Small countries face specific challenges in health workforce sustainability, but policy responses are a testbed for resilience for all countries

While countries across Europe are facing challenges in building and sustaining a health workforce, small countries (official population of under 2 million people) face specific challenges that go beyond resource constraint. Limited population size constrains training capacity, specialist care provision, and career development opportunities, making these systems highly vulnerable to workforce shortages. Experiences in Cyprus, Luxembourg, North Macedonia, and the Caribbean Netherlands illustrate these dynamics. Cyprus and Luxembourg have expanded in-country medical education and postgraduate training to reduce the need for training abroad. In contrast, North Macedonia trains sufficient health professionals but struggles with outmigration. Island territories face additional logistical and geographic barriers. The Caribbean Netherlands rely on rotations and cross-border care for many healthcare services. Small countries are like a microscope that magnifies both the problems and the policy responses and may thus serve as a testbed for all health systems confronting workforce challenges. Small country experiences underscore the need for collaborative solutions to respond to the health workforce crisis, including enhanced training opportunities, mitigation of migration risks and improved retention. Ensuring resilience of the health workforce in the face of demographic and mobility pressures requires effective planning and integrated strategies addressing remuneration, working conditions, and professional development across all roles and sectors.