6	27.3	16	72.7
	Yes, for educational purposes using my own means (e.g., language course, summer school).	18	48.6	19	51.4
	Yes, for tourism using my own means.	149	58.7	105	41.3
	Yes, as a participant in an international social project (e.g., volunteer work, NGO activity).	22	75.9	7	24.1
What preparations have you made for an international career? (You may select multiple options)	Other options	184	65.2	98	34.8	0.372
	Not undertaking any specific preparations	64	70.3	27	29.7

The Pearson chi-square test was used for analysis

Approximately one-third of the students planning to work abroad reported “to conduct scientific research” as the most influential factor in their decision to pursue medicine, a finding that was statistically significant (p < 0.001). Those intending to work abroad were significantly less likely to prefer a specialty in internal medicine than those planning to stay in Türkiye. Conversely, a significantly greater proportion expressed an interest in pursuing a career in basic medical sciences (p = 0.026).

Compared with those without such experience, participants who had gained educational experience abroad during their undergraduate studies expressed a significantly stronger desire for an international career (p < 0.001). While 78.4% of those wishing to pursue a career abroad reported preparations to do so, a surprisingly high proportion of those who declared an intention to remain in Türkiye (74.2%) also reported undertaking similar preparatory activities; no significant difference was found between the two groups.

An analysis of language proficiency revealed that among participants who wished to stay in Türkiye due to patriotism, only 7.1% reported advanced English proficiency. Furthermore, only 0.4% of this group reported advanced German proficiency, and only 0.7% reported advanced proficiency in a language other than English or German (Supplementary Table 2). Among all participants with advanced English proficiency, only 2.9% agreed with the statement “I would not consider living abroad under any circumstances” (p = 0.014).

Table 5 presents a binary logistic regression analysis examining the factors associated with medical school graduates’ intentions to work abroad. Maternal education level emerges as a particularly influential factor. A mother with a tertiary education degree was associated with a higher likelihood of planning to work abroad (OR = 1.862) than those whose mothers had only a primary or middle school education. This effect was even more substantial when the mother held a postgraduate degree (master’s or Doctorate), with an odds ratio of 2.294.

Table 5.

Results of binary logistic regression analysis of factors associated with the plan to work abroad after graduation from medical school

		p-value	OR (95% Confidence Interval)
Gender	Female vs. I do not want to specify	0.054	0.240 (0.056–1.023)
	Male vs. I do not want to specify	0.083	0.277 (0.065–1.182)
What is your mother’s level of education?	Secondary Education (High school graduate) vs. Primary Education (Primary/Middle school graduate)	0.759	1.065 (0.714–1.588)
	Tertiary Education (Bachelor’s degree) vs. Primary Education (Primary/Middle school graduate)	0.003	1.862 (1.244–2.788)
	Postgraduate Education (Master’s degree, Doctorate) vs. Primary Education (Primary/Middle school graduate)	0.012	2.294 (1.199–4.389)
	Other vs. Primary Education (Primary/Middle school graduate)	0.223	0.617 (0.283–1.342)
What is your father’s level of education?	Secondary Education (High school graduate) vs. Primary Education (Primary/Middle school graduate)	0.061	0.650 (0.413–1.021)
	Tertiary Education (Bachelor’s degree) vs. Primary Education (Primary/Middle school graduate)	0.584	0.885 (0.571–1.371)
	Postgraduate Education (Master’s degree, Doctorate) vs. Primary Education (Primary/Middle school graduate)	0.523	0.823 (0.453–1.495)
	Other vs. Primary Education (Primary/Middle school graduate)	0.103	2.425 (0.837–7.029)
To conduct scientific research		0.002	1.599 (1.187–2.154)
What are your career plans after graduating from Medical School?	A surgical specialty (e.g., general surgery, orthopedics, neurosurgery) vs. No specific career goal	0.122	1.593 (0.883–2.875)
	A non-surgical (internal medicine) specialty (e.g., cardiology, neurology, pediatrics) vs. No specific career goal	0.629	1.158 (0.639–2.097)
	A basic medical science field (e.g., anatomy, pharmacology, physiology) vs. No specific career goal	0.037	2.394 (1.056–5.426)
	An academic career/professorship vs. No specific career goal	0.571	1.247 (0.581–2.676)
Have you ever been abroad?	Yes, through a student exchange program (e.g., Erasmus, etc.). vs. No, I have never been abroad.	< 0.001	5.368 (2.012–14.32)
	Yes, for educational purposes using my own means (e.g., language course, summer school) vs. No, I have never been abroad.	0.028	2.163 (1.087–4.307)
	Yes, for tourism using my own means vs. No, I have never been abroad.	0.086	1.327 (0.96–1.835)
	Yes, as a participant in an international social project (e.g., volunteer work, NGO activity) vs. No, I have never been abroad.	0.186	0.548 (0.225–1.337)

OR Odds ratio

Academic and career goals also showed strong associations with international work intentions. Students aspiring to conduct scientific research were more likely to plan to work abroad (OR = 1.599) than those without such aspirations. Similarly, students pursuing careers in the basic medical sciences (e.g., anatomy, pharmacology, or physiology) had increased odds of planning to work abroad (OR = 2.394) compared with students without specific career goals.

Previous international experience was the most potent predictor of international career intentions. Students who participated in exchange programs (such as Erasmus) demonstrated substantially greater odds of planning to work abroad (OR = 5.368) than those with no international experience. Likewise, students who had studied abroad independently (e.g., through language courses or summer schools) also showed higher odds of planning an international career (OR = 2.163).

Discussion

This study elucidates the complex interplay of gender, socioeconomic factors, and systemic push-pull dynamics shaping the career motivations and migration intentions of medical students in Türkiye. Our findings paint a picture of a generation deeply committed to medicine yet profoundly concerned about its future, leading to a state of strategic ambivalence and preparation for emigration.

This study reveals that an intrinsic desire to help people is the primary motivation for pursuing medicine among all participants, closely followed by the extrinsic factor of job security. This finding is consistent with the profile of Swiss Gen Z medical applicants, who exhibit high intrinsic motivation, altruism, and a strong willingness to perform, thereby sharing core values with previous generations. Nonetheless, this cohort reportedly prioritizes adequate work-life balance and job security [13]. A further finding underscores the distinctly gendered nature of these professional motivations and aspirations. Female students were predominantly driven by altruism and job security, later preferring nonsurgical specialties, whereas their male counterparts were more influenced by financial prospects, prestige, and surgical fields. These findings align with the literature showing that while both genders frequently cite altruism as a top motivation, female students consistently rate these motives higher and are more likely to prioritize patient care and relationship-oriented aspects of medicine [14, 15]. Male students are more likely to be motivated by status, job security, income, and the technical or research-oriented aspects of medicine, while these factors are less influential for female students [16–18]. These fundamental motivational differences are consequently reflected in the divergent specialty preferences between genders, with female students more frequently choosing fields such as pediatrics, obstetrics & gynecology, and general practice, and male students showing a greater preference for surgery, orthopedics, and other technical specialties [16].

As our analysis reveals, the decision to pursue an international medical career is not arbitrary but is significantly influenced by an individual’s capital assets; higher levels of parental education, language proficiency, and prior international experience all serve as key predictors. Our results specifically highlight maternal education as a substantial and independent predictor. However, the influence of parental education and socioeconomic status presents a complex and often inconsistent picture across different national contexts. For instance, a Turkish study identified higher maternal education as a significant predictor for pursuing residency abroad, while paternal education and economic status were insignificant [20]. Studies from Honduras and Iran found that both parents’ education levels were correlated with migration intent [19, 20]. Conversely, an Ethiopian study revealed no significant link [21]. This suggests that the influence of family background is highly context-dependent. Further complicating this relationship, a Norwegian study revealed that for medical students specifically, neither parental income nor education level retained a significant association with the likelihood of studying abroad after controlling for academic grades. In fact, for medical students, studying abroad is often perceived less as a product of family capital and more as a strategic alternative for those with lower academic achievement [22]. Ultimately, these cross-national discrepancies might be attributed to differences in countries’ income levels and the quality of their domestic education and healthcare systems.

Most critically, advanced foreign language proficiency emerges as a powerful enabler of mobility, fundamentally shaping career outcomes. Its necessity is twofold: it is both a prerequisite for qualifying for international positions and a critical determinant of professional integration. A study demonstrated that migrants with higher language skills (e.g., a B2 certificate) are significantly more likely to secure employment at their previous professional level or higher, whereas those without strong language skills are often forced into lower-ranked jobs or face unemployment [23]. Our study reveals that among those who prefer to work domestically, 10% cite a lack of language proficiency as their primary reason. Conversely, 20% of those who plan to work in Türkiye stated that they would consider working abroad if they acquired the necessary language skills. Among students who intend to migrate, approximately 70% report currently learning a foreign language, making this the most frequently reported preparatory activity. This aligns with global trends; a significant majority of aspiring migrant medical students identify language barriers as their greatest obstacle, with studying English being the most common preparatory step [24].

Our findings indicate that participants who gained international educational experience during their undergraduate studies expressed a significantly stronger desire to pursue a career abroad than their peers without such exposure. This result aligns with existing international research; for example, a study on Pakistani medical students found that prior international living experience was positively associated with the intention to migrate [25]. Similarly, research from Türkiye has shown that prior international experience is significantly associated with the intention to pursue residency training abroad [26]. This consistent pattern across studies suggests that early exposure to international environments serves as a critical formative factor, potentially familiarizing students with global opportunities and strengthening their intent to seek professional pathways outside their home country.

Patriotism and family ties represent powerful noneconomic motivators that promote retention of medical talent. In Türkiye, among students who preferred to pursue their careers in their home country, the most common reason for both genders was “patriotism/sense of belonging to the country,” followed closely by “familial reasons.” This pattern is consistent with robust global findings; multiple studies from Pakistan, for instance, report that a desire to serve the nation and strong family ties are the primary reasons for medical students to remain. One study reported that 82.1% of students cited “desire to serve the nation” as their main reason, while 80.0% cited family ties as the most important factor behind the decision to stay [27]. Another study confirmed these findings, with 60.6% of participants citing a desire to serve the nation and 72.7% citing family ties as major factors in their decision to stay [25].

However, this powerful sense of national duty and familial obligation is complicated by a striking contradiction. A striking 74.2% of the same Turkish cohort that cited patriotism as their primary reason for staying also reported actively preparing to work abroad. This apparent contradiction is best interpreted not as insincerity but as a strategic form of risk mitigation against perceived systemic instability. A critical layer of this paradox is revealed in the language proficiency data: within this patriotic group, rates of advanced language skills were remarkably low (e.g., only 7.1% possessed advanced English). This suggests that for many, the stated intention to stay may be influenced by a constraint, a lack of foreign language proficiency, rather than a purely unconstrained choice. For these individuals, advanced language proficiency serves as a crucial enabler that transforms migration from a mere abstract intention into a tangible possibility, thereby insulating them from potential future deterioration in the national healthcare environment. The paradox, therefore, highlights a population under significant strain: deeply connected to their homeland yet compelled by circumstance to prepare for its possible failure.

Research indicates that the motivations behind medical migration intentions from Türkiye are overwhelmingly driven by push factors inherent within the domestic healthcare system. These include low remuneration, demanding working conditions, unsupportive management environments, and a pervasive lack of societal respect for the profession [9, 10]. Furthermore, political instability and anxiety about the future contribute to a sense of professional and personal restriction, devaluing the profession and motivating emigration [9]. A particularly potent driver is the fear of workplace violence (WPV), as health workers report escalating exposure to physical and verbal abuse, compounded by ineffective institutional safety measures, which fuels profound personal security concerns [11]. Our study revealed that this concern is significantly greater among female students, underscoring how the experience of systemic insecurity is distinctly gendered. This finding is contextualized by global data indicating that WPV against female healthcare workers is widespread, with pooled prevalence estimates of 45–49% globally, and is even higher in specific regions and professions such as nursing [28]. While direct data linking WPV to international migration are limited, studies consistently show that such violence is a key factor driving healthcare workers, especially women, to consider leaving their positions or the profession altogether [29] or seeking opportunities abroad [30]. Conversely, this dynamic also functions as a retention mechanism in safer countries, as research reveals that individuals with a high fear of violence are more likely to stay in nations where they feel secure [12]. This illustrates that the perception of safety is not merely a push factor but also a critical pull factor, influencing both the decision to leave and the choice of destination.

Beyond these push factors, limited opportunities for career advancement, residency training, and research also propel emigration, particularly among younger professionals and students. Our study specifically identified a strong desire to emigrate among students interested in scientific research and basic sciences, a finding that aligns with the work of Eser et al. [11], who reported that individuals seeking careers in research and development were 1.37 times more likely to emigrate. In our study, demanding working conditions, systemic problems, and, most acutely, the fear of violence were identified as the primary drivers compelling students to consider leaving. Crucially, the finding that improvements in these exact areas — such as rights, safety, and working conditions — are the primary factors that make students reconsider leaving, offers a clear and actionable policy prescription. This suggests that the decision to emigrate is not a choice for an idealized abroad but often a flight from deteriorating professional conditions. Consequently, it positions potential brain drain not as inevitable but as a direct consequence of remediable domestic failure.

Medical students predominantly utilize digital resources, personal networks, and lectures from Physicians with international work experience to acquire information while pursuing careers abroad. A Japanese national survey revealed that 33% of students rely on internet-based sources, such as blogs, forums, and official websites, for this purpose, while 17% attend relevant lectures or seminars [24]. This trend was further emphasized by a recent Italian study, in which nearly 80% of participating students reported limited knowledge of international application procedures and cited relatives, friends, social networks, and websites as their primary information sources. In contrast, fewer than 30% consulted medical associations [31]. Consistent with these findings, our study revealed that over half of the students sourced information from social media platforms, websites, and doctors with international experience, while a very small minority (4.6%) utilized university career centers. This collective evidence points to a significant overreliance on informal channels and a corresponding underutilization of formal institutional support. This represents a significant institutional failure to engage with and guide a generation of future doctors who are actively seeking direction, ultimately weakening the system’s ability to retain its workforce.

In conclusion, the findings presented paint a complex picture of medical student emigration from Türkiye, revealing that it is a multifaceted phenomenon driven by a confluence of systemic failure and individual aspirations. The research underscores that the decision to pursue an international career is not merely a matter of professional advancement but is profoundly influenced by a spectrum of push factors, including pervasive violence, demanding working conditions, political instability, and a lack of institutional support. Crucially, these drivers are not uniform; they disproportionately affect marginalized groups, such as nonbinary individuals and women, for whom sociopolitical climate and personal safety are paramount concerns. Conversely, the strong emigration intent among research-oriented students and those with prior international experience highlights a parallel narrative of pull factors, where the pursuit of specialized opportunities and a safer environment also play a critical role. Ultimately, this study positions brain drain not as an inevitable outcome but as a direct consequence of remediable domestic deficiencies. The clear policy prescription that emerges is that substantive reforms aimed at ensuring safety, improving working conditions, and creating inclusive, merit-based opportunities for advancement and research are not just ethical imperatives but are essential strategic investments to retain the nation’s future medical talent.

Limitations

While this study provides valuable insights into the migration intentions of medical students in Türkiye, several limitations should be acknowledged. First, the cross-sectional design captures attitudes and intentions at a single point in time, which may fluctuate due to changing socioeconomic conditions or personal circumstances. Longitudinal follow-up is necessary to determine how many students ultimately actualize their emigration plans. Although the sample size was substantial (n = 1134), the participation of students from 20 different universities may not be fully representative of all medical students in Türkiye. Most notably, the overrepresentation of a single institution, which constituted 54.2% of the sample, introduces a considerable risk of institutional bias and limits the institutional diversity of the sample. This uneven distribution limits the representativeness and institutional diversity of the sample, and thus, the generalizability of our findings to the broader population of medical students in Türkiye may be limited. Future research would benefit from employing stratified sampling strategies to ensure a more balanced institutional representation and to incorporate objective measures alongside self-reports to triangulate findings. Selection bias may exist if students with stronger opinions on migration are more likely to respond. Additionally, the study relied on self-reported data, which are susceptible to social desirability bias. For example, respondents may have overemphasized altruistic motivations for studying medicine or underreported intentions to emigrate due to patriotic sentiments. The grouping of “nonsurgical” and “surgical” specialties, while useful for analysis, may oversimplify specialty preferences, as significant diversity exists within these broad categories. Furthermore, the small subgroup of students who preferred not to specify their gender (0.8%) limits detailed analysis and precludes meaningful statistical inference for these groups, despite notably high emigration intentions being observed. This limitation highlights a significant gap in the literature regarding the migration intentions and experiences of gender minorities and other underrepresented groups, such as LGBTQ + students. Finally, the study did not deeply explore region-specific migration policies or the role of cultural ties, which could influence destination choices and feasibility. Future research could incorporate qualitative methods (e.g., in-depth interviews) to provide richer context and explore the nuanced decision-making processes and emotional drivers behind migration intentions, with a specific focus on understanding how minority identities, such as gender identity, shape these decisions.

Abbreviations

LMICs

Low- and middle-income countries

OECD

Organisation for Economic Co-operation and Development

WHO

World Health Organization

WPV

Workplace violence

Authors’ contributions

MOA and ZA were involved in research design. GO and MOA developed the data collection tool. ASK collected the data. MOA, ZA, GO, BA, and SAC contributed to the interpretation of the results. BA, MOA, and SAC took the lead in writing the manuscript. All authors provided critical feedback and contributed to shaping the research, analysis, and manuscript. All authors reviewed and approved the manuscript.

Funding

The author(s) received no financial support for the research.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from Bursa Uludağ University, Faculty of Medicine, Clinical Trials Ethical Committee (Date May 11, 2022; Number: 2022-10/30). We conducted this study according to the principles of the Declaration of Helsinki. Since the survey was conducted online, the participants were informed at the beginning of the questionnaire that this was a research study and that participation was entirely voluntary. By choosing to complete the questionnaire, participants provided their informed consent to take part in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.