# Understanding Health Professionals’ Migration in Bulgaria: Driving and Retention Factors Among Physicians and Nurses

## TL;DR

This study explores why Bulgarian health professionals emigrate and what keeps them in the country, identifying key factors like work environment, finances, and personal considerations.

## Contribution

The study identifies distinct underlying factors influencing migration and retention among Bulgarian physicians and nurses using factor analysis.

## Key findings

- Three main factors drive migration: professional advancement, financial incentives, and family benefits.
- Retention is influenced by socioeconomic factors, career development, and personal/social environment.
- Physicians are less influenced by financial incentives, while nurses are more affected by personal and social factors.

## Abstract

Background: In recent decades, the emigration of Bulgarian health professionals has become a persistent challenge driven by multiple interplaying factors. A comprehensive understanding of these key determinants is essential for the development of targeted retention strategies. This study examines the primary factors influencing the migration and retention of physicians and nurses in Bulgaria. Methods: A cross-sectional study was conducted in 2022 involving 338 health professionals without professional experience abroad. Data were collected using an online questionnaire administered by a polling agency. To identify the underlying structure of the driving and retention factors, we conducted Exploratory Factor Analysis (EFA). Subsequently, the Mann–Whitney U test was employed to examine the differences in retention and motivational factors between physicians and nurses. Results: EFA of the migration drivers identified a three-factor structure, explaining 70.34% of the total variance: professional advancement and work environment; financial incentives; and family benefits. The analysis of retention determinants revealed three distinct constructs, explaining 54.46% of the variance: socioeconomic and healthcare framework; employment and career development; and personal considerations and social environment. The Mann–Whitney U test indicated that the impact of financial incentives on migration decisions exerted a weaker influence on physicians’ intentions (r = −0.23). Personal considerations and the social environment emerged as more significant retention determinants for nursing professionals (r = −0.15). Conclusions: This study extends current understanding by identifying the underlying constructs of driving and retention factors in health professional migration. The findings underscore the need for evidence-based interventions to mitigate brain drain and retain skilled professionals.