The Invisible Team Behind International Patient Care
How should we prepare the health tourism workforce?
Behlül Ünver | President, World Health Tourism Platform
Before travelling to Türkiye for surgery, an international patient sends in a medical file. Someone notices what is missing, gets the test results to the physician, arranges a consultation and explains the limits of a possible treatment in a language the patient understands. Once the patient arrives, the laboratory, imaging department, blood bank, operating theatre, sterilisation unit, pharmacy and ward must work to the same clinical plan. A delayed flight changes the bed plan; an unexpected test result may change the clinical decision and length of stay. After treatment, the documents and follow-up questions still have to reach the right person.
We often describe this large organisation through a photograph of a physician and a patient reception desk. Yet international patient care is a system in which a hospital’s clinical services, management, support teams and external partners work together. The invisible team extends far beyond a few interpreters and coordinators. I want to examine its true scope and how Türkiye can prepare and retain the people on whom it depends.
Who works behind a single treatment?
Consider a planned operation. The surgeon’s decision can be carried out only when the anaesthetic assessment, reliable tests, sufficient nursing staff, sterile supplies, a postoperative bed and, when needed, intensive care are available. A patient from abroad also needs language support, documentation, payment arrangements and coordination for the return journey. The table offers a practical framework for mapping an institution’s workflow:
Stage | Teams that must work together | Critical decision or handover |
Enquiry and eligibility | Physician, patient coordination, medical interpreter, records and IT | Is the file complete? Does the patient mistake a remote preliminary opinion for a final treatment decision? |
Diagnosis and preparation | Laboratory, pathology, radiology, anaesthesia, pharmacy and blood bank | Do the findings or risks change the timing or suitability of the procedure? |
Treatment and admission | Physician, theatre, sterilisation, nursing, intensive care and infection control | Is the same safe clinical capacity available by day and at night? |
Recovery and return | Physiotherapy, dietetics, discharge, interpretation, coordination and transport | Does the patient understand the medicines, warning signs and clinical fitness to travel? |
Follow-up at home | Named clinical lead, patient coordinator, secure records and home-country physician | Who receives a new symptom, how quickly and with what clinical information? |
Procurement, biomedical maintenance, cleaning, logistics, quality management, human resources, finance, legal services, insurance and data security stand behind this chain as well. If a device cannot be maintained, imaging is disrupted; if medicines or interpreting services are unavailable, the clinical timetable slips. An outsourced service is still part of the experience the institution is responsible for managing. Responsibilities and contingency plans must be reflected in contracts, day-to-day practice and duty rosters.
Scale is not the same as usable capacity
The Turkish Ministry of Health’s 2025 statistical bulletin shows the scale of healthcare services across all sectors: [1]
Indicator | Türkiye, 2025 |
Active hospitals | 1,553 |
Beds in active use | 270,829 |
Physicians, total | 232,315 |
Nurses | 264,172 |
Midwives | 60,948 |
These totals do not represent teams dedicated to health tourism. A hospital must also meet the emergency and routine needs of its local population. Capacity for international patients should be assessed alongside specialty, case complexity, theatre and intensive-care occupancy, nursing shifts, language support and follow-up after discharge. The limiting factor is often the skilled professional who must be available at a particular hour, not the building itself.
Geographical distribution matters too. The same bulletin reports 402 physicians per 100,000 people in Western Anatolia and 173 in Southeastern Anatolia. The OECD’s 2025 Türkiye note reports 2.4 practising doctors and 2.9 practising nurses per 1,000 people, compared with OECD averages of 3.9 and 9.2 respectively. [1, 2] The national totals and OECD indicators use different definitions and reference years; I am not deriving a staffing shortfall by subtracting them. But any target for international patients must take account of local access to care and the existing workload of the team.
Language support and nursing are system responsibilities
Informed consent depends on a patient understanding the procedure, alternatives and risks before signing a form. A World Health Organization review shows that language barriers can affect access to and the quality of healthcare. [3] A medical interpreter should prepare for the consultation, avoid adding a personal clinical interpretation and ask the physician to clarify an ambiguous statement. Multilingual leaflets help, but cannot replace an explanation tailored to the individual patient.
Nurses provide continuity. They monitor pain, medicines, daily care and changing symptoms; pass information between teams; and teach the patient what to do after discharge. In many institutions, however, international patient work adds a further communication burden to an existing shift. Training alone cannot solve this if language support, time for care and workload per patient are not planned together. Patient safety has too many steps to depend on the vigilance of one person. [4]
The coordinator routes a clinical question to the appropriate clinical lead; the coordinator does not assess a complication or recommend medicines. Handover between physician, nurse, interpreter and coordinator should be documented. When an employee is away, the patient’s record and contact history must not remain on that employee’s personal phone.
Healthcare talent now faces international competition
While Türkiye seeks to attract patients from other countries, physicians, nurses and other health professionals trained here also consider opportunities to study and work abroad. The OECD’s 2025 migration review examines competition between countries for doctors and nurses and the reliance of many health systems on migrant personnel. The World Health Organization’s 2025 nursing report estimates a global shortage of 5.8 million nurses in 2023 and projects 4.1 million in 2030. [5, 6] These global figures do not measure departures from Türkiye, but they help explain the demand that Turkish professionals face.
Türkiye’s Certificate of Professional Good Standing is an official document that health workers can use in authorisation procedures for education or employment in another country. [7] An application for this certificate must not be treated as proof of emigration, permanent relocation or departure from the profession. We need to distinguish applications, actual departures, returns and movement between institutions for physicians, nurses and other professions if we want a sound picture of the issue.
Pay alone cannot explain whether physicians and nurses remain. A safe working environment, predictable shifts, professional respect, opportunities to specialise and academic advancement also matter. If experienced staff leave as health tourism grows, it takes time to train their replacements, especially in theatres, intensive care and other specialist services. The cost to the institution and to patients of losing trained people belongs in the capacity calculation.
Training and retention belong in the same plan
Universities and hospitals can bring medicine, nursing, pharmacy, healthcare management, biomedical engineering, information systems and interpreting together around shared case exercises. Assessment should extend beyond language tests. Teams can rehearse consent discussions, unexpected findings, complication reports, discharge and secure information exchange with a physician in the patient’s home country.
Each priority treatment area also needs a skills inventory. Who is competent to perform which task? Who can communicate in which language? Who is available at night, and who takes over in an absence? A target for new patients should be approved alongside that inventory, the training schedule and the local patient workload. Mentoring, reasonable shifts, development opportunities and a career path for experienced staff are part of the same plan.
International experience need not automatically be seen as a loss. Institutions can maintain relationships that enable returns, joint teaching and remote academic collaboration. But their first response to the possibility of emigration should be to listen to why staff may want to leave and improve the conditions in which they work.
Performance measures should make the team visible
We should measure how the system works from treatment decision to return home, alongside patient numbers and revenue. Useful indicators include reasons for postponed operations; timely access to complete test results; vacancies on critical shifts; consent discussions with appropriate language support; patient understanding of the discharge plan; the time it takes for a complication report to reach a clinical team; and staff turnover.
These measures should not be used to blame an employee. A delayed laboratory result, staff shortage and interrupted digital record arise for different reasons; measurement helps managers choose the right response. Clinical and operational leaders need to examine handover failures together. Leaving problems that an international patient office cannot solve on its desk is not a management model.
The patient may remember the surgeon’s name. But the surgeon’s ability to work safely, and the patient’s confidence after returning home, depend on the coordination of dozens of professions. Türkiye can strengthen its position in health tourism by building institutional capacity that trains, retains and brings those people together.
Comments