Entrance to and advancement within the Swedish medical labour market for physicians with a medical degree from outside the European Union

Sammanfattning: Background Many physicians who migrate wish to continue practicing medicine in their destination country. However, they may meet barriers and obstacles that prolong the process of entering and advancing within the destination country’s medical labour market. Migrant physicians’ competences are needed, and if fully utilised, it will be beneficial for them, the patients, the medical workforce, and for society. Aim The aim was to explore the entrance to and the advancement within the Swedish medical labour market for physicians with a medical degree from outside of the EU/EEA. Method The study participants were mainly physicians who had enrolled in a complementary programme for physicians with a medical degree from outside the EU/EEA and Switzerland. Both qualitative and quantitative methods were used. Study I included semi-structured interviews with 24 physicians. Study II was a cross-sectional study that included questionnaire data from 283 respondents. Study III included test data from physicians with a medical degree from outside the EU/EEA who had taken a licensing exam 2013–2019 (n = 564), and 14 semi-structured interviews. Study IV included questionnaire data from 101 respondents, and four semi-structured interviews. Interview transcripts and questionnaire free-text answers were thematically analysed. For Study II, the statistical data were descriptively analysed. For Study III, linear and logistic regression analysis were used. In Study IV, descriptive and inferential statistical analyses were performed on the data. To understand and discuss how MPs enter and advance within the medical labour market in Sweden, Bourdieu’s concepts of the social field, symbolic capital and doxa were used as a lens. As a complement to Bourdieu’s theory, self-determination theory (SDT) was used. Results In Study I, several conceptions about working in rural and remote areas in Sweden were identified. These regarded the themes finding work, work content and tasks, and living. Conceptions about working in a certain type of area gave rise to conceptions about what it would be like to live in the same area. The participants’ conceptions derived from their own and from others’ experiences; and conceptions influenced study participants’ motivation of where to work, negatively or positively. In Study II, 88% of the respondents held a position as a physician when answering the questionnaire, but they were in varying stages of their careers from one another; as they also had begun the complementary programme at different times. The respondents had mainly found their first job after the programme via spontaneous job applications, during internships or via friends or other programme participants. Barriers and facilitating aspects as well as the different strategies they used were explored. During their job-seeking process, the respondents reported experiencing discrimination or having their competences undervalued. To increase job prospects, the respondents had, for example, worked as assistant nurses or medical assistants before beginning the complementary programme. Respondents had developed their language by using different resources. Due to high labour market conditions, respondents had moved or changed specialty to increase job prospects. Study III revealed that age was a predictor for succeeding on the licensing exam, and that the complementary programme seemed to reduce the negative age effect for participants aged 45 years or older. In the qualitative material, perceived influential aspects for succeeding or failing on the exam related to the two themes preparations and biographical aspects, and to the exam and exam situation. Study IV explored aspects that influenced choices of employment and specialty, and found that the most important aspects related to choosing employment were the ability to combine work with family, and possibilities for developing competences. The majority of the respondents had specialised in general medicine, and women were more likely to specialise in general medicine than men. Influencers on the interviewees’ motivation and choice to specialise in general medicine related to the themes of job opportunities, positive experiences from PHC, working conditions and family conditions. Conclusions Barriers and limiting circumstances may derive from the micro and meso levels, and influence on a micro level; however, individuals still have agency. They can influence their paths to the labour market and advance within it through certain strategies and/or facilitating aspects. Many barriers and facilitating aspects corresponded to one another and were two sides of the same proverbial coin. The social context and environment influenced the study participants’ choices regarding where to work and in which specialty. Aspects relating to work life and private life collaborated to influence motivation and choices. As a group, these MPs could be interpreted as being hierarchically positioned lower in the Swedish medical field than physicians who trained in the country. However, on an individual level, this may not hold true, as the group is heterogeneous in terms of gender, ethnicity, country of origin, country for medical education, and age. Influential aspects on the macro, meso and micro levels may change over time.