Sammendrag
This paper examines what we know, and don t know, about migration of international physicians. It sought to determine if internationally trained medical doctors have similar work qualifications as Scandinavian trained physicians and if the current national integration process is a cause of concern. It addresses the issue of the quality of the primary health care provided by IMGs, resident in Norway, as experienced by their Norwegian professional peers.
Questionnaires were sent to 485 physicians. 327 returned the filled-in questionnaires and reported about their experiences with colleagues with a non-Scandinavian medical education. The returned questionnaires show how the respondents assess the professional, cultural, and communication skills of the foreign-trained physicians after their authorization as medical doctors in Norway. Interviews were conducted with representatives from the medical faculty, SAFH and the Norwegian Board of Health to discuss their plans for the future assessment and support of IMGs.
Results:
1. Respondents express low satisfaction with IMGs trained in Eastern Europe, Asia, Africa and South America, and point to inadequate language and communication skills as the number-one problem among these physicians.
2. Respondents report that the problems they see with the foreign trained physicians were compromising the quality of health care provided. Substantial proportions (5%) of all reports conclude that poor communication skills are a very or fairly serious problem for patients, and of even greater concern, 4,6% of all respondents say that as a result of poor communication quality of care suffers and may put patients at risk.
3. Beyond the problems with communication, the Eastern Europe and World groups are united when it comes to IMGs medical professional skills (core medical knowledge, technical skills). Almost one third of the respondents pointed out that they are poorly satisfied with the quality of the professional skills of these IMGs.
4. Only a minority of respondents had concerns about IMGs respect for the autonomy of patients.
5. The solutions to the quality problems identified by the respondents and the interviewees include mandatory increased support and good parenting practices, better opportunities for continuing education and a stronger social and cultural training.
To conclude, this study indicates that there are greater variations in the skill mix among internationally trained medical doctors than among their Scandinavian trained colleagues in tertiary health care. About one third of the reports point to more or less impaired quality of care. In 5 per cent of the reports these quality problems are closely linked to patient and colleague (dis)satisfaction. The problems are so grave in these cases that they may affect patient safety. The single most important problem identified in this report is inadequate language and communication skills. Given these results, it is clearly not a problem limited to certain facilities, professions, regions or places of education. Those working closely with foreign-trained physicians do, however, think that it is possible to introduce an educational program that might significantly alleviate the problems identified through this study.