Abstract
BackgroundIn many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors).MethodsThree different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis.ResultsThe number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful.ConclusionsPrimary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.
Highlights
In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs)
The aim of the present study was, i) to examine, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector; ii) to examine, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary health care in Finland; and, iii) to compare experiences of the psychosocial workplace environment among foreign-born physicians working in various health care sectors
We analyzed the differences in psychosocial work environment between foreign-born GPs and other foreignborn physicians using ANCOVA in continuous variables adjusting for background factors, and we present means and F-statistics for these differences
Summary
In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). An increasing shortage of general practitioners (GPs) threatens the effective functioning of primary health care in many countries. In Finland, health care is mainly publicly funded, and responsibility for running the health care system is delegated to local government. Primary health care services provided by the private health care sector account for 16% of outpatient physician visits. Occupational health services account for about 13% of outpatient physician visits; these are mainly provided by private sector firms [4]. In Finland, the shortfall from the required number of physicians at primary care health centres was 6% in 2010 [5], considering both domestic and foreign-born physicians
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