Author: Karim Moutchou
Medical Student, Fez Faculty of Medicine and Pharmacy
Editor: Yuki Senoo
Morocco, the birthplace of millions of immigrants living around the world, is currently marking a new rise in the figures of “VIP immigration.” Medical doctors are not an exception, and an essential portion of the Moroccan population is deciding to leave the country to seek better social and professional lives. Moroccan doctors and medical students are heading to Germany as a primary destination. In recent decades, Germany seems to have opened its arms to foreign doctors more than any other countries in the world. This circumstance has raised hopes and concerns among everyone on both sides of the Mediterranean.
In 2010, the Organization for Economic Co-operation and Development (OECD) mentioned that at least 2.6 million people born in Morocco are living outside of their home country. This number accounts for approximately 10 percent of Moroccan citizenship holders. Now, Morocco is the 10th largest population of immigrants around the world. This position in the ranking is exceptional for us, considering that Morocco is only in the 40th place for the total population of the world. This report pointed out that 7,000 of those immigrants are medical doctors.
The number of practicing doctors in Germany rose from 237,000 to 385,000 between 1990 and 2017, despite having low modifications in the general population numbers. In addition, we have to consider that German doctors are leaving their country as well. The Doctors' Directive 93/16, a directive on the recognition of professional qualifications 2005/36, which is allowing medical doctors in the European Union to cross borders legally, is contributing to this free movement.
In 2013, the German Medical Association published a report analyzing the number of doctors from different countries who are practicing in Germany. According to this report, 580 physicians from Egypt and 533 physicians from Jordan are practicing in German medical institutions. However, the report did not mention the number of Moroccan doctors. This is because the wave of immigration from Morocco to Germany has been seen only in more recent times, after this report was published, and the official research will only take after some time.
The language barrier does not seem to prevent Moroccan doctors from trying to reach Germany, even though a very limited number of high schools in Morocco offer German courses. A doctor must pass a B2-level German language test to practice in Germany, which takes a significant amount of time and energy, and over USD 10,000 is needed to prepare for the exam.
A second-year Moroccan resident who is practicing in a small town in Germany said that “it wasn’t easy. I was depressed and disappeared during the process.” Furthermore, he mentioned that it cost about USD 12,000 for him to move there and that he had to process a pile of documents. However, he believes that “it was all worth it. Practicing in Germany makes me feel the new energy similar to the one I had when I just started medical school. I recommend that every colleague in Morocco should follow my path.”
I would like to share another example. Omaima, a medical doctor who recently graduated from medical school, has been studying the language and planning to move to Germany as soon as she is accepted. Omaima had a more personal reason for leaving Morocco: She was diagnosed with multiple sclerosis and thus felt more motivated to move to a developed country because she distrusted the current health care system in Morocco. She said that she knows her condition can became worse at any moment, so she wants to be in a place with a reliable health care system. What she is saying is sadly on point. Even in the most privileged hospital in Morocco, the treatment that an individual will receive is incomparable to the treatment provided in the European Union.
Many experts assume that this immigration phenomenon in Germany is an opportunity to benefit from developing countries. On an epidemiological level, the new wave of immigration from third-world countries is placing new challenges on European medicine, especially in terms of cardiovascular risk factors, cancers, and low fertility. Immigrants often come from countries where infectious diseases are still dominant, and they bring a large number of children and adolescents with a presumably higher fertility rate than the average European family. Immigration is still a very sensitive subject in all destination countries, and doctors from Morocco and other developing nations are facing discriminative actions from the nationalists’ movements.
Omar, a young doctor who is also trying to practice in Germany, started to have second thoughts about his dreams after spending one month as an exchange student in Heidelberg’s hospital. This hospital is one of the oldest and the best medical centers in Germany. Through this experience, he realizes that an important minority of the population, including professors, especially the old generation, is still not welcoming doctors from third-world countries. He says he felt real discrimination in their eyes and prejudiced actions from many people inside and outside the hospital the Middle East.
Omar believes that there was a clear preference for German students and that he might not be welcome in some departments and hospitals unless he proves his excellent skills. He did not miss the chance to do so, and after that occasion, young medical students and residents became much more welcoming than the older professors. He still thinks that one experience that happened at a hospital in a small town does not prove the presence of discrimination in the entire nation. However, it is crucial for students and doctors to try similar short-term internships to obtain an idea about the social circumstances of the country before taking a final decision to move there.
On the Moroccan side, it is still not clear whether the majority of the doctors and medical students who move to Germany will eventually decide to practice there for a long time, to switch to another country in the European Union, or to go back to practicing in the private sector in Morocco and bring what they learned back to their country.
Two doctors named Khalid and Mohammed, who studied medicine and finished their residency training in Germany, said that they preferred going back to Morocco. According to them, despite the considerable medical knowledge provided and the decent social life in Germany, they wanted to be closer to family and have a more stable financial situation. Most of the Moroccan citizens in other fields work for low wages, averaging about USD 350?450 in Germany, which is just a small fraction of what a doctor with good experience can earn in the private sector. They said that it is “better to be very rich in a poor country than just above the average in a rich country.”
A residency program in Germany could provide much knowledge and experience, and Moroccan students or doctors who would like to go there believe that they could receive them for sure. A resident in Germany obtains much more experience than his or her peers in Morocco.
For example, angiography is still exclusive to professors in university hospitals in Morocco. The vast majority of Moroccan residents never have the opportunity to learn it, but in first-world countries, it is obligatory for residents to perform and master it before they graduate. The same goes for many other medical procedures.
It is practically impossible to predict what the future holds for this generation of young doctors moving to Germany. We cannot tell whether this is just a wave that is going to disappear soon or a long-term phenomenon. However, what is certain is that thousands of young students around Morocco are waiting to know the outcome. The success of the first generation will send positive echoes to those who are still in medical schools. Failure of the first tries will make students consider other destinations. Immigration for a better future continues to be a solid pillar of the Moroccan culture, especially in the medical field.