Doctors on the move 2: a qualitative study on the social integration of middle eastern physicians following their migration to Germany

Abstract

Background The integration of immigrating physicians has become a challenge for many societies and health care systems worldwide. Facilitating the integration process may benefit both the uptaking country and the immigrating physicians. Previous studies have approached this problem from a system integration perspective. The present study explores the degree of social integration of an exemplary group of Middle Eastern physicians following their migration to Germany from an individual perspective. Methods Based on social constructivist epistemology, a series of fifteen interviews and two focus groups with immigrated Middle Eastern physicians (n = 23, purposively sampled) were conducted between 2017 and 2020 in Germany. The audio recordings were transcribed, translated into English and analysed deductively based on Esser’s model of social integration, consisting of four dimensions: acculturation, positioning, interaction and identification. Results The social integration of the participants showed a multifaceted picture. The early phase was characterized by disorientation and trial and error. Cultural differences were of major importance. Acculturation was facilitated by German language acquisition and increased over time, although some cultural difficulties remained. Professional positioning was facilitated by the need for physicians and a relatively low-hurdle relicensing procedure. Interaction and identification depended on the efforts of the individual physicians. Conclusions This study provides a comprehensive picture of the individual social integration of Middle Eastern physicians in Germany. Language and cultural adaptation are identified as being of primary importance. Social integration can be facilitated through orientation programmes or cross-cultural training that benefits the uptaking countries as well as the immigrating physicians.

Inequitable treatment as perceived by international medical graduates (IMGs): a scoping review

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“…In this work, navigating the challenges of identifying and supplying relevant documents to the Regulator was a lengthy and uncertain process for TCQR applicants, reflecting challenges reported for migrant healthcare professionals elsewhere. 26 , 27 All applicants were required to revert to the role of students for the equivalence and PRE exams, and some reverted to mentees, if an adaptation was required. Challenges were described by some participants concerning engagements with potential employers, notably concerning the status of entry permits on arrival in Ireland.…”

Snakes and ladders: An integrative literature review of refugee doctors' workforce integration needs

“…15 This theory consists of four domains: acculturation (language, skills and knowledge acquisition, including knowledge of culture); positioning/placement (occupying positions in society, for example relevant work); interaction (establishing social connections); and identification (acquiring cultural values, forming an emotional attachment to the host system). 14,15 Esser's theory includes the term 'identification', sometimes known as 'identity work', which is defined as the process of 'forming, repairing, maintaining, strengthening or revising the constructions that are productive of a sense of coherence and distinctiveness'. 16 This term assumes that identity is dynamic, and may be relevant when considering how refugee doctors integrate into their new environments.…”

“…We incorporated a second theory because we felt that the Home Office theory was missing an element of identity transition. We chose Esser's theory of social integration, 14 exploring the processes of integration experienced by international migrants, 14 because it had been previously applied to investigate IMGs' integration experiences in Germany 15 . This theory consists of four domains: acculturation (language, skills and knowledge acquisition, including knowledge of culture); positioning/placement (occupying positions in society, for example relevant work); interaction (establishing social connections); and identification (acquiring cultural values, forming an emotional attachment to the host system) 14,15 .…”

“…It has also been used to explore the integration of IMGs (though not refugees). 15 SES and EC independently coded the same six papers.…”