Description of the project :
We aim to investigate the presence of discrimination in any form as experienced by medical practitioners working in public health service. Apart from the so-called racial discrimination, other forms of discrimination will also be investigated in this project, including experiences of discomfort, embarrassment and/or suffering associated to additional factors such as gender, physical disability, sexual orientation and religious affiliation. These manifestations may also include workplace or institutional discrimination. All medical practitioners within the Sydney West Area Health Service, including IMGs and local graduates, will be requested to complete a set of questionnaires that investigate the presence, frequency and intensity of experiences of discrimination. Considering that all members of society are susceptible to be discriminated against in any of the forms mentioned above, this investigation represents a comprehensive investigation that will include all volunteers regardless of their nationalities, physical attributes or “race”, and religious affiliations. A pre-posted envelope addressed back to the authors will be dispatched to all medical practitioners that satisfy the inclusion criteria of this study. along with the questionnaires.
Theoretical, conceptual basis, and background evidence, for the research proposal.
According to the World Health Organization, human resources are "the most important of the health system's inputs" (1). Considering that there is a progressive increase in demand for health care worldwide, many developed countries reacted to these needs by recruiting medical and other health care workers from developing countries. This phenomenon spurred a migratory shift of physicians at international level (2). Recent evidence indicates that the most advanced economies will face a physician shortage in the years to come (3). In contrast to the rather complex strategy of generating more qualified medical graduates locally, the option for international recruitment has been considered as an easier approach to minimize the problem. In order to understand the phenomenon of international medical migration in Australia, there is a need for additional research evidence on the different aspects of this trend in medical labour. (4). The phenomenon of medical migration has been the object of closer scrutiny lately as evidenced by an increasing number of scientific papers devoted to this theme.
In spite of this, the personal experiences and opinions of migrant doctors who come to Australia have not been studied extensively. International Medical Graduates (IMGs) are more vulnerable to being discriminated against members of the host society, including their own patients and co-workers. Frequent encounters with discriminatory manifestations can lead to poor job satisfaction and emotional discomfort among other adverse consequences. From a historical perspective, migrant workers have been exposed to unfair and exploitative working conditions as well as discrimination and stigma (5).
A recently published investigation, which surveyed 529 doctors from diverse “racial” or ethnic backgrounds in the United States revealed that IMGs and other non-majority doctors experience significantly discrimination in the workplace (6). In addition, it has been reported that many IMGs face unfair delegations from local medical boards and councils. Recently, the College of Physicians and Surgeons of British Columbia was found guilty for discriminating against foreign doctors by requiring them to do additional training (7). Similarly, a report commissioned by the General Medical Council (GMC) of the United Kingdom (UK) claimed that the GMC may have incurred in racial bias when addressing complaints against doctors who qualified outside the UK (3). Additional studies reveal that ethnic disparities and discrimination involving IMGs also take place in recruitment and in faculty promotion (8). Fair progression to leadership roles in medical specialties for foreign IMGs have also been curtailed (9).
An even larger survey conducted on behalf of the Massachusetts Medical Society obtained data from 1930 practicing physicians (10). The results of this study revealed that physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant (10). Discrimination against IMGs also occurs during job application processes at early stage of their medical training, a fact that has been repeatedly highlighted by research evidence and public debate over the years (11). A selection bias against IMGs applicants for U.S. residency training positions in psychiatry has also been observed (12). However, several articles in the media have criticized for reporting “racist slurs against foreign doctors” (13).
This research evidence contrasts sternly with the multiple benefits provided by the international medical workforce to their patients and their respective communities in the host countries. It has been observed that IMGs tend to provide more advantageous access to medical care for under-served minorities and rural populations than local graduates (14). In fact, IMGs are prepared to assess and treat a wide range of clinical entities (15). The fact IMGs offer satisfactory clinical practice but also contribute significantly for the academic development of rural clinical schools in Australia has been acknowledged as a “double debt” that Australia owes these professionals (16).
The composition of the local Australian medical workforce is formed mostly by people of Anglo-Saxon background, representing the majority culture, medical practitioners from local minorities groups, and IMGs (17). Immigrants tend to face discrimination and prejudice on the basis of their physical attributes –also conceived as “race” –, religious affiliations, idiosyncrasies, gender, linguistic differences among other factors (18, 19). Australia exerts a unique role in the geopolitical scenario of medical migration in that it attracts IMGs from developed or “wealthy” countries as well doctors from less developed economies because of its economical as well as lifestyle, climate and touristic values. This study represents a pioneering initiative in Australia vis-à-vis one of the usual obstacles faced by migrant workers while adapting to the local environment. It is hoped that this enterprise will generate significant evidence to promote satisfactory working conditions for all medical professionals in Australia.
Research aims:
The aim of this study is to investigate the presence of discrimination in any form as experienced by medical practitioners working in public health services. Apart from the so-called racial discrimination, other forms of discrimination will also be investigated in this project, including experiences of discomfort, embarrassment and/or suffering associated to factors such as gender, physical disability, sexual orientation and religious affiliation. These manifestations may occur through interpersonal, workplace-related or institutional discrimination.
Our expected outcome & rationale:
The authors expect that the experiences of discrimination faced by doctors working in public health will be common and intense phenomena. It is hypothezised that, in the case of IMGs, there may be higher levels of discriminatory stress during the early periods of adaptation immediately after the arrival in Australia. As IMGs become more familiar with the local customs and norms, there will be a lesser vulnerability to experience discrimination, considering the increasing levels of confidence and familiarity with the host culture. It is also hypothesized that the experiences of discrimination will be more significant among junior doctors, due to their relative inexperience and lower ranking in the medical and institutional hierarchy. Additional hypotheses include the possibility of finding more intense experiences of discrimination among those with noticeable language difficulties, non-white skin colour, and foreign idiosyncratic characteristics.
REFERENCES :
1. World Health Organization. World Health Report 2000 - Health Systems: Improving Performance., 2000.
2. Forcier M SS, Giuffrida A. Impact, regulation and health policy implications of physician migration in OECD countries. Human Resources for Health 2004; 2(1):12.
3. Dyer O. GMC may be open to accusations of racial bias. BMJ 2004; 326:22:411.
4. Akl EA MN, Major S, Chahoud B, Schünemann HJ. Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians. BMC Health Serv Res 2007; Apr 5;7:49.
5. Donkin, R. Blood, sweat and tears: The evolution of work. South-Western Educational & Professional Eds., 2002
6. Nunez-Smith M, Pilgrim N, Wynia M, Desai MM, Jones BA, Bright C, Krumholz HM, Bradle. Race/Ethnicity and Workplace Discrimination: Results of a National Survey of Physicians. J Gen Intern Med. 2009 Sep 1. [Epub ahead of print].
7. Kent H. College to appeal discrimination ruling. CMAJ. 2000; 162(6):854.
8. Price EG GA, Kern DE, Powe NR, Wand GS, Golden S, Cooper LA. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med 2005; 20(7):565-71.
9. Baker SR CH, Tilak GS. Indian radiologists in the United States: hierarchical distribution and representation. J Am Coll Radiol 2007; 4(4):234-9.
10. Coombs AA KR. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005; 97(4):467-77.
11. Esmail A ES. Asian doctors are still being discriminated against. BMJ 1997; 314(7094):1619
12. Nasir LS. Evidence of discrimination against international medical graduates applying to family practice residency programs. Fam Med. 1994; 26(10):625-9.
13. Masters C. Surgical openings. Weekend Herald, 1 March 2008, B5.
14. Howard DL BC, Mundia WO, Konrad TR, Edwards LJ, Amamoo MA, Jallah Y. Comparing United States versus international medical school graduate physicians who serve African- American and White elderly. Health Serv Rev 2006; 41(6):2155-81.
15. Bayram C. KS, Miller G, Ng A, Britt H. Clinical activity of overseas-trained doctors practising in general practice in Australia. Aust Health Rev 2007; 31 (3):440-448.
16. Playford DE, Maley MA. Medical teaching in rural Australia: should we be concerned about the international medical graduate connection?Med J Aust. 2008 Jul 21;189(2):125-7.
17. Self-sufficiency and International medical Graduates-Australia- Peter Carver, National Health Workforce taskforce.
18. Zubaran, C. The Quest for Recognition: Brazilian Immigrants in the United States. Transcult Psychiatry2008; 45; 590.
19. Zubaran, C. Human nomenclature: from race to racism. World Health Popul. 2009; 11(2):43-52.
We aim to investigate the presence of discrimination in any form as experienced by medical practitioners working in public health service. Apart from the so-called racial discrimination, other forms of discrimination will also be investigated in this project, including experiences of discomfort, embarrassment and/or suffering associated to additional factors such as gender, physical disability, sexual orientation and religious affiliation. These manifestations may also include workplace or institutional discrimination. All medical practitioners within the Sydney West Area Health Service, including IMGs and local graduates, will be requested to complete a set of questionnaires that investigate the presence, frequency and intensity of experiences of discrimination. Considering that all members of society are susceptible to be discriminated against in any of the forms mentioned above, this investigation represents a comprehensive investigation that will include all volunteers regardless of their nationalities, physical attributes or “race”, and religious affiliations. A pre-posted envelope addressed back to the authors will be dispatched to all medical practitioners that satisfy the inclusion criteria of this study. along with the questionnaires.
Theoretical, conceptual basis, and background evidence, for the research proposal.
According to the World Health Organization, human resources are "the most important of the health system's inputs" (1). Considering that there is a progressive increase in demand for health care worldwide, many developed countries reacted to these needs by recruiting medical and other health care workers from developing countries. This phenomenon spurred a migratory shift of physicians at international level (2). Recent evidence indicates that the most advanced economies will face a physician shortage in the years to come (3). In contrast to the rather complex strategy of generating more qualified medical graduates locally, the option for international recruitment has been considered as an easier approach to minimize the problem. In order to understand the phenomenon of international medical migration in Australia, there is a need for additional research evidence on the different aspects of this trend in medical labour. (4). The phenomenon of medical migration has been the object of closer scrutiny lately as evidenced by an increasing number of scientific papers devoted to this theme.
In spite of this, the personal experiences and opinions of migrant doctors who come to Australia have not been studied extensively. International Medical Graduates (IMGs) are more vulnerable to being discriminated against members of the host society, including their own patients and co-workers. Frequent encounters with discriminatory manifestations can lead to poor job satisfaction and emotional discomfort among other adverse consequences. From a historical perspective, migrant workers have been exposed to unfair and exploitative working conditions as well as discrimination and stigma (5).
A recently published investigation, which surveyed 529 doctors from diverse “racial” or ethnic backgrounds in the United States revealed that IMGs and other non-majority doctors experience significantly discrimination in the workplace (6). In addition, it has been reported that many IMGs face unfair delegations from local medical boards and councils. Recently, the College of Physicians and Surgeons of British Columbia was found guilty for discriminating against foreign doctors by requiring them to do additional training (7). Similarly, a report commissioned by the General Medical Council (GMC) of the United Kingdom (UK) claimed that the GMC may have incurred in racial bias when addressing complaints against doctors who qualified outside the UK (3). Additional studies reveal that ethnic disparities and discrimination involving IMGs also take place in recruitment and in faculty promotion (8). Fair progression to leadership roles in medical specialties for foreign IMGs have also been curtailed (9).
An even larger survey conducted on behalf of the Massachusetts Medical Society obtained data from 1930 practicing physicians (10). The results of this study revealed that physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant (10). Discrimination against IMGs also occurs during job application processes at early stage of their medical training, a fact that has been repeatedly highlighted by research evidence and public debate over the years (11). A selection bias against IMGs applicants for U.S. residency training positions in psychiatry has also been observed (12). However, several articles in the media have criticized for reporting “racist slurs against foreign doctors” (13).
This research evidence contrasts sternly with the multiple benefits provided by the international medical workforce to their patients and their respective communities in the host countries. It has been observed that IMGs tend to provide more advantageous access to medical care for under-served minorities and rural populations than local graduates (14). In fact, IMGs are prepared to assess and treat a wide range of clinical entities (15). The fact IMGs offer satisfactory clinical practice but also contribute significantly for the academic development of rural clinical schools in Australia has been acknowledged as a “double debt” that Australia owes these professionals (16).
The composition of the local Australian medical workforce is formed mostly by people of Anglo-Saxon background, representing the majority culture, medical practitioners from local minorities groups, and IMGs (17). Immigrants tend to face discrimination and prejudice on the basis of their physical attributes –also conceived as “race” –, religious affiliations, idiosyncrasies, gender, linguistic differences among other factors (18, 19). Australia exerts a unique role in the geopolitical scenario of medical migration in that it attracts IMGs from developed or “wealthy” countries as well doctors from less developed economies because of its economical as well as lifestyle, climate and touristic values. This study represents a pioneering initiative in Australia vis-à-vis one of the usual obstacles faced by migrant workers while adapting to the local environment. It is hoped that this enterprise will generate significant evidence to promote satisfactory working conditions for all medical professionals in Australia.
Research aims:
The aim of this study is to investigate the presence of discrimination in any form as experienced by medical practitioners working in public health services. Apart from the so-called racial discrimination, other forms of discrimination will also be investigated in this project, including experiences of discomfort, embarrassment and/or suffering associated to factors such as gender, physical disability, sexual orientation and religious affiliation. These manifestations may occur through interpersonal, workplace-related or institutional discrimination.
Our expected outcome & rationale:
The authors expect that the experiences of discrimination faced by doctors working in public health will be common and intense phenomena. It is hypothezised that, in the case of IMGs, there may be higher levels of discriminatory stress during the early periods of adaptation immediately after the arrival in Australia. As IMGs become more familiar with the local customs and norms, there will be a lesser vulnerability to experience discrimination, considering the increasing levels of confidence and familiarity with the host culture. It is also hypothesized that the experiences of discrimination will be more significant among junior doctors, due to their relative inexperience and lower ranking in the medical and institutional hierarchy. Additional hypotheses include the possibility of finding more intense experiences of discrimination among those with noticeable language difficulties, non-white skin colour, and foreign idiosyncratic characteristics.
REFERENCES :
1. World Health Organization. World Health Report 2000 - Health Systems: Improving Performance., 2000.
2. Forcier M SS, Giuffrida A. Impact, regulation and health policy implications of physician migration in OECD countries. Human Resources for Health 2004; 2(1):12.
3. Dyer O. GMC may be open to accusations of racial bias. BMJ 2004; 326:22:411.
4. Akl EA MN, Major S, Chahoud B, Schünemann HJ. Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians. BMC Health Serv Res 2007; Apr 5;7:49.
5. Donkin, R. Blood, sweat and tears: The evolution of work. South-Western Educational & Professional Eds., 2002
6. Nunez-Smith M, Pilgrim N, Wynia M, Desai MM, Jones BA, Bright C, Krumholz HM, Bradle. Race/Ethnicity and Workplace Discrimination: Results of a National Survey of Physicians. J Gen Intern Med. 2009 Sep 1. [Epub ahead of print].
7. Kent H. College to appeal discrimination ruling. CMAJ. 2000; 162(6):854.
8. Price EG GA, Kern DE, Powe NR, Wand GS, Golden S, Cooper LA. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med 2005; 20(7):565-71.
9. Baker SR CH, Tilak GS. Indian radiologists in the United States: hierarchical distribution and representation. J Am Coll Radiol 2007; 4(4):234-9.
10. Coombs AA KR. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005; 97(4):467-77.
11. Esmail A ES. Asian doctors are still being discriminated against. BMJ 1997; 314(7094):1619
12. Nasir LS. Evidence of discrimination against international medical graduates applying to family practice residency programs. Fam Med. 1994; 26(10):625-9.
13. Masters C. Surgical openings. Weekend Herald, 1 March 2008, B5.
14. Howard DL BC, Mundia WO, Konrad TR, Edwards LJ, Amamoo MA, Jallah Y. Comparing United States versus international medical school graduate physicians who serve African- American and White elderly. Health Serv Rev 2006; 41(6):2155-81.
15. Bayram C. KS, Miller G, Ng A, Britt H. Clinical activity of overseas-trained doctors practising in general practice in Australia. Aust Health Rev 2007; 31 (3):440-448.
16. Playford DE, Maley MA. Medical teaching in rural Australia: should we be concerned about the international medical graduate connection?Med J Aust. 2008 Jul 21;189(2):125-7.
17. Self-sufficiency and International medical Graduates-Australia- Peter Carver, National Health Workforce taskforce.
18. Zubaran, C. The Quest for Recognition: Brazilian Immigrants in the United States. Transcult Psychiatry2008; 45; 590.
19. Zubaran, C. Human nomenclature: from race to racism. World Health Popul. 2009; 11(2):43-52.
