Abstract
Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration.
Highlights
Since the 1990s medical migration has attracted considerable interest from health and social science researchers and policy-makers alike [1]
We focused on problems that were experienced and/or perceived in the work of foreign-born and foreign-trained (FB&FT) physicians, how these problems should be resolved and who should be considered responsible for implementing change strategies
The central process that we identified during our analysis was the comparison of the physicians’ work performance with assumed professional standards (PS)
Summary
Since the 1990s medical migration has attracted considerable interest from health and social science researchers and policy-makers alike [1]. The situation within destination countries and the process of professional integration of foreign-educated health professionals has long received only scant attention [6] This has, changed over the last decade with the topic attracting more academic and policy attention in many traditional destination countries [7,8,9]. Research on professional integration of foreign-educated health professionals, physicians who migrated to Germany, had been practically non-existent. Restrictive policies had made it difficult to enter the German labor market even for highly skilled migrants [13] When these policies changed, hospitals in rural, less affluent areas increasingly recruited doctors from abroad [12]. The topic of professional integration of foreign-born and foreign-trained (FB&FT) physicians is of increasing interest to stakeholders and researchers in the German context
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