Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study

Human Resources for Health

Marko Elovainio²  Ilmo Keskimäki¹  Kristiina Manderbacka²  Anna-Mari Aalto²  Riikka Lämsä²  Hannamaria Kuusio² 

[1] School of Health Sciences, University of Tampere, Mannerheimintie 103 b, P.O. Box 30, FI-00271 Helsinki, Finland;National Institute for Health and Welfare (THL), Service System Research Unit, Mannerheimintie 103 b, P.O. Box 30, FI-00271 Helsinki, Finland

关键词: Professional migration;    Primary care;    Physicians;    Finland;    General practitioners;   

Others  :  1161182
DOI  :  10.1186/1478-4491-12-41

 received in 2013-10-08, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Background

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). 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).

Methods

Three 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.

Results

The 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.

Conclusions

Primary 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.

【 授权许可】

   
2014 Kuusio et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Thompson MJ, Hagopian A, Fordyce M, Hart LG: Do international medical graduates (IMGs) fill the gap in rural primary care in the United States? A national study. J Rural Health 2009, 25(2):124-134.
• [2]Smith SD: The global workforce shortages and the migration of medical professions: the Australian policy response. Aust New Zealand Health Policy 2008, 5:7.
• [3]Roach S, Atkinson D, Waters A, Jefferies F: Primary health care in the Kimberley: is the doctor shortage much bigger than we think? Aust J Rural Health 2007, 15(6):373-379.
• [4]Vuorenkoski L: Health Systems in Transition. In European Observatory on Health Systems and Policies. Edited by Philipa M, Elias M. Denmark: European Observatory on Health Systems and Policies; 2008.
• [5]Ruskoaho J: Terveyskeskusten lääkäritilanne 3.10.2012 [Physicians’ in Health Care Centres]. Finnish; [ http://www.laakariliitto.fi/en/ webcite] Accessed 18 January, 2013
• [6]Mullan F: The metrics of the physician brain drain. N Engl J Med 2005, 353(17):1810-1818.
• [7]Kuusio H, Elovainio M, Vänskä J, Heponiemi T, Aalto A-M, Koivuniemi S, Ailasmaa R, Keskimäki I: Terveydenhuoltohenkilöstön liikkuvuus Suomen ja muiden maiden välillä. (in Finnish) (International mobility of health care professionals – the situation in Finland. Suom Laakaril 2010, 41(65):3323.
• [8]Dauphinee WD, Buske LB: Medical workforce policy-making in Canada, 1993–2003: reconnecting the disconnected. Acad Med 2006, 81(9):830-836.
• [9]Buchan J, Dal Poz MR: Skill mix in the health care workforce: reviewing the evidence. Bull World Health Organ 2002, 80(7):575-580.
• [10]The Finnish Immigration Service. [ http://www.migri.fi/frontpage webcite]
• [11]Directive 2005/36/EC. [ http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2005:255:0022:0142:en:PDF webcite]
• [12]Mick SS, Lee SY, Wodchis WP: Variations in geographical distribution of foreign and domestically trained physicians in the United States: ‘safety nets’ or ‘surplus exacerbation’? Soc Sci Med 2000, 50(2):185-202.
• [13]Baer LD, Ricketts TC, Konrad TR, Mick SS: Do international medical graduates reduce rural physician shortages? Med Care 1998, 36(11):1534-1544.
• [14]Chen PG, Curry LA, Bernheim SM, Berg D, Gozu A, Nunez-Smith M: Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. Acad Med: JAAMC 2011, 86(11):1383-1388.
• [15]Kuusio H, Heponiemi T, Vänskä J, Aalto A-M, Ruskoaho J, Elovainio M: Psychosocial stress factors and intention to leave job: differences between foreign-born and Finnish-born general practitioners. Scand J Public Health 2013, 41(4):405-411.
• [16]Karasek RA: Job demands, job decision latitude, and mental strain: implications for job redesign. Adm Sci Q 1979, 24:285-308.
• [17]Elovainio M, Kuusio H, Aalto A, Sinervo T, Heponiemi T: Insecurity and shiftwork as characteristics of negative work environment: psychosocial and behavioural mediators. J Adv Nursing 2010, 66:1080-1091.
• [18]Vahtera J, Kivimäki M, Pentti J, Töres T: Effect of change in the psychosocial work environment on sickness absence: a seven year follow up if initially health employees. J Epidemiol Comm Health 2000, 54:484-493.
• [19]Linzer M, Manwell LB, Williams ES, Bobula J, Brown R, Varkey A, Man B, McMurray J, Maguire A, Horner-Ibler B, Schwartz M: Working conditions in primary care: physician reactions and care quality. Ann Intern Med 2009, 151(1):28-36.
• [20]Kuusio H, Heponiemi T, Sinervo T, Elovainio M: Organizational commitment among general practitioners: a cross-sectional study of the role of psychosocial factors. Scand J Prim Health Care 2010, 28(2):108-114.
• [21]Heponiemi T, Kouvonen A, Aalto AM, Elovainio M: Psychosocial factors in GP work: the effects of taking a GP position or leaving GP work. EJPH 2013, 23(3):361-366.
• [22]Heponiemi T, Kuusio H, Sinervo T, Elovainio M: Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators. EJPH 2011, 21(4):520-525.
• [23]Hellgren J, Baraldi S, Falkenberg H, Sverke M: Bäst arbetsklimat på sjukhus som bolagiserats eller privatiserats. läkares upplevelser av att arbeta i olika driftsformer [Best working climate in private or investor-owned hospitals. physicians’ experiences with different management forms]. Lakartidningen 2006, 11:2040-2044.
• [24]Harris PE: The nurse stress index. Work Stress 1989, 3(4):335-346.
• [25]Karasek R: Job Content Questionnaire and User’s Guide. Lowell, MA: Department of Work Environment, University of Massachusetts; 1985.
• [26]Kivimäki M, Lindström K: Työstressi ja hyvinvointi hoitoalalla: kyselylomakkeen kehittely. [Job stress and well-being of care providers: development of a standardized survey instrument.] In Finnish. Hoitotiede [Nursing Research] 1992, 4(3):115-124.
• [27]Hackman JR, Oldham GR: Development of the Job Diagnostic Survey. J Applied Psychol 1975, 1975(60):159-170.
• [28]Lawler E, Hall D: Relationship of job characteristics to job involvement, satisfaction, and intrinsic motivation. J Applied Psychol 1970, 54:305-312.
• [29]Kivimäki M, Elovainio M: A Short version of the Team Climate Inventory: Development and psychometric properties. J Occup Environment Med 1999, 60:27-34.
• [30]Jinks C, Ong BN, Paton C: Mobile medics? The mobility of doctors in the European Economic Area. Health Policy 2000, 54(1):45-64.
• [31]Prime Minister’s Office: Programme of Prime Minister Jyrki Katainen’s Government. 2011. [ http://valtioneuvosto.fi/etusivu/en.jsp webcite]
• [32]Han GS, Humphreys JS: Overseas-trained doctors in Australia: community integration and their intention to stay in a rural community. Austr J Rural Health 2005, 13(4):236-241.
• [33]Buchan J: Migration of health workers in Europe: policy problem or policy solution? [ http://www.aspeninstitute.org/sites/default/files/content/images/Section%206d-James%20Buchan%20article%20for%20Feb2009%20BB.pdf webcite]
• [34]Hussey PS: International migration patterns of physicians to the United States: a cross-national panel analysis. Health Policy 2007, 84(2–3):298-307.
• [35]Saar P, Habicth J: Migration and Attrition: Estonia’s Health Sector and Cross-Border Mobility to its Northern Neighbour. In Health Professional Mobility and Health Systems. Evidence from 17 European Countries. Edited by Matthias W, Maier CB, Glinos IA, Gilles D, Josep F. United Kingdom: The European Observatory on Health Systems and Policies; 2011:339-364.
• [36]Klein D, Hofmeister M, Lockyear J, Crutcher R, Fidler H: Push, pull, and plant: the personal side of physician immigration to Alberta Canada. Fam Med 2009, 41(3):197-201.
• [37]Audas R, Ryan A, Vardy D: Where did the doctors go? A study of retention and migration of provisionally licensed international medical graduates practising in Newfoundland and Labrador between 1995 and 2006. Can J Rural Med 2009, 14(1):21-24.
• [38]Audas R, Ross A, Vardy D: The use of provisionally licensed international medical graduates in Canada. CMAJ 2005, 173(11):1315-1316.
• [39]OECD: International Migration Outlook 2013. OECD Publishing; 2013. http://dx.doi.org/10.1787/migr_outlook-2013-en webcite
• [40]Haukilahti R, Virjo I, Mattila K: Success in licensing examinations of doctors from outside the European economic area: experiences from Finland 1994–2009. Ed Primary Care 2012, 23(5):342-349.
• [41]Lääkärikysely: Suomen Lääkäriliiton tilastoja 2009. (Physicians’ Survey). Finnish Medical Association; [ http://www.laakariliitto.fi/en/ webcite]
• [42]Elovainio M, Forma P, Kivimäki M, Sinervo T, Sutinen R, Laine M: Job demands and job control as correlates of early retirement thoughts in Finnish social and health care employees. Work Stress 2005, 19:84-92.
• [43]de Jonge J, Dollard M, Dormann C, Le Blanc P, Houtman I: The demand-control model: specific demands, specific control, and well-defined groups. Inter J Stress Management 2000, 7:269-287.
• [44]Lämsä R, Larivaara M, Heponiemi T, Elovainio M: Terveyskeskuslääkäri kärsii tai nauttii työn hajanaisuudesta. (Descriptions of the work of health centre physicians) In Finnish. Suomen Lääkärilehti [Finnish Medical Journal] 2011, 66:2009-2013.
• [45]Vänskä J, Viitanen H, Hyppönen M, Elovainio I, Winblad J, Reponen T, Lääveri I: Lääkärien arviot potilastietojärjestelmistä kriittisiä [Doctors critical of electronic patient record systems] In Finnish. Suomen Lääkärilehti [Finnish Medical Journal] 2010, 65:50-52.
• [46]Elovainio M, Kivimäki M: Work and strain on physicians in Finland. Scand J Soc Med 1998, 26(1):26-33.
• [47]Lockyer J, Fidler H, de Cara C, Keefe J: Mentorship for the physician recruited from abroad to Canada for rural practice. Canada Medical Teacher 2010, 32:e322-e327.
• [48]Szafran O, Crutcher R, Banner S, Watanabe M: Canadian and immigrant international medical graduates. Can Fam Physician 2005, 51:1242-1243.
• [49]Aalto A-M, Elovainio M, Heponiemi T, Hietapakka L, Kuusio H, Lämsä R: Ulkomaalaistaustaiset lääkärit ja hoitajat suomalaisessa terveydenhuollossa. Haasteet ja mahdollisuudet. In [Foreign-born physicians and nurses in Finnish health care] In Finnish. Report (7/2013). Helsinki: Juvenes Print, Suomen Yliopistopaino Oy, Tampere. Terveyden ja hyvinvoinnin laitos;