Physicians In Finland Research Articles

Decision support systems as supporters of clinical work: perspectives from physicians in Finland

Abstract Background The digitalisation of healthcare has changed physicians’ clinical and administrative work. For example, decision support systems (DSSs) are expected to support physicians’ daily work. The present study examined physicians’ experiences of DSSs’ support for their work analysed by age, gender, employment sector and leadership position. Methods Altogether 4630 physicians (64% women) from Finland responded to the online survey. Logistic regression analyses were conducted to examine the associations of age, gender, employment sector, and leadership position with experiences of DSSs’ support for their work. Results Of the respondents, 21.3 % agreed that DSSs supported their work, whereas 43.5 % were neutral and 35.2 % disagreed with the statement. Age (Wald’s F = 15.5, p = 0.001), employment sector (Wald’s F = 84.6, p < 0.001), and leadership position (Wald’s F = 16.3, p < 0.001) were significantly associated with the assesment, whereas gender was not. Those aged between 45 and 54 (OR 0.65, 95% CI 0.51-0.81) and between 55 and 64 (OR 0.74, 95% CI 0.59-0.93) had lower odds for agreeing compared to those aged 35 or under. Compared to physicians in hospitals, primary care physicians had 2.18 times (95%CI=1.84-2.59) greater odds for agreeing that DSSs support their work. Those who were in leadership positions had 1.50 times (95%CI=1.23-1.82) greater odds for agreeing compared to those not in leadership positions. Conclusions Finnish physicians did not experience DSSs supporting their work. Especially older physicians, hospital physicians and those not in leadership positions gave negative assessments. DSSs should be better integrated to physician workflow, it is also possible that usability problems of DSSs such as alert fatigue affected user experiences. More attention should be paid to developing DSSs in a way that they support physicians work better. Key messages • Finnish physicians did not experience that decision support systems would actually support their work. • Especially older physicians, hospital physicians and those not in leadership positions did not agree that decision support systems would support their work.

Varieties of silence – a mixed-methods study exploring reasons and justifications for nondisclosure of the use of complementary therapies to physicians in Finland

BackgroundIn health care, two in three users of complementary therapies (CT) stay silent about their CT use. Disclosure of CT use to physicians is important for patient safety, participation, and shared decision-making. Common reasons for CT nondisclosure include patients´ expectations of physicians’ unaccepting response to disclosure, physicians not asking, and patients believing it is unnecessary. This study aimed to increase understanding of patient silence. We investigated how the reasons for nondisclosure of CT use reported by CT users were associated with the frequency of CT disclosure and how these associations and reported justifications to keep silent reflect patient silence among the study participants.MethodsThis mixed-methods study used existing data from the non-probability-based online survey (n = 6802) targeted to CT users among the general population in Finland. A qualitative structured tabular thematic analysis was conducted for the selected 342 brief texts describing the reasons and justification for not telling physicians about CT use. The associations between the frequency of CT disclosure and the reasons for CT nondisclosure were analysed by crosstabulations and binary logistic regression analysis with SPSS (v28).ResultsThree types of patient silence were revealed. Avoidant silence illustrates the respondents coping with the fear of unwanted response from a physician and avoiding the expected negative consequences of CT disclosure. Precautionary silence exemplifies respondents striving to prevent the reoccurrence of previously experienced frustration of wishes to be seen and heard as CT users. Conditional silence portrays the self-confidence of respondents who assessed their need to disclose CT use to physicians on a case-by-case basis.ConclusionsSilence, for some patients, may serve as a way of warding off past and possible future fears and frustrations related to CT disclosure. It is important to recognise different types of patient silence related to CT disclosure to enhance patient participation and shared decision-making in health care. Efforts are needed to provide health policy decision-makers with information about CT users’ lived experiences with CT communication in health care.

Team players and helpers – describing professional identity among finnish physicians in a cross-sectional study

BackgroundEvery physician has a unique professional identity. However, little is known about the diversity of identities among physicians. This study aimed to quantitatively assess the professional identity of physicians in Finland using descriptions of professional identity.MethodsThis study was part of a larger cross-sectional Finnish Physician 2018 Study. The target population consisted of all Finnish physicians under the age of 70 (N = 24,827) in 2018. The sample was drawn from physicians born on even numbered days (N = 11,336) using the Finnish Medical Association register. A total of 5,187 (46%) physicians responded. Professional identity was examined by 27 given characterisations using a five-point Likert scale. Multivariate logistic regression was used in assessing how place of work, graduation year and gender were associated with identity descriptions.ResultsThe descriptions which most physicians identified with were “member of a working group/team” (82%), “helper” (82%), and “health expert” (79%); the majority reported these as describing them very or quite well. Identity descriptions such as “prescriber of medications” (68% vs. 45%), “prioritiser” (57% vs. 35%) and “someone issuing certificates” (52% vs. 32%) were more popular among junior than senior physicians. The biggest differences between the genders were found in the descriptions “provider of comfort” (62% vs. 40%) and “someone engaged in social work” (45% vs. 25%), with which women identified more frequently than men.ConclusionsStrong identification as a member of a team is an important finding in the increasingly multiprofessional world of health care. Importantly, most physicians shared several core professional identity descriptions (i.e., helper, health expert) that reflect the traditional image of an exemplary doctor.

Home Editorial Board Reviewers Online first CEEMR Issues View All Issues Current Issue Previous Issue Index by Author Author's Guidelines Open Access Statement Publication Ethics Privacy Policy Accessibility Statement Contact Subscribe Enter your email below E-mail * ‘For a Secure and Stable Life’: Constructing Life Satisfaction in the ‘Migratory Careers’ of Russian Immigrant Physicians in Finland

Home Editorial Board Reviewers Online first CEEMR Issues View All Issues Current Issue Previous Issue Index by Author Author's Guidelines Open Access Statement Publication Ethics Privacy Policy Accessibility Statement Contact Subscribe Enter your email below E-mail * ‘For a Secure and Stable Life’: Constructing Life Satisfaction in the ‘Migratory Careers’ of Russian Immigrant Physicians in Finland

Post-graduate Course in Palliative Medicine: Experiences from an E-Learning-Based Pilot Program, a Mixed Methods Study.

Objective: To study whether E-learning methods are feasible in the post-graduate education of palliative medicine. Methods: A mixed-methods study. Evaluations from pilot course attendees were analyzed numerically and answers to open-ended questions about E-learning were analyzed using inductive content analysis. A national pilot E-learning-based post-graduate course in palliative medicine with 24 participating physicians in Finland. The evaluation of teaching modules and different aspects of the course was achieved from the participants through numerical statements and open-ended questions. Results: The feedback on most aspects of the course was good. For example, issues of pain and symptom control, lectures, pre-exams, and group discussions were deemed suitable for E-learning, while studying communication and existential issues through E-learning was considered more challenging. The benefits of E-learning included efficacy, better accessibility, and the possibility to go back to the teaching material. Reduced networking and face-to-face interactions were stated as challenges of E-learning. Conclusions: E-learning is feasible in the post-graduate education of palliative medicine and can be 'surprisingly rewarding'. It allows easy access to learn many important topics, while social networking may fall short. Further studies are needed to assess the increase in competence by different learning methods.

Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland

BackgroundDebates around euthanasia and physician-assisted suicide (PAS) are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there have been changes in these attitudes over three decades.MethodsA questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013.ResultsThe proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020 (from 5 to 25%, p < 0.001, and from 30 to 34%, p < 0.001, respectively). The number of physicians, who expressed no opinion for or against euthanasia (cannot say) decreased from 19 to 5% (p < 0.001) during the same period. The proportion of physicians having no opinion (cannot say) of whether a physician should be punished for assisting in a suicide decreased from 20 to 10% (p < 0.001).ConclusionsThis study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession.

The effect of Covid-19 in digital media use of Finnish physicians – Four wave longitudinal panel survey

BackgroundCovid-19 pandemic has boosted digitalization in healthcare, as mobility restrictions and social distancing rules have made healthcare providers to adopt digital tools to replace or complement face-to-face interactions. PurposeWe discuss the effects of Covid-19 pandemic on physicians’ use of digital media. We examine whether Covid-19 conditions have changed how physicians use internet resources for information search, how they engage in social media, and their attitude towards online events. Basic proceduresThe study was done as a longitudinal panel survey in four waves. The sample was a panel including active physicians in Finland. The panel was updated annually. Identical surveys were administered in 2018, 2019, 2020 and 2021. Spring 2020 was the time when Finland executed mobility restrictions and re-organization of healthcare because of pandemic. Comparing results of the survey before and after Covid-19 restrictions gives us a unique opportunity to do comparative analysis of Covid-19 effects. Main findingsOur results show that the use of digital media for information search stayed relatively stable without statistically significant change during the four-year period covered in the study. The use of social media rose steadily from 2018 to 2021 with no significant difference in the trend. However, there was a significant change in the attitude of Finnish physicians on online events. Year 2021, the attitude remained in this more positive level. Principal conclusionsAs use of digital media including social media was already high prior Covid-19 in Finland, our results do not show significant change because of special circumstances introduced in 2020. However, our results show that the attitudes towards online events turned more positive during Covid-19 related restrictions. This could indicate that Covid-19 era has triggered a change that might continue also when pandemic related restrictions will be removed.

Differentiated Embedding and Social Relationships Among Russian Migrant Physicians in Finland: A Narrative Socio‐Analysis

Migrants’ processes of (dis)embedding in local and transnational social networks have received growing attention in recent years, but most research focuses on low‐skilled migration. This study explores the affordances and challenges that Russian physicians, as a high‐skilled migrant group in Finland, experience in these processes in work and non‐work domains. Based on semi‐structured biographical interviews with 26 Russian physicians, the study employs Bourdieu’s socio‐analysis to analyze their narratives. The results reveal that Russian migrant physicians negotiate and experience differentiated embedding across work–life domains in local and transnational contexts. They mostly develop collegial relationships with Finnish colleagues and benefit from fulfilling professional relationships in the work domain. However, alongside time and efforts needed for building social ties, various factors often impede friendship making and socialization with locals beyond the work domain. These physicians cope with individual life circumstances through their enduring and supportive relationships with their Russian relatives and colleagues–friends. These results indicate that high‐skilled migrants have a greater opportunity to connect professionally with locals than low‐skilled migrants, but experience similar challenges to the latter in building close personal relationships.

Limitation of treatment in prehospital care \u2013 the experiences of helicopter emergency medical service physicians in a nationwide multicentre survey

BackgroundMaking ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in the prehospital setting, including situations where they are dispatched to healthcare facilities or nursing homes.MethodsA nationwide multicentre study was conducted among all HEMS physicians in Finland in 2017 using a questionnaire with closed five-point Likert-scale questions and open questions. The Ethics Committee of the Tampere University Hospital approved the study protocol (R15048).ResultsFifty-nine (88%) physicians responded. Their median age was 43 (IQR 38–47) and median medical working experience was 15 (IQR 10–20) years. All respondents made limitation of care orders and 39% made them often. Three fourths (75%) of the physicians were often dispatched to healthcare facilities and nursing homes and the majority (93%) regularly met patients who should have already had a valid limitation of care order. Every other physician (49%) had sometimes decided not to implement a medically justifiable limitation of care order because they wanted to avoid conflicts with the patient and/or the next of kin and/or other healthcare staff. Limitation of care order practices varied between the respondents, but neither age nor working experience explained these differences in answers. Most physicians (85%) stated that limitations of care orders are part of their work and 81% did not find them especially burdensome. The most challenging patient groups for treatment limitations were the under-aged patients, the severely disabled patients and the patients in healthcare facilities or residing in nursing homes.ConclusionMaking limitation of care orders is an important but often invisible part of a HEMS physician’s work. HEMS physicians expressed that patients in long-term care were often without limitations of care orders in situations where an order would have been ethically in accordance with the patient’s best interests.

The turnover intentions and intentions to leave the country of foreign-born physicians in Finland: a cross-sectional questionnaire study

BackgroundA physician shortage is a worldwide problem and foreign-born physicians fill in the shortage of physicians in many developed countries. One problem that is associated with the physician shortage is increased physician turnover. Also, regarding foreign-born physicians, migration can be costly. The present study aimed to examine the turnover intentions and intentions to leave the country of foreign-born physicians. We examined how demographics, discrimination, language problems, perceived employment barriers, satisfaction with living in Finland, team climate, job satisfaction and patient-related stress were associated with these factors.MethodsThe present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland that were aged between 26 and 65 (65% women). Binary logistic regression analyses were conducted to examine the associations.ResultsHalf of the respondents had turnover intentions and 14.5% had considered leaving the country. High satisfaction with living in Finland was associated with a lower likelihood of both turnover intentions and intentions to leave the country. High levels of discrimination and employment barriers were associated with a high likelihood of turnover intentions whereas good team climate was associated with a low likelihood of turnover intentions. High levels of language problems were associated with a high likelihood of intentions to leave the country.ConclusionsThe present study showed the importance of satisfaction with living in the host country, the prevention of discrimination and employment barriers, language skills and a good team climate for the retention of foreign-born physicians in their current job and in the host country. Thus, to keep their foreign-born physicians, health care organisations should implement measures to tackle these challenges. Organisations could arrange, for example, diversity training, self-assessment, team reflections, leadership coaching and culturally-specific networks. Moreover, internships associated with the qualification process could be utilised better in order to give a thorough introduction to the host country’s health care environment and the possibilities for learning the language.

What's Driving Migrant Russian Physicians to Stay Permanently in Finland? A Life-Course Approach

Abstract This article addresses driving forces that influence Russian migrant physicians in Finland to stay permanently or return to Russia in post-migration. Despite many studies on Russian migration to Finland, little is known on the topic of highly skilled migration and especially the migration process of healthcare doctors. I argue that a blend of factors incites Russian physicians to stay, and these factors affect both present and future migration prospects. Using a qualitative life-course perspective and grounded on interactive migration theories, this study provides new empirical evidence of why Russian physicians decide to stay permanently in Finland. This study adds new knowledge on an under-researched immigrant group and in a less theorized research area in Finnish scholarship. Different social markers form contingent relationships with multiple objectives and implications in the personal and professional life-course of these migrant professionals, and the strategies they employ are analyzed within the context of a Nordic welfare country that is increasingly adapting policies to attract foreign-born health professionals. The study uses semi-structured interviews to provide empirical findings and evidence. The results inform us about important interactive multi-level factors that meet these migrants' negotiated aspirations and expectations to stay in Finland.

Foreign-born physicians\u2019 perceptions of discrimination and stress in Finland: a cross-sectional questionnaire study

BackgroundForeign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians’ experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors.MethodsThe present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations.ResultsA good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives.ConclusionsThe present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one’s skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.

Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty

BackgroundPersonality influences an individual’s adaptation to a specific job or organization. Little is known about personality trait differences between medical career and specialty choices after graduating from medical school when actually practicing different medical specialties. Moreover, whether personality traits contribute to important career choices such as choosing to work in the private or public sector or with clinical patient contact, as well as change of specialty, have remained largely unexplored. In a nationally representative sample of Finnish physicians (N = 2837) we examined how personality traits are associated with medical career choices after graduating from medical school, in terms of employment sector, patient contact, medical specialty and change of specialty.MethodsPersonality was assessed using the shortened version of the Big Five Inventory (S-BFI). An analysis of covariance with posthoc tests for pairwise comparisons was conducted, adjusted for gender and age with confounders (employment sector, clinical patient contact and medical specialty).ResultsHigher openness was associated with working in the private sector, specializing in psychiatry, changing specialty and not practicing with patients. Lower openness was associated with a high amount of patient contact and specializing in general practice as well as ophthalmology and otorhinolaryngology. Higher conscientiousness was associated with a high amount of patient contact and specializing in surgery and other internal medicine specialties. Lower conscientiousness was associated with specializing in psychiatry and hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice and occupational health. Lower agreeableness and neuroticism were associated with specializing in surgery. Higher extraversion was associated with specializing in pediatrics and change of specialty. Lower extraversion was associated with not practicing with patients.ConclusionsThe results showed distinctive personality traits to be associated with physicians’ career and specialty choices after medical school independent of known confounding factors. Openness was the most consistent personality trait associated with physicians’ career choices in terms of employment sector, amount of clinical patient contact, specialty choice and change of specialty. Personality-conscious medical career counseling and career guidance during and after medical education might enhance the person-job fit among physicians.

Physicians' experiences with sickness absence certification in Finland.

Aims: The aim of this study was to explore Finnish physicians' perceptions of sickness absence (SA) certification. Methods: A questionnaire was sent to 50% of the physicians in Finland who provide care to working-age patients in a clinical practice setting. Of the 8867 physicians, 3089 responded. Physicians handling SA certification patients at least a few times per month were included (n = 2472). Results: At least a few times per month, 61% of all physicians perceived SA issues as problematic, 60% had experienced a lack of time in dealing with SA matters, 36% had disagreed with a patient on SA certification, and 36% had met a patient who wanted a SA certificate for reasons other than a disease or injury. Physicians were least worried about patients filing complaints (4%), exhibiting threatening behaviour (2%), or switching physicians for SA certification reasons (1%). A total of 60% of physicians had prescribed SA for a longer period than necessary because of long waiting times for further care/measures. Non-specialized physicians, general practitioners, and psychiatrists experienced problems more frequently than surgeons and occupational health physicians. Over 50% of the respondents had a fairly large or very large need to deepen their knowledge of social insurance matters. The need for national guidelines for all or some diseases was reported by 80% of the respondents. Conclusions: Many physicians perceive SA tasks as problematic and are unable to dedicate enough time to them. Shortcomings in physicians' sickness certification know-how, as well as obstacles in the healthcare and rehabilitation system, prolong the SA process. Attitudes towards the adoption of national guidelines on the duration of SA were positive.

Health Information Systems (HIS)-induced patient safety incidents – experiences of physicians in Finland

Health Information Systems (HIS)-induced patient safety incidents – experiences of physicians in Finland

Medication safety and the usability of electronic prescribing as perceived by physicians-A semistructured interview among primary health care physicians in Finland.

In Finland, a fully operational and nationwide electronic prescription (ePrescription) system was implemented by law in 2012 to 2015. From 2017, all prescriptions have to be electronic. ePrescriptions are intended to facilitate prescribing and to improve medication safety in Finnish health care. In this study, the aim was to explore physicians' experiences with the impacts of ePrescriptions on prescribing and medication safety in Finland. Data were collected by conducting 42 interviews among primary health care physicians in spring 2015. The data obtained were analyzed by means of qualitative content analysis. Most of the physicians considered ePrescriptions to be convenient to issue because of the paperless procedure. Additionally, physicians stated that information concerning patients' prescriptions was better available through the Prescription Centre since physicians were able to check patients' prescriptions, including those issued elsewhere. In particular, ePrescriptions have improved the control of narcotics and medicines classified as primarily affecting the central nervous system. However, establishing a patient's overall medication through the Prescription Centre was regarded as difficult because prescription information was sometimes incoherent and had not been updated. The ePrescribing system was also described as inflexible, especially the correcting, cancelling, or renewing of ePrescriptions. For example, the system required too many "mouse clicks" and PIN entries to justify the actions taken in prescriptions. The system's slowness and the poor connection between physicians' electronic patient records and the Prescription Centre were also underlined. According to the Finnish physicians interviewed, ePrescriptions have facilitated prescribing in some respects. However, the ePrescribing system still has problems and the Prescription Centre cannot be fully used for the management of a patient's overall medication.

Work-related fear and the threats of fear among emergency department nursing staff and physicians in Finland.

To describe fear, the threats causing fear and the occurrence of fear among emergency department nursing staff and physicians. The emergency department is a challenging workplace where the staff is often confronted by factors that cause fear. A cross-sectional study. A survey was conducted in 16 hospitals (n=544). Nurses, practical nurses, orderlies and physicians from those hospitals participated in the survey. The survey questionnaire was based on the analysis of interviews of 30 nurses from one university hospital and one central hospital. The results of the interviews were analysed using the inductive content analysis method. The analysis of the survey was performed using statistical methods, such as frequencies, cross-tabulation and principal component analysis. The results showed that nearly all of the emergency department personnel had experienced work-related fear. Generally, the fear had been momentary. According to the survey results, fear was most often caused by medication errors, the resuscitation of a child, a catastrophic accident, urgent or violent situations or patients armed with weapons. Threats that caused fear included insecurity, danger in the work environment, threat of loss of one's health and threat of the consequences of one's mistakes and actions. The staff of emergency departments often encountered factors or situations that caused fear. The main threats causing fear that were raised by the respondents were insecurity and danger in the work environment. The data obtained from this study can be utilised in identifying and describing work-related fear and threats of fear among emergency department nursing staff and physicians. Based on the information herein, it will be possible to develop methods to prevent situations that cause fear in emergency departments.

On-call work and physicians' well-being: testing the potential mediators

On-call duties have been rated to be among the most stressful aspects of physicians' work. On-call work has been associated, for example, with medical errors, injuries and lower well-being. Thus, because it is not possible to remove on-call duties, measures to decrease the negative ramifications of on-call work are needed. To examine whether working on-call would predict psychological distress, job satisfaction and work ability in a 4-year follow-up and whether sleeping problems or work interference with family (WIF) would act as mechanisms in these associations. Questionnaires in 2006 and 2010 among physicians in Finland. The mediation analyses were conducted using methods suggested by Preacher and Hayes to examine direct and indirect effects with multiple mediators. There were 1541 respondents (60% women) of whom 52% had on-call duties. Sleeping problems and WIF acted as mechanisms in the association of existence of on-call duties with high distress, low job satisfaction and low work ability. On-call work was associated with higher levels of sleeping problems and WIF, and the number of active on-call hours was associated with higher levels of WIF, but not with sleeping problems. According to our results, one way to attenuate on-call work's negative ramifications is to make it easier for on-call physicians to connect work and family lives and develop work arrangements to promote better sleep and protected sleep time.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care

Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention.

Is working in culturally diverse working environment associated with physicians’ work-related well-being? A cross-sectional survey study among Finnish physicians

International mobility of health care professionals is increasing, though little is known about how working in a culturally diverse team affects the native physicians’ psychosocial work environment. We examined Finnish physicians’ perceptions of work-related wellbeing according to whether they had foreign-born colleagues (FBCs) in their work unit. We also examined whether work-related resources moderate the potential association between work-related wellbeing and working alongside FBCs. A cross-sectional survey was conducted for a random sample of physicians in Finland in 2010 (3826 respondents, response rate 55%). Analyses were restricted to native Finnish physicians working in public health care. The results were analyzed by ANCOVA. In unadjusted analyses, having FBCs was related to poor team climate (p<0.001) and poor job satisfaction (p=0.001). Those physicians who reported high procedural justice and high job control perceived also higher job satisfaction even if they had many FBCs in the work unit (p=0.007 for interaction between FBCs and procedural justice and p<0.001 for interaction between FBCs and job control). These associations were robust to adjustments for age, sex, health care sector, specialization, on-call duty, employment contract, full-time employment and leadership position. The results indicate that culturally diverse work units face challenges related to team climate and job satisfaction. The results also show that leadership plays an important role in culturally diverse work units. The potential challenges of culturally diverse teams for native physicians may be reduced by fair decision-making and by increasing physicians’ job control.