Physician Brain Drain from Turkey: Push-Pull Dynamics, Return Intentions, and the Normative Challenge for Health Policy.

This mixed-methods study examines the push-pull factors influencing physician emigration from Turkey and assesses the feasibility of reverse brain drain, framing physician migration as a challenge for health governance rather than merely an individual career choice. Quantitative data from 1331 physicians (700 specialists, 631 interns) across 19 provinces and qualitative interviews with 32 emigrated physicians in four destination countries reveal that violence against healthcare workers (81.6%), low salary (74.3%), and challenging working conditions (59.8%) constitute the primary push factors. A statistically significant negative correlation between job satisfaction and brain drain attitudes (r = - 0.132, p < 0.01) confirms an association but explains only limited variance, indicating that structural and systemic conditions matter beyond individual satisfaction alone in shaping migration orientations. The qualitative findings identify professional burnout, performance system dysfunction, and sociopolitical instability as additional drivers. Only 2 of 32 emigrated physicians were considering return, and no female participant expressed return intention. Drawing on the ethics of health workforce governance, the study argues that when the state fails to protect physicians from violence and provide sustainable professional conditions, the normative responsibility for brain drain shifts from the emigrating individual to the institutional structures that render emigration rational. Policy interventions targeting salary alone are insufficient; comprehensive reforms in professional safety, meritocratic career pathways, workload standards, and sociopolitical stability are required.