Understanding why oral health professionals migrate: A qualitative investigation of Iranian dentists who have moved to Canada (Oral health professionals' migration)

BACKGROUND

The migration of health professionals from Low- and Middle-Income Countries (LMICs) to High-Income countries (HICs) is an ongoing phenomenon that has been accelerating with globalisation. While there has been growing research around the migration of physicians and nurses, there is less understanding of the motives surrounding the migration of dentists, and even less about their migration from specific countries.

OBJECTIVES

This qualitative study explores the migration motivations of Iranian dentists who have moved to Canada.

METHODS

Semi-structured interviews of 18 Iranian-trained dentists in Canada were conducted to obtain information about their motives for migration. Interviews were coded and categorised into themes using qualitative thematic analysis.

RESULTS

Motivations to migrate were grouped into four analytical areas: socio-political; economic; professional; and personal. An inverse relationship was identified between the strongest motives to migrate and the topics respondents were least comfortable discussing. Socio-political-related motives were predominant with respondents focusing on their dissatisfaction with the social ethos and restrictions on personal freedom within Iran.

CONCLUSION

Country-specific context is critical to fully understand health professional migration; in particular, the dynamics and interplay between socio-political, economic, and professional/personal factors within the home country. While Iranian dentists' motives to migrate have some similarities to other health professionals who migrated from Iran, and dentists from other countries, differences need to be considered to fully understand migration patterns.

Towards more effective health workforce governance: The case of overseas-trained doctors

OBJECTIVE

The over-reliance on overseas-trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas-trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance.

DESIGN

Qualitative interviews were undertaken with overseas-trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas-trained doctors.

SETTING

Migrant doctors working in general practice in rural and remote Australia.

PARTICIPANTS

Overseas-trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group.

RESULTS

Overseas-trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas-trained doctors, policy-makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous-related health and cultural challenges.

CONCLUSIONS

In the context of Australia's continuing reliance on overseas-trained doctors, this study revealed the need for improved communication and coordination between overseas-trained doctors, policy-makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.

The Practice of Dentistry by Australian- and Overseas-Trained Dentists in Australia: Discriminant Analysis of key Predictors

INTRODUCTION

Overseas-trained dentists comprise at least one-fourth of the overall Australian dental workforce. This study examined characteristics and practice differences between Australian- and overseas-trained dentists to identify key predictors that best differentiate their dentistry practices.

METHODS

Data for the study were from the Longitudinal Study of Dentist Practice Activity (LSDPA), a survey of a nationally representative random sample of dentists in Australia commencing in 1983-1984 and repeated every 5 years. Dentists were surveyed on a wide range of items including participant characteristics, practice patterns, practice inputs, direct demand, and productivity measures. Data were weighted to provide national estimates by age, sex, and practice type. Discriminant function analysis was used to examine the predictor variables that best distinguished between the two groups. Analysis was limited to the most recent wave of the study.

RESULTS

A total of 1148 dentists (response rate = 67%) responded to the survey in 2009-2010; 648 cases were available for the discriminant analysis. The discriminant functions for the full sample and each of the 3 age groups (<35 years; 35-50 years; and 50+ years) were found effective to separate dentists into 2 groups (Australian and overseas), with the proportion of cases correctly classified being highest for the oldest age group (89.7% for 50+ years). Female gender, type of practice (working in public sector), and working in disadvantaged areas were significant predictors, with more prominence in the 35- to 50-year age group. Practice inputs, demand, and productivity measures offered less discriminative capacity between the dentists.

CONCLUSION

Overseas-trained dentists contribute towards providing dental care to underserved populations, the public sector, and in rural and remote locations. This study provided basis to argue that policies to encourage overseas-trained dentists to contribute towards areas of need locations have been successful, and key productivity measures were also similar to Australian-trained dentists.

Regulation, migration and expectation: internationally qualified health practitioners in Australia-a qualitative study

BACKGROUND

The global movement of internationally qualified health practitioners (IQHPs), seeking to live and work outside of their place of origin, is subject to considerable study and scrutiny. Extensive published material exists, from government enquiries and print news media articles to peer-reviewed papers, reporting on the views and impacts of migration and practitioner registration. Unsurprisingly much of the research focuses on the two largest groups of health professionals, international medical graduates (IMG) and internationally qualified nurses (IQN). This paper presents a unique case study examining the challenges and complexities of navigating the regulatory processes for skilled migration and practitioner registration in Australia.

DISCUSSION

The study comprised a review and analysis of the current policy frameworks, standards and assessment models applied by regulators affecting skilled migration and registration of IQHPs. To target the triangulated themes of regulation, experience and expectations, a phenomenological component was also conducted with the mapping of shared experiences of four key participant groups comprising the following: assessors operationalising the current policies and processes governing skilled migration and registration, educators offering preparatory and training programs to IQHP, workforce agencies engaging with and recruiting IQHP and internationally qualified doctors, nurses and midwives. The study was informed by rich qualitative data extracted from twenty-eight in-depth semi-structured participant interviews. Key themes and points of intersection between participant experiences and the regulatory frameworks were identified using theory and data-driven coding and thematic analysis via the NVivo 12 plus software.

CONCLUSION

From studying the complexities of the current regulatory processes for skilled migration and practitioner registration and informed by participants with first-hand knowledge and experience, this research found a clear argument for a re-examination and update of the current regulatory requirements for IQHP. Without greater innovation, harmonisation, evidence-based solutions and reform, it is likely that Australian regulators, policymakers, employers, and the nursing, midwifery and medical professions at large will continue to experience challenges in registering, employing and supporting IQHP, while maintaining the safety of the public requiring care in the Australian healthcare system.

The experiences of foreign doctors in Saudi Arabia: A qualitative study of the challenges and retention motives

Background

The Saudi healthcare system is mainly staffed by foreign doctors who constitute about 73% of the total medical workforce. But, the high rate of turnover among these foreigners had deposited an additional unbearable cost and threatens the stability of the provided healthcare services in the country.

Objectives

This study was conducted to explore the professional and personal challenges that were experienced by foreign medical doctors while working in one of the major governmental tertiary-care hospitals in Riyadh city. The study also seeks to explore the factors that could influence or motivate their retention.

Methods

A qualitative study based on semi-structured interviews was conducted on January 2018. A total of 16 foreign doctors were recruited purposefully using a maximum variation sampling strategy. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis technique.

Results

Three primary themes have been emerged based on the data analysis: (1) Work-related challenges such as; communication and discrimination challenges. (2) Living-related challenges such as; supportive services and restricted movement challenges. (3) Factor motivating retention such as providing good children education, offering flexible traveling regulations, and providing professional development opportunities.

Conclusions

The findings of this study have indicated that there are more important motivators than money for improving the retention of foreign doctors in the country. Several policy actions have been recommended to maintain their essential role. For example; implementing an ethical code to protect them from receiving deceptive hiring information, developing a specialized pocket dictionary to overcome language barriers, embracing "workforce diversity management" techniques to minimize discrimination at institutional level, and finally it is also recommended to include the foreign doctors' family needs and other living related challenges in any future retention strategies.

The Dark and the Light Side of the Expatriate’s Cross-Cultural Adjustment: A Novel Framework Including Perceived Organizational Support, Work Related Stress and Innovation

The new context of the Psychology of Sustainability and Sustainable Development has reached the attention of the scientific community in recent years, due to its comprehensive approach aimed at enhancing the sustainability of interpersonal and intrapersonal talent, as well as of groups and communities. In this scenario, research on employee cross-cultural adjustment (CCA) is considered a key theme in human resource management. It is known that psychological support in the host country may alleviate distress and facilitate the integration of the expatriate workers. However, there is a lack of research investigating expatriate adjustment as an antecedent of the perceived organizational support. The aim of the study was to investigate the relationship among cross-cultural adjustment (CCA), perception of organizational support (POS), work-related stress (WRS), and innovation, considering these factors as a part of a unique innovative framework. A cross sectional study was performed using a sample of 234 expatriate workers of a multinational organization. Data were collected through a monitoring survey for the assessment of work-related stress risk factors of their expatriate staff. The results showed a positive correlation between CCA, POS, and innovation. On the other hand, a negative correlational effect of CCA and WRS, CCA and POS on WRS, and POS and WRS was found. Finally, POS was found to be a significant antecedent of CCA. These findings have implications for both international human resource management researchers and practitioners.

The Life Story Experience of "Migrant Dentists" in Australia: Potential Implications for Health Workforce Governance and International Cooperation

BACKGROUND

The migration of dentists is a major policy challenge facing both developing and developed countries. Dentists from over 120 countries migrate to Australia, and a large proportion are from developing countries. The aim of the study was to assess the life story experience (LSE) of migrant dentists in Australia, in order to address key policy challenges facing dentist migration.

METHODS

A national survey of all migrant dentists resident in Australia was conducted in 2013. Migrant experiences were assessed through a suite of LSE scales, developed through a qualitative-quantitative study. Respondents rated experiences using a five-point Likert scale.

RESULTS

A total of 1022 migrant dentists responded to the survey (response rate = 54.5%). LSE1 (health system and general lifestyle concerns in home country), LSE2 (appreciation towards Australian way of life) and LSE3 (settlement concerns in Australia) scales varied by migrant dentist groups, sex, and years since arrival to Australia (chi-square, P < .05). In a logistic regression model, migrants mainly from developing countries (ie, the examination pathway group) faced greater health system and general lifestyle concerns in their home countries (9.32; 3.51-24.72) and greater settlement challenges in Australia (5.39; 3.51-8.28), compared to migrants from well-developed countries, who obtained direct recognition of qualifications. Migrants also are more appreciative towards the Australian way of life if they had lived at least ten years in Australia (1.97; 1.27-3.05), compared to migrants who have lived for less than ten years.

CONCLUSION

Migrant dentists, mainly from developing countries, face challenges both in their home countries and in Australia. Our study offers evidence for multi-level health workforce governance and calls for greater consensus towards an international agenda to address dentist migration. Better integration of dentist migration with the mainstream health workforce governance is a viable and opportunistic way forward.