The Cross-Cultural Adaptation of International Medical Graduates to General Practice in New Zealand

This study demonstrates that occupational success is an important factor in the adaptation of highly skilled migrants to host societies, as seen through the experiences of the international medical graduates (IMGs) who came to New Zealand and became general practitioners (GPs). New Zealand is reliant on IMGs to support and deliver quality health care to its population: IMGs constitute over 40% of the current medical workforce. The central contributions of this thesis are to three distinct discourses on the experiences of migrants. The first contribution is an investigation and critical analysis of the experiences of IMGs who came to practise medicine in New Zealand. During the course of analysing the primary data, and relating it to existing literature, it was observed there was a lack of a model that captured the essence of the specific acculturation of highly skilled migrants such as IMGs. Therefore, the second contribution is the development of a concise integrated framework - the Integrated Framework for Acculturative Research (IFAR), for the study of highly skilled migrants’ acculturation to new environments. The experiences of the IMGs who came to New Zealand have been used to develop and discuss the application of the IFAR to cross-cultural adaptation research. There is an historical component to these narratives as the IMGs in this research spanned nearly five decades of acculturation into New Zealand society. The third contribution is in the domain of qualitative research, where email interviews (e-interviews) have been used to gather data within the context of ethnography. While there has been significant literature, theories and models developed about cross-cultural and intercultural adaptation of migrants into host nations, there are gaps in the understanding of the experiences of highly skilled migrants, who are different from other types of migrants, given their predispositions and higher levels of human capital such as education and work experience. There is an emerging literature on this subject, to which this study adds. The IMGs in this study used their human capital to become medical practitioners in New Zealand, achieving their main motivation for migrating in the first place. The reasons the IMGs stated for migration are consistent with existing literature on ‘push’ and ‘pull’ factors; however for all of them, the primary reason was to pursue their medical careers in New Zealand. After arrival, most of them had to do additional training before they were allowed to practise independently. The medical training ranged from those required to achieve the registration of the Medical Council of New Zealand (MCNZ), to those needed to achieve the Fellowship of the Royal New Zealand College of General Practitioners (RNZCGP). The participants noted several challenges during their training period, including a lack of clear information on what was required; having to prove their ability despite many years of experience as medical practitioners; dealing with poor teachers for some; having to travel long distances to attend training seminars; and for a few, dealing with financial constraints. However, they all overcame such challenges and became successful independent GPs. Their age, pre-migration human capital, and post-migration motivation were essential in initiating their desired occupations in New Zealand. These three success factors are supported by emerging literature on highly skilled migrants. The early participants initially worked in hospital settings before choosing general practice. Some left because they experienced issues in the hospital environment such as tensions with local colleagues, and the need to work long unfriendly hours. All participants noted that the reasons for choosing general practice included their desire to work more closely with communities and to experience a greater variety of medicine. Additionally, many reported that the flexibility of working in general practice gave them a better work/life balance that allowed them to do other things within the community and outside of their general practice. Female participants noted that general practice was more conducive when raising a family, compared to hospital-based specialties. These are the strengths of general practice that are well documented in literature. While the participants did not note any major ongoing challenges, some reported being frustrated with the poor links between primary and secondary health care that impacted on the timely care of their patients. With an increase in chronic conditions and mental health issues, coupled with an ageing population, many participants reported that they needed more time and frequent consultations to treat certain patients. Given New Zealand’s co-payment system, participants reported having to consider the appropriate levels of care for patients with chronic conditions so as not to financially overburden them. For participants working in rural and economically deprived areas, there were other social factors that affected their medical practice, such as the high levels of family violence, sexual health issues, teenage pregnancies and substance abuse. These issues are supported by current literature regarding health and society in New Zealand. Despite the challenges they faced, all the IMGs planned on continuing to work in general practice in New Zealand for the foreseeable future. Migrants’ pledge of continuing in their chosen occupations in host nations can be a very good indicator of acculturation and integration. The MCNZ reported that nearly two-thirds of all IMGs left New Zealand two years post-registration. However, retention rates improved significantly once IMGs obtained their vocational registration. Occupational continuity sheds light on immigrants’ level of acculturation because it establishes that they are comfortable living among the hosts, and working in their chosen professions. This study demonstrates that occupational success is a key prerequisite to continuity and long-term integration into host societies. As highly skilled migrants, they could have gone to almost any country but they chose New Zealand. They remain here, having forged their medical careers and a lifestyle of their choosing. They now consider New Zealand their home, at least until they enter a different stage of their lives