The professional and social integration of international medical graduates working in rural communities of NSW : a study assessing the utility of Han and Humphreys' (2006) typological analysis

Abstract

The demand for health care professionals in Western developed nations cannot be supplied by local labour markets. One of the challenges countries face is matching the supply of doctors to the demand particularly in rural areas. To overcome these shortages, countries have designed workforce policies to suit this particular area of labour market need. Australia is not immune to this shortage and relies on recruiting International Medical Graduates (IMGs) particularly to address the demand for doctors in rural areas of Australia. In response to this, state, territory and federal governments have introduced various policy measures to facilitate the supply of doctors in rural areas. Integrating IMGs to a new health system and a new geographical place is important for the success of these policies. The integration of IMGs to rural medical practice areas influences their retention. There is limited knowledge about the professional and social integration of IMGs in rural communities of NSW, Australia. Consequently, this thesis examines factors of integration and how this impacts on retention. A particularly distinct approach to integration is provided by Han and Humphreys' (2006) four-fold typology. The study identified four types of IMGs based on how well IMGs integrate in rural communities. This thesis reports analysis of semi-structured interviews of IMGs working in rural communities of NSW, to examine the factors of integration and how this might influence retention of IMGs. Twenty-five IMGs (n=25) from seven non-metropolitan Local Health Districts (LHDs) in NSW were interviewed. Analysis of the interview data broadens the understanding of the dimensions of integration and the relationship between IMG integration and rural area retention. The thesis research revealed all IMGs were professionally engaged in rural practice. Their ability to use a variety of medical skills, provide continuity of care to patients, and develop doctor-patient relationships led to strong attachment to rural practice. Although they were critical of aspects of their experience, such as professional development, training and workload, their overall experience was positive and far outweighed the disadvantages of working in rural practice. They were engaged with rural communities and their families were happy and settled. Some IMGs showed a strong willingness to work in rural communities beyond the terms of their initial employment contracts. There were complexities in the application of the Han and Humphreys' (2006) typology to the NSW located IMG interviewees. Although all IMGs could be aligned to the typology, parts of the typology had a highly limited application and the typology struggled to address clearly the experience of IMGs whose integration was conditional. Regardless of IMG attachment to rural practice, IMGs who are presently integrated may leave rural practice in the future mainly for family reasons (i.e. education and employment opportunities). The link between integration and retention was found to be complex. Integration influences retention but does not guarantee retention. Family, social or cultural factors challenge retention of IMGs in rural areas. The results of the study cast some doubt on the utility of the Han and Humphreys' (2006) typology in geographically different jurisdictions. Understanding the factors that underpin the process of integration may benefit the development of policy measures to facilitate integration of IMGs into the Australian Health system and rural practice. The findings of this thesis suggest that initial support is needed which can be provided by health organisations to integrate IMGs professionally in the Australian health system and in rural practice. Support is also needed to IMGs' families for increased retention in rural communities. Results from this thesis could inform how health organisations design orientation and integration programs for IMGs. The findings make contributions to knowledge, policy and practice. However, the limitations of the research are acknowledged and these might diminish the value of generalisations and their application outside the NSW context. Future studies of integration can extend to other states of Australia and also to other groups of health care professionals working in rural communities. Similar examinations of integration of participants also provide an opportunity to develop Han and Humphreys' (2006) typology, so that it encompasses a variety of geographical settings.

Date of Award	2018
Original language	English