Health and wellbeing of international medical graduates: Acculturation into the Tasmanian rural and remote context

Australia has experienced health workforce shortages, especially in rural and remote areas. In addition, rural and remote populations suffer the lowest levels of health access, the highest levels of medical practitioner maldistribution and the greatest health disadvantage in Australia. As a result, the recruitment of overseas trained doctors, also known as international medical graduates (IMGs) is one government strategy to fill these gaps. Currently, the medical workforce remains heavily dependent on IMG recruitment; however, their retention in these areas remains challenging. It is reported, IMGs seek to relocate into more metropolitan areas once compulsory services obligations are complete. This requires continued recruitment of new IMGs; however it remains an implausible solution. The study aims to examine the experiences and challenges of IMGs living and working in rural and remote Tasmania. As such, the research attempts to respond to the following research questions: 1). What are the enablers and barriers IMGs face as they live and work in Tasmania? 2). What are the acculturation process and strategies which facilitate trust, co-operation and connections between IMGs, other health care professionals and the community? 3). What are the strategies used by IMGs to improve community engagement and integration? and 4).What acculturation strategies and barriers are observed by key informants who support IMGs in Tasmania? A number of key theoretical concepts and frameworks underpin this study to address the aims of the study. This includes the internationalisation and globalisation of health workforce; acculturation; and human and social capital of migrants in new social and workplace environments. These theories draw attention to the challenges of acculturation and identity, which migrants, those in the health workforce and particularly IMGs face in new cultural and healthcare contexts. The study used a mixed method approach employing a double stage sequential explorative design to collect data for the study. Data were collected through an IMG questionnaire, and face-to-face semi-structured interviews with Tasmanian IMGs and key informants, who recruit, support and act as educators and advisors to IMGs. The study gathered 105 returned questionnaires (response rate 30%), while interviews were conducted with 45 participants recruited through purposive snowball sampling. The interview data were analysed using thematic analysis and Critical Discourse Analysis by way of NVivo v10.0. In addition, descriptive statistics and inferential statistics were used to analyse the questionnaire data using Statistical Package for Social Science (SPSS) 20.0. The study provided insight into the everyday experiences of IMGs within hospital and rural community settings and how this impacts acculturation, cultural shock and adaptation. It provided a comprehensive understanding of the social and psychological indicators of successful integration, settlement and life satisfaction while highlighting hospital and community challenges. Lastly, it has outlined the importance of identity-community transformation and how connections within a community are vital in establishing extensive social and support networks and the development of greater social capital; greater cross-cultural adaptation; reducing local stigma; and increasing positive cultural attitudes. The research provides insight into the complexities and principal motivators why IMGs are staying or leaving Tasmania. The study delivers greater insight into the needs, desires and challenges encountered by IMGs locally, nationally and internationally, while offering an understanding for policy augmentation to not only aid recruitment and the retention of IMGs, but also to maintain their and the community's health and wellbeing.