Migrant physicians' choice of employment and the medical specialty general practice: a mixed-methods study.

OBJECTIVE: In many countries, migrant physicians (MP) tend to fill staff shortages in medical specialties perceived as low status. The aim of this study was to explore aspects that influence MPs', with a medical degree from outside EU/EEA, choice of employment and medical specialty in Sweden, and to explore and understand a potential over-representation in general practice (family medicine), a specialty suffering from staff shortages in Sweden. METHODS: A mixed-methods approach was applied. This included questionnaire data from 101 MPs training and working as medical specialists in Sweden and semi-structured interview data from four MPs specializing in general practice. RESULTS: Regardless of specialty, the most influential aspects when choosing employment were the ability to combine work with family, to develop one´s competence, and to have highly competent colleagues. Women scored higher on some aspects related to private life and the surroundings. More than half (55%) of the respondents specialized in general practice, and more women than men. The MPs in general practice scored higher on the aspect 'ability to have the same patients for a longer period' than MPs specializing in other specialties. No significant difference between MP general practitioner respondents and MPs in other medical specialties was found in relation to the item 'Was the specialty your first choice?'. Aspects identified in the interviews that influenced the choice to specialize in general practice related to job opportunities, positive experiences of primary health care, working conditions, and family conditions. CONCLUSION: Labour market conditions such as high competition, and the time-consuming recertification process, can influence the choice to specialize in general practice as this reduces the time to become a medical specialist. We however did not find any results indicating that MPs' decision to specialize in general practice and to work as general practitioners was any less voluntary than that of MPs who chose other specialties.

Migrant physicians' entrance and advancement in the Swedish medical labour market: a cross-sectional study.

BACKGROUND: Worldwide, physicians are migrating to new countries and want to practise their profession. However, they may experience difficulties doing so. To optimise and accelerate their entrance into and advancement within the Swedish healthcare system, there is an urgent need to explore how they are currently doing so, as their competences should be put to use without any unnecessary delay. The aim of the study was to explore how migrant physicians with a medical degree from outside EU/EEA enter and advance within the medical labour market in Sweden and to identify perceived barriers and facilitating aspects in the process. The empirical findings are discussed in light of Bourdieu's concept symbolic capital as adapted in the Swedish medical field. METHODS: A cross-sectional study with a self-administrated questionnaire was disseminated. A sample of 498 migrant physicians were identified. Descriptive statistical analysis and qualitative thematic analysis were used to analyse the data. RESULTS: The response rate was 57% (n = 283). Respondents mainly found their first positions via spontaneous job applications, during internships, while participating in an educational intervention or via personal contacts. Perceived barriers to entering and advancing within the medical field in Sweden were mainly related to having a medical degree from and/or originating from another country, which could in turn represent discrimination and/or having one's competence undervalued as a result. Facilitating aspects included having or developing contacts in Swedish healthcare and gaining proficiency or fluency in the Swedish language. CONCLUSIONS: When MPs find their first positions, the contacts they have developed appear to play a role, and when advancing in their positions, the active development of a variety of contacts seems to be beneficial. MPs experience a variety of barriers to entering and advancing within the field that could be related to discrimination. Many MPs perceived having their competences undervalued due to their origin or to being educated abroad. Based on the respondents' experiences, our interpretation is that MPs as a group are hierarchically positioned lower in the Swedish medical field than physicians trained in the country. Facilitating aspects included educational interventions, having contacts and developing language skills. For optimal entry into the labour market, it is vitally important for MPs to learn the new language and obtain a job or internship in the field as soon as possible.

Everyday navigation between adaptation and resistance: How young people negotiate their well-being in relation to assigned migrant positions in school.

Concerning the so-called "refugee crisis" in 2015 and how it affected the position of young migrants in society, researchers have underscored the value of studies challenging one-sided images of migrant youth. This study examines how migrant positions are constituted, negotiated, and related to young people's well-being. The study was undertaken using an ethnographic approach combined with the theoretical concept of translocational positionality to acknowledge how positions are created through historical and political processes and, at the same time, are context-dependent over time and space and thus contain incongruities. Our findings show how the newly arrived youth used multiple ways to navigate the school's everyday life and ascribed migrant positions to achieve well-being as illustrated through the distancing, adapting, defense, and the contradictory positions. Based on our findings, we understand the negotiations that occur in forming migrant positions within the school as asymmetric. At the same time, the youths' diverse and often contradictory positionality showed in various ways the striving for increased agency and well-being.

Migrant physicians' unlocking of gateways to practise their knowledge: A qualitative quasi-longitudinal study.

This study explores the establishment experiences of physicians in the Swedish medical context who have been trained outside the European Union. The study used a qualitative approach with a quasi-longitudinal research design. The data were gathered via 63 semi-structured interviews with migrant physicians at three different periods. The data were analysed using qualitative thematic content analysis, adopting the theory on the context dependence of knowledge, which includes different forms of knowledge as sensitising concepts in the discussion. The MPs perceived themselves as having the medical knowledge (encoded knowledge) needed to work in Sweden. However, they perceived that they needed to develop knowledge of how to use the encoded knowledge in the Swedish medical context. The needed knowledge was thus foremost encultured, embedded, embodied, or embrained. The results are presented in the following themes: medical knowledge; knowledge of the healthcare system and its variations; knowledge of administrative routines; understanding the role as a physician, interaction and hierarchies between physicians and other healthcare staff; understanding the interaction and hierarchies between physicians and patients; and knowledge of the Swedish language. Knowledge, as described in the themes, function as gateways that needs to be unlocked for practising medicine in a new context. Embedded, embrained, embodied, and encultured knowledge interact and are interdependent, and the different forms of knowledge work as gateways to other forms of knowledge, and thus, they open for each other. However, to pass the gateways, managing the common language is important. We conclude that language is an enabler and a key to unlocking gateways to practise.

Migrant physicians' conceptions of working in rural and remote areas in Sweden: A qualitative study.

OBJECTIVE: To explore migrant physicians' conceptions about working in rural and remote areas in Sweden to understand what influences their motivation to work in these areas. METHOD AND MATERIAL: The study employed a qualitative approach with semi-structured interviews with 24 migrant physicians. Transcripts were thematically analysed. RESULTS: Conceptions were identified about foremost work content and tasks, and about living in rural and remote areas. Work content and tasks related to the health care systems, type of health care facility, duties, specialty, resources, patient population, colleagues, and professional development. Conceptions about living concerned geographical characteristics, people living in rural and remote areas, opportunities for travelling, family, leisure activities, social life, and language skills. Conceptions seemed to be influenced by individual, professional and societal aspects from both previous countries and Sweden. Conceptions and biographical aspects both appeared to affect motivation. DISCUSSION: Motivation regarding working in rural and remote areas appeared to be influenced by conceptions of these areas. A specific type of place could be understood as being able to provide (or not) the external conditions needed for fulfilling needs and reaching goals, whether professional or personal, and as a tool for reaching or facilitating the achievement of these. Conceptions of an area can hence affect motivation and choices for where to work and live. However, biographical aspects also impact motivation. Our results indicate that positive rural experience in the recipient country might be a predictor for motivation. CONCLUSION: Professional and personal life and are intertwined. Conceptions about an area influence willingness to work there. Willingness is also affected by, and intertwined with, other aspects such as previous experiences, age, marital status and family circumstances.