Understanding the intention-action gap in physician migration during crises: Interrupted time-series evidence from...

Health workforce migration is a global phenomenon with far-reaching implications for health systems. Turkey has experienced an unprecedented rise in physician emigration over the past decade, yet the relationship between migration intentions and realised mobility remains insufficiently explored, particularly under overlapping economic, political, and health system crises.

To examine the divergence between physician emigration intentions and realised migration from Turkey to OECD countries (2012-2022), and to assess how the 2017-2018 structural crisis coincided with shifts in migration dynamics.

Data on Good Standing Certificate applications from the Turkish Medical Association (intentions) were combined with OECD Health Workforce Migration data (realised flows). An interrupted time-series design and structural break analysis were applied to detect significant changes associated with the crisis period.

The intention-action ratio increased from 0.77:1 in 2012 to 4.16:1 in 2022, with a notable structural break at 2017-2018. The interrupted time-series estimate indicated a crisis-related rise of +1.6 ratio points (p < 0.001). Certificate applications grew from 59 to 2685, while OECD inflows rose from 77 to 645, illustrating intensifying migration friction.

Periods of crisis appear to amplify emigration intentions while constraining their realisation, widening the intention-action gap. This pattern has implications beyond Turkey, highlighting the need for friction-sensitive forecasting, evidence-based retention strategies in source countries, and ethically balanced recruitment in destination countries.