Retention and turnover intention of foreign-trained physicians (FTPs): A scoping review

BACKGROUND

In many high-income countries, there is a regional or indication-specific shortage of physicians. One way to alleviate these shortages is to recruit physicians from abroad. However, the high turnover rate of foreign-trained physicians (FTPs) makes it difficult to maintain stable medical care. The purpose of this scoping review was to analyze recent studies on turnover intentions and retention in order to, first, understand how they are assessed and, second, to identify the parameters that contribute to reducing turnover and improving the retention of FTPs.

METHOD

A total of six articles were included, and a thematic analysis was conducted. The literature search was limited to English-language articles from bibliographic databases related to public health and health services research (MEDLINE, CINAHL, Web of Science, PsycINFO) between 2010 and 2022.

RESULTS

The topis identified were: (1) the quality of working relationships, (2) the quality of the work environment, (3) personal life and migration issues, (4) employment-related issues, and (5) career and training opportunities. Three approaches were considered in examining the retention and turnover intentions of FTPs: satisfaction, motivation for migration, and professional integration. Underrepresented fields are discrimination and social integration.

CONCLUSIONS

The processes of turnover intention and retention are still poorly understood. Standardizing definitions and certain parts of the methodology would help researchers navigate the process with more accuracy. Further studies should look at the causal relationships that can be collected in the form of qualitative data, as these are currently lacking.

Alternative career pathway decision-support job database for international medical graduates in Canada

Objectives

Canadian regulations have made it challenging for the international medical graduates (IMGs) to get jobs in their original profession as physicians. Consequently, alternative careers are gaining interest among IMGs to avoid underemployment or unemployment. We conducted research to identify the factors that IMGs consider for taking up an alternative career in Canada. Based on those understandings, we aimed to create a database where information about health-related alternative jobs is presented in a searchable way, which can aid IMGs’ strategic job search.

Data description

We first determined job searching preferences and constraints for IMGs regarding alternative career through focus groups. We used their preferred and constraining factors for collecting job-specific information through systematically reviewing job advertisements. Using this information, we created a database that contains available alternative career pathways for IMGs living in Canada. In total, we have identified 1374 job titles under 192 unique job categories comprising 47 National Occupational Classification (NOC) codes that could be suitable for IMGs seeking an alternative career based on their own short, intermediate, and long-term career goals. We expect that this database will help IMGs in deciding on alternative careers.

Accreditation and professional integration experiences of internationally qualified dentists working in the United Kingdom

INTRODUCTION

Regulatory processes for Oral health care professionals are considered essential for patient safety and to ensure health workforce quality. The global variation in their registration and regulation is under-reported in the literature. Regulatory systems could become a barrier to their national and international movement, leading to loss of skilled human resources. The General Dental Council is the regulatory authority in the UK, one of the nine regulators of health care overseen by the Professional Standards Authority.

AIM

The aim of this paper is to present the professional integration experiences of internationally qualified dentists (IQDs) working in the UK, against the background of regulation and accreditation nationally.

METHODS

Registration data were obtained from the General Dental Council to inform the sampling and recruitment of research participants. Semi-structured interviews of 38 internationally qualified dentists working in the United Kingdom were conducted between August 2014 and October 2017. The topic guide which explored professional integration experiences of the dentists was informed by the literature, with new themes added inductively. A phenomenological approach involving an epistemological stance of interpretivism, was used with framework analysis to detect themes.

RESULTS

Internationally qualified dentist's professional integration was influenced by factors that could be broadly classified as structural (source country training; registration and employment; variation in practising dentistry) and relational (experiences of discrimination; value of networks and support; and personal attributes). The routes to register for work as a dentist were perceived to favour UK dental graduates and those qualifying from the European Economic Area. Dentists from the rest of the world reported experiencing major hurdles including succeeding in the licensing examinations, English tests, proving immigration status and succeeding in obtaining a National Health Service performer number, all prior to being able to practice within state funded dental care.

CONCLUSION

The pathways for dentists to register and work in state funded dental care in UK differ by geographic type of registrant, creating significant inconsistencies in their professional integration. Professional integration is perceived by an individual IQD as a continuum dictated by host countries health care systems, workforce recruitment policies, access to training, together with their professional and personal skills. The reliance of the UK on internationally qualified dentists has increased in the past two decades, however, it is not known how these trends will be affected by UK's exit from the European Union and the COVID-19 pandemic.

Rehabilitation-specific challenges and advantages in the integration of migrant physicians in Germany: a multiperspective qualitative interview study in rehabilitative settings

OBJECTIVES

In Germany, rehabilitative healthcare institutions increasingly rely on migrant physicians to meet their staffing needs. Yet until now, research on the integration of migrant physicians has focussed entirely on the acute care setting. This study is the first to address the specific advantages and challenges to integration in the field of rehabilitative medicine where a high number of migrant physicians work. From the experiences of migrant physicians and their colleagues, we provide actionable suggestions to counteract potential sources of conflict and thereby improve the integration of migrant physicians in the German workforce.

STUDY DESIGN

We conducted a qualitative interview study.

METHODS

We conducted 23 interviews with a total of 26 participants occupying a variety of roles in two different rehabilitation centres (maximum variation sampling). Interviews were recorded, transcribed verbatim and parsed through thematic analysis.

RESULTS

Our research revealed advantages and challenges to integration in three distinct areas: rehabilitative care institutions, competencies of migrant professionals and interpersonal relations. The first set of issues hinges on the work processes within rehabilitative hospitals, professional prospects there and the location of the institutions themselves. Second, migrant physicians may encounter difficulties because of limited linguistic skills and country-specific knowledge. And finally, aspects of their interactions with care teams and patients may constitute barriers to integration.

CONCLUSIONS

Some of the factors influencing the integration of migrant physicians are the same in both rehabilitative and acute medicine, but the rehabilitative setting presents distinct advantages and challenges that are worthy of study in their own right. We outline several measures which could help overcome challenges to the integration of migrant physicians, including those associated with professional relationships. Further research is needed to develop concrete support programmes.

Scoping review about the professional integration of internationally educated health professionals

BACKGROUND

Over the last decade, Canada has been one of the top destination countries for internationally educated health professionals (IEHPs). After arrival, many struggle to professionally recertify and secure employment in their field. Considerable funding has been allocated to the development of new policies and programs to facilitate IEHPs' professional integration. Literature about the professional integration process and the available policies and programs is abundant, not synthesized and dispersed among a wide range of health professions and the academic and grey literature. This, in combination with the sustained policy relevance, contributed to the timeliness and necessity for conducting this scoping review.

METHODS

We used an updated version of Arskey and O'Malley's six-stage scoping review framework to summarize the amount, types, sources and distribution of the literature. Findings were summarized numerically and thematically. The themes included pre-immigration activities and programs, early arrival activities and programs, professional recertification and workplace integration.

RESULTS

Four hundred and seven published sources from 2000-2012 were retained for data charting and extraction. Most focused on international medical graduates or internationally educated nurses. IEHPs from the allied health professions were underrepresented. Methodologically, about one quarter of the papers are empirical studies with the next largest category being reports from professional certification bodies and educational institutions. The overarching concern is with workplace integration, professional recognition and bridging programs. Nursing dominates the literature about pre-immigration activities and programs whereas the literature about early arrival activities and programs, professional recertification and workplace integration is dominated by medicine. Although the literature does contain some information for IEHPs in the allied health professions, the thematic analysis did not identify a clear trend. A notable increase in the number of publications was present.

CONCLUSIONS

The literature about IEHPs' professional integration in Canada is abundant. This reflects the sustained policy relevance of the recruitment, recognition and professional integration for IEHPs in Canada. This demonstrates that Canada provides an excellent case for this review from which the findings may have international significance. Nevertheless, little information is available about the effectiveness of the policies and programs available to facilitate IEHP integration, an area that requires further consideration.

Professional integration as a process of professional resocialization: internationally educated health professionals in Canada

This paper examines the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada. Analyzing data from qualitative interviews with 179 internationally educated physicians, nurses, and midwives and 70 federal, provincial and regional stakeholders involved in integration of IEHPs, we examine (1) which aspects of professional work are modified in transition to a new health care system; (2) which aspects of professional practice are learned by IEHPs in the new health environment, and (3) how IEHPs maintain their professional identity in transition to a new health care system. In doing so, we compare the accounts of IEHPs with the policy stakeholders' positions and analyze the similarities and the differences across three health care professions (medicine, nursing, and midwifery). This enables us to explore the issue of professional resocialization from the analytical intersection of gender, professional dominance, and institutional/organizational lenses.

Support system for the professional integration of people with disability into the labour market

BACKGROUND

Successful cases of professional reintegration were achieved when adequate conditions were created for the adaptation of the worker with disability to the working environment and to the professional activity, allowing them to carry out all their functions without any restriction. In this sense, this paper presents a methodology for professional integration of people with disability in service companies and industry. It has as results a matrix of analysis of a set of observables for the reintegration of people with disability into the labour market, as well as an auxiliary tool for those who work in recruitment of personnel.

OBJECTIVE

The main objective was to develop a tool (i.e., a software) based on the crossing of data obtained from the analysis of the individual capacities and the requirements of the job to optimise the relationship between worker and the workplace. There was also considered a series of strategies which can be adopted by the individuals and the possible adaptations in the workplace, as a way to reduce the handicap in the accomplishment of different activities.

METHODS

The methodology for the development of this study is divided in two phases: Phase I, destined to the assessment criteria and classification of the indispensable functional characteristics of the individuals; Phase II, related to the assessment criteria of the jobs and the functions that have to be performed.

RESULTS

As a result it was developed an evaluation tool to match the individuals' capabilities and the job requirements. A software was created to support the evaluation and to help professionals during the assessment.

CONCLUSIONS

This methodology together with the support tool demonstrated to be a quite inclusive tool, as it considers, as a matter of priority, the capacities of the individuals and the real necessities of the workplaces.