Boston, MA — A new study led by the Harvard Pilgrim Health Care Institute evaluates the impact of a voluntary code intended to improve ethical recruitment of physicians from World Health Organization-designated shortage countries. While the Code initially reduced physician migration from these countries, the research finds it did not improve their physician supply, highlighting the need for broader investments to strengthen global health systems.
The study is published on February 6 in JAMA Health Forum .
Global health care workforce shortages are intensified when physicians from lower-to-middle income countries (LMICs) migrate to high-income countries (HICs). In 2010, all member states of the World Health Organization (WHO) unanimously signed the WHO Global Code of Practice to reduce this physician outflow and promote investment in the physician workforce in LMICs. This is the first study to examine whether implementing the Code led to real changes in doctor emigration from shortage countries and improved their physician supply.
Using data from 2000–2021, researchers analyzed physician migration to Organization for Economic Co-operation and Development (OECD) countries, a group that includes most HICs. They compared 56 WHO-designated shortage countries with 116 non-shortage countries.
Initially, say the researchers, the code showed promise. "We saw a clear short-term drop in physicians leaving shortage countries after the WHO Code, but the effect faded over time," said senior author Hao Yu, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute.
On average, the Code was associated with approximately 2,600 fewer physicians leaving shortage countries each year or roughly 17,000 physicians during the first five years of implementing the Code, a nearly 30% annual reduction in physician emigration. However, the effects of the Code diminished over time, and physician density (the number of physicians per 10,000 people) in shortage countries did not improve across the full study period.
The authors note that in addition to the Code, HICs and international agencies need to help LMICs build support systems, improve working conditions, and provide career support.
"Improving working conditions and training capacity is critical if countries want to sustainably invest in their physician workforce,” noted Tarun Ramesh, lead author of the study and research fellow at the Harvard Pilgrim Health Care Institute. “Reducing migration alone won’t move the needle in the quest for global health equity.”
Broadly, the study supports the use of the WHO Code as a policy lever for reducing physician recruitment by HICs from LMICs and promoting global health equity. The findings demonstrate the important role played by the WHO in promoting global health development. Withdrawal from the WHO can have negative effects on global health development. Rather than withdrawing from the WHO, countries should take steps to recommit themselves to and bolster their support of this global health governance body, including its efforts to combat physician shortages in LMICs.
About the Harvard Pilgrim Health Care Institute’s Department of Population Medicine
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky , X , and LinkedIn .
JAMA Health Forum
Changes in Physician Emigration and Density after the 2010 WHO Global Code of Practice
6-Feb-2026