Elitism and professional control in a saturated market: immigrant physicians in Israel

Abstract

Using Israel as a case study, the paper considers the social mechanisms by means of which the medical profession seeks to maintain its boundaries and control in a social context characterised by the recent arrival of twelve thousand immigrant physicians from the former Soviet Union. This situation poses a threat to the veteran medical profession which is described as combining elitist and proletarian elements in an uneasy balance. In the past the principal mode of resolution with regard to this duality has taken the form of demonstrative assertions of the elitist component. With the large influx of immigrant doctors, three mechanisms geared to maintain control have been utilised: (I) the formal licensing examination for general practice; (2) full control of employment options in the health care system and (3) a widespread negative stereotype regarding the level of immigrant physicians' professional skills. The paper discusses these mechanisms and their implications for the profession.IntroductioD

Professional Identities in Transit: Factors Shaping Immigrant Labour Market Success

“…Of apparent weight is the general phase of the business cycle (boom or recession) and the demand for a specific occupational group; for example, software designers in the years of a high‐tech boom or nurses in any aging society. At the same time, immigrants’ chances in the labour market depend on the supply of locally trained specialists and the industry’s reaction to competition with immigrants in the form of stricter licensure regulation, barriers to senior posts and so on (Shuval, 1995). Governmental regulation of certain occupations – for example, the requirement of citizenship (e.g.…”

“…These concerns reflected the centralized character of the Israeli healthcare system, whereby the numbers of medical posts and residencies, medical facilities and beds are regulated by the MOH and services are delivered by means of managed care organizations. At the same time, local practitioners, and the Israeli Medical Association (IMA) representing their interests, felt threatened by the potential wage depression due to the oversupply of physicians, and a potential compromise in quality of care reflecting dubious standards of medical education and practice in the FSU (Shuval, 1995).…”

“…For the same reason, the credentials of Soviet-trained engineers and ''hard'' scientists are accepted automatically, while economists and social scientists often cannot reconfirm their diplomas, since the gap in social disciplines between Western and socialist countries had been very wide (Lerner and Menachem, 2003). Although some objective validation of foreign credentials and skills is essential in most cases, it is often used as a gate-keeping instrument by local professional elites to reduce competition with immigrant peers and control the professional markets in terms of openings, wages and entry criteria (Kugler and Sauer, 2005;Shuval, 1995).…”

Stratification in the Medical profession: Non-Western Physicians in Norway

“…In contrast to former Soviet physicians in Israel who were supposed to integrate into a saturated market (Bernstein & Shuval, 1998;Shuval, 1995), the deficiency in the Norwegian market, also of specialists, may facilitate integration. These characteristics of the profession and the labour market should yield minor differences between the extent to which FEN and FEA pursue specialisation and in the specialties to which they enter.…”

“…Siniver (2011) showed that immigrant physicians receive lower earnings owing to statistical discrimination in Israel, and Shuval (1995) addressed the negative stereotyping of immigrant physicians' qualifications as a barrier for integration. Such stereotypically informed perceptions about productivity, and employers' preferences, create ethnic and gendered hiring queues where employees apply for the best jobs and employers hire those workers whom they perceive to be the best (Reskin & Roos, 1990).…”