Multiscalar (Dis)connections in Medical Education and Healthcare Work in Romania and Beyond

ABSTRACT

Healthcare systems worldwide face growing challenges related to workforce shortages, uneven personnel distribution, governance and long‐term sustainability. The training and mobility of healthcare professionals are central to these challenges, yet the interdependencies between medical education, healthcare provision, workforce planning and mobility are often governed across different institutions, policy domains and scales. This article examines how the Romanian healthcare and medical education systems are shaped by (dis)connections across individual, regional, national and international scales. Romania provides a particularly revealing case, occupying a dual position within Europe as both a major supplier of doctors to other countries and an international hub for medical education. Adopting a multi‐scalar approach, we develop (dis)connection as an empirically derived category and diagnostic tool to examine how divergences between policy domains, geographic inequalities and the frictions between individual career trajectories and national and international labour market demands contribute to a fragmented yet transnationally entangled healthcare system. Drawing on fieldwork conducted in Romania and Switzerland, the study foregrounds the perspectives of key actors across medical education, policy, and labour sectors, offering a nuanced examination of the tensions and negotiations that shape current healthcare systems. Our findings show that horizontal institutional coordination, spatial inequalities and misalignments between individual aspirations and systemic needs create persistent strain within Romania's healthcare system. While international mobility for education and work generates opportunities at the individual and institutional levels, it often undermines sustainable workforce planning and retention from a national perspective. Tracing the ambivalent effects of (dis)connections across multiple scales reveals both dysfunctions and potential leverage points for transformation. With these findings and the conceptual lens of (dis)connections, we contribute to broader interdisciplinary debates on the sustainability of healthcare systems in increasingly interconnected contexts.