‘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

Abstract

Background: Due to the civil war in Syria, many Syrian citizens have had to flee their country during recent years, among them many physicians. Germany is among the preferred immigration countries. Immigrant Syrian physicians could help overcome the prevailing shortage of medical specialists in Germany. This study explores the experiences and perceptions of Syrian physicians of the licensure process and job application. The study aims at understanding barriers in integrating Syrian doctors into the German health care system. Methods: We conducted 20 semi standardized interviews with Syrian doctors (n = 17 m; n = 3 f) living in different federal states in Germany. The interviews dealt with the procedure of the accreditation process, its speed and challenges, the interactions with authorities, and the job application process; they were transcribed verbatim. A detailed content analysis was performed. Results: All interviewees described the licensure process as a complex, lengthy, ever-changing and non-transparent procedure, which is perceived as a partly unfair, sometimes arbitrary bureaucracy. They often feel at mercy of Government employees and report experiences with reviewers who ask for absurd and impossible accomplishments, refuse to give information, and act at random. As a consequence, the interviewees describe themselves as depressed, irritated and/or in despair. According to the interviews, informational and practical support from official institutions was scarce. Instead, the Syrian doctors relied on peers or, in some cases, German friends to understand the requirements and seek information about the licensure process. To find a job placement, it was very helpful, if not essential, to have a German acquaintance establishing contact with possible employers. All three interviewed female doctors reported that their wearing a Hijab led to episodes of discrimination in their job search.

In their own time: Refugee healthcare professionals’ attempts at temporal re-appropriation

“…Further, research indicates that procedural transparency, accomplished through the accessibility of the responsible agency, is important. The inaccessibility of information concerning the state of one’s application and the related perception of arbitrary discretion can weigh heavily on the applicants, leading to feelings of exasperation, angst and desperation (Loss et al, 2020).…”

“…This holds especially true for highly educated refugees, whose employment re-entry is shaped through not only the asylum regime and civic integration programmes but also processes of foreign qualification recognition (FQR), such as the licensure. Even though FQR processes are usually explored in relation to the inclusion and exclusion of knowledge (Andersson, 2021), research dealing with refugee participation in FQR procedures hints at the embedded temporal challenges relating to their duration (Bucken-Knapp et al, 2018; Bygnes, 2021), the pervasiveness of waiting (Loss et al, 2020) and the mechanisms of discontinuation (Kum et al, 2010).…”

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

“…The health care system in Germany is increasingly characterized by a shortage of physicians, especially in rural areas and in the primary care sector [25]. There is a predicted gap of more than 100,000 physicians in 2030, which equates to approx.…”

“…Given the differences in culture and medical training, their findings may likely be limited in their transferability to physicians trained in Middle Eastern countries [26]. Approaching this topic, a recent study by Los et al focused on barriers in licence procedures and job application for Syrian-trained physicians following their migration to Germany [25]. While both studies reported in part on social integration experiences, they did not build on an existing integration framework based on theory and empirical studies.…”

“…The study participants consisted of 21 residents and 2 specialists from various source countries working in hospitals in different geographic locations in Germany. The small number of specialist participants could be attributed to the fact that Middle Eastern physicians' migration to Germany has started to increase only since 2011 and reached its peak in 2015 and 2016 [25]. That is why there are still few Arabic speaking specialists in Germany, unlike Turkish physicians, for example, who have been migrating to Germany since the 1960s [29].…”