How the organisation of medical work shapes the everyday work experiences underpinning doctor migration trends: The case of Irish-trained emigrant doctors in Australia

John-Paul Byrne,Edel Conway,Aoife M Mcdermott,Anne Matthews,Lucia Prihodova,Richard W Costello,Niamh Humphries

doi:10.1016/j.healthpol.2021.01.002

Abstract

Medical migration is a global phenomenon. In Ireland, hospital doctor emigration has increased significantly in recent years, with Australia a destination of choice. With work and employment conditions cited as a driver of these trends, this article explores how health system differences in the organisation of medical work shape the everyday experiences of hospital doctors which underpin migration decisions. Drawing on 51 semi-structured interviews conducted in July-August 2018 with Irish-trained hospital doctors who had emigrated to work in Australia, the findings highlight doctors’ contrasting experiences of medical work in the Irish and Australian health systems. Key system differences in the organisation of medical work manifested at hospital level and related to medical hierarchy; staffing, support and supervision; and governance and task coordination. Findings indicate that retention of hospital doctors is as much about the quality of the work experience, as it is about the quantity and composition of the workforce. At a time of international competition for medical staff, effective policy for the retention of hospital doctors requires an understanding of the organisation of work within health systems. Crucially, this can create working contexts in which doctors flourish or from which they seek an escape.

Highlights

Doctor migration is a global phenomenon which must be addressed by policymakers in low, middle, and high-income countries [1]
Extending Burke at al.’s [10] analysis of an Irish health system under pressure, we show how austerity-related cuts to the Irish healthcare system continue to affect the organisation and experience of medical work within hospitals, and the migration intentions of hospital doctors in Ireland
Health system contexts matter for the creation and reproduction of working conditions which impact on the sustainability of medical workforces

Summary

Introduction

Doctor migration is a global phenomenon which must be addressed by policymakers in low, middle, and high-income countries [1]. To understand the work-related drivers of hospital doctor emigration, we need an in-depth, exploration of the health system contexts and working conditions which shape the experience of medical work [7,8]. Understanding these dynamics requires context-specific analyses, asking ‘What works?’, but ‘What works, for whom, under what circumstances, and how?’ [9]. This paper seeks to address this gap In so doing, it provides insights relevant for doctor retention in other health systems

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Conclusion