Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study

Abstract

BackgroundWith Germany facing a shortage of doctors, hospitals have been increasingly recruiting physicians from abroad. Studies in other countries have shown that migrant physicians experience various difficulties in their work, which might impact the quality of patient care, physician job satisfaction, and, accordingly, retention. The experiences of migrant doctors in Germany have not been systematically studied so far and will likely differ from experiences migrant physicians make in other contexts. A thorough understanding of challenges faced by this group, however, is needed to develop adequate support structures—as required by the WHO Global Code of Practice on the International Recruitment of Health Personnel.MethodsA qualitative study was conducted to give an overview of the multifaceted difficulties migrant physicians might face in German hospitals. Twenty semi-structured interviews with foreign-born and foreign-trained physicians were conducted in German. Participants were recruited via the State Chambers of Physicians and snowballing based on a maximum variation sampling strategy varying purposefully by source country and medical specialty. The interviews were recorded, transcribed verbatim, and analysed using qualitative content analysis.ResultsParticipants described difficulties relating to healthcare institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organization of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate for other reasons.ConclusionsThis is the first study to describe the broad range of issues migrant physicians experience in Germany. Based on this information, institutional actors should devise support structures to ensure quality of care, physician wellbeing, and retention. For example, training opportunities should be offered where needed to support acquisition of setting-specific knowledge. Discrimination experienced by participants calls for better diversity management as a leadership task in healthcare institutions. Misinformation practices in recruitment could be managed by a voluntary code of ethical conduct. Further research is necessary to identify strategies that adequately address diverging normative positions between migrant health personnel and their patients and colleagues.

‘Wait and wait, that is the only thing they can say’: a qualitative study exploring experiences of immigrated Syrian doctors applying for medical license in Germany

“…As these processes may take several months, many doctors use the waiting time working on a temporary license, which is easier to obtain, but expires after 2 years. Abbreviations: yr. = years assessed for equivalency to the German medical studies in a licensure process, so as to be allowed to work permanently as a doctor [17]. Records of medical training and working experience have to be handed in at the professional regulatory bodies, i.e.…”

“…the State Chambers of Physicians (Landesärztekammer), where experts ('reviewers') compare the medical qualification of the applicant with the Germany curriculum. Another option for obtaining a permanent license is to take a theoretical exam to prove competency, either right away, or as a second option in case the medical training received in the home country is not considered equivalent [14,17]. Furthermore, language skills are obligatory: In addition to the B2 German language level, some federal states require a language exam focusing on medical technical terms ('Fachspracheprüfung') [18].…”

Occupational experiences of high‐skilled intra‐EU immigrants in a transnational space? How European physicians in Germany perceive their career prospects

“…Furthermore, learning to work in a different medical system was a major challenge. It is difficult to learn and adjust to new daily routines in the hospital, communication practices, codes of conduct, and different medical equipment (Jansen, Hänel, & Klingler, 2018;Klein, 2016;Klingler & Marckmann, 2016;Kovacheva & Grewe, 2015), as doing so relies, at least in part, on implicit knowledge (Klein, 2016).…”

“…Although some physicians report being content with working conditions, professional performance, and career advancement, others experience de-skilling and struggles for recognition of their competences, often being assigned to "rudimentary tasks" (Boström & Öhlander, 2012;Kovacheva & Grewe, 2015). Perceived discrimination and inter-professional struggles between physicians and nurses were experienced by some migrant physicians, whereas others report a supportive working environment (e.g., Klein, 2016;Klingler & Marckmann, 2016;Kovacheva & Grewe, 2015). Gender differences might be expected (see Heru, 2005, for physicians in general) but have, so far, not proven to be relevant, as Klein (2016) states in her qualitative study on Eastern European physicians in Germany.…”

Migration, health, and ethics

“…This is unfortunate, as empirical studies have shown that migrant physicians as well as the receiving care teams may face many struggles. 25 Furthermore, the question of how to conduct migration-sensitive research has so far not been addressed sufficiently.…”