Healthcare staff migration has been reported in the past few decades worldwide [1], [2], [3], [4], [5]. Portes suggests the dynamics of labour migration are driven primarily by the economic and innovation inequalities among the sending and receiving countries, creating the respective “brain drain” and “brain gain” pathways and resulting in economic development [6]. Historical and political events also contribute to the migration patterns; examples of this are the addition of countries to the European Union (EU) since 2004 and the relocation of medical professionals from newly joined countries [7], [8], [9], [10], as well as the Brexit-related impact on healthcare staff recruitment and retaining in the United Kingdom (UK) [11,12].

Due to innovations and advances in healthcare, population ageing along with the demand for workforce in the field increases. This projects significant shortages of multiple specialties and professions, particularly in high and middle-income countries, leaving the low-income countries with lower workforce supply [13,14]. Notably, the association between worse outcomes and the workforce shortage have been reported [15].

Having joined the EU in 2004, Lithuania has been a sending country in labour migration [16]. While Lithuania has no formal society- or government-led monitoring of healthcare staff migration, the State Health Care Accreditation Agency under the Ministry of Health recorded 323 applications (277 medical physicians, 46 odontologists) in 2020 for their professional qualification recognition according to the European Parliament and Council Directive 2005/36/EC [17]. However, the Agency notes that this number does not reflect actual migration trends: some doctors, having not registered their licence abroad, apply more than once [18]. In addition, it is essential to note that not everyone with their qualifications recognised eventually leaves the country.

Despite the multiple policy changes implemented to move from the Soviet Union healthcare model after regaining independence in 1991 [19], [20], [21], there has been a residual disparity in healthcare staff salaries compared to the receiving high-income countries. On average, a Lithuanian physician's gross pay was just above 2500 euros/month in 2019 [22], while, for example, the UK physician's gross annual salary grades range between £28,808 and £110,683 per year, depending on career stage [23]. This means than on average, Lithuanian physicians earn a similar salary compared to the most junior counterparts in the UK. Moreover, Bertasiute et al. found only 6% of surveyed 611 doctors reported their full-time salary as sufficient to provide for themselves and their families in 2018 [24].

Reasons for migration among doctors and medical students have been assessed in several sending EU countries [25], [26], [27], [28], [29]. Despite the differences in economic status and wages among countries [30], it has been reported that salary disparities, while being one of the main reasons for doctors’ migration to Europe, are closely followed by training and career opportunities, workload disbalance and work environment [26,29,[31], [32], [33], [34], [35], [36]]. This spectrum of reasons supports the argument by Vujicic et al. that salary differences alone may not be the main drivers in healthcare staff migration and that working and living conditions and tailored training policies are important variables (24).

Regarding non-economic factors, poor workplace well-being, burnout and bullying are associated with decreased patient safety [37], [38], [39]. The effects of poor physician well-being, bullying, and ineffective leadership models in healthcare have been increasingly reported and discussed worldwide [40], [41], [42], [43], [44], [45], [46], [47], [48]. Their impact on migration, however, has not yet been widely studied. Burnout has been recently found as one of the reasons doctors emigrate from Hungary [36].

A few studies have assessed healthcare staff migration intentions in Lithuania since 2004 [49], [50], [51]. In 2018, in addition to economic reasons, doctors’ perceived low social worth and unacceptable workplace climate were predictors for emigration among doctors and medical students in Lithuania [51]. Recently, Aranauskas et al. found the severity of burnout was linked to the workload among healthcare staff in Lithuania [52]. However, to our knowledge, emigration intentions have only been investigated among Lithuanian doctors practising in Lithuania.

The purpose of this study was to assess why Lithuanian doctors practising abroad (including board-certified physicians and doctors in training) chose to leave the country and the factors that would favour their return.