title: Impact of policies regulating foreign physician migration to Switzerland: a modelling case study in anaesthesia.
abstract: BACKGROUND
  Several countries have developed policies that restrict or limit duration of stay, clinical privileges or the number of residency permits allocated to migrating physicians. Switzerland is currently preparing a new law limiting overall foreign immigration. The impact of such restrictive policies is currently unknown. In a case study of anaesthesia care in Switzerland we modelled, trends in the size of physicians' workforce until 2024, following the implementation of a strict quota policy for foreign medical trainees.
  
  
  METHODS
  We developed a computer-based Markov model with Monte-Carlo simulations to project, in the context of a strict quota policy for foreign trainees, supply and demand for anaesthesia positions until 2024. We used data from a cross-sectional study performed in the French- and Italian-speaking cantons of Switzerland and the Health dataset from the OECD.
  
  
  RESULTS
  With 8 to 12 (95% CI 4-20) anaesthetists retiring per year, the implementation of strict quotas of foreign graduates would result in a 38% decrease in the number of anaesthetists in intermediary (senior registrars) positions by 2024. This decrease would be particularly important in district hospitals where nearly half (49%) of the non-Swiss anaesthetists are practising. Swiss graduates are unlikely to balance the shortage. Despite efforts by Swiss universities to increase the number of medical graduates, their number has dropped from 10.5 to 9.7/100 000 inhabitants between 2000 and 2012, due to the growth of the population.
  
  
  CONCLUSIONS
  This case study in Latin Switzerland shows that a restrictive policy limiting foreign immigration of trainees would result in a major deficit in the number of anaesthetists available to meet population needs. These aspects should be carefully considered when countries develop restrictions and limitations of foreign immigration.
authors.affiliation: Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care University Hospitals of Geneva, 4, rue Perret-Gentil, 1211, Genève 14, Switzerland. guy.haller@hcuge.ch.|Health Services Management and Research Unit, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia. guy.haller@hcuge.ch.
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.affiliation: CRC and Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland. christophe.combescure@hcuge.ch.
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.affiliation: Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care University Hospitals of Geneva, 4, rue Perret-Gentil, 1211, Genève 14, Switzerland. chantal.mamie@hcuge.ch.
authors.forename: Chantal
authors.initials: C
authors.lastname: Mamie
authors.affiliation: Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care University Hospitals of Geneva, 4, rue Perret-Gentil, 1211, Genève 14, Switzerland. davide.zocatelli@hcuge.ch.
authors.forename: Davide
authors.initials: D
authors.lastname: Zoccatelli
authors.affiliation: Division of Anaesthesia, Department of Anaesthesiology, Pharmacology and Intensive Care University Hospitals of Geneva, 4, rue Perret-Gentil, 1211, Genève 14, Switzerland. francois.clergue@hcuge.ch.
authors.forename: François
authors.initials: F
authors.lastname: Clergue
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000458:organization & administration; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005006:Ethnicity / Q000331:legislation & jurisprudence*; D005260:Female; D005551:Foreign Professional Personnel / Q000600:supply & distribution*; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000331:legislation & jurisprudence* / Q000600:supply & distribution*; D013337:Students, Medical / Q000331:legislation & jurisprudence*; D013557:Switzerland