Academic journal article Health Sociology Review

Degrees of Difference: The Politics of Classifying International Medical Graduates

Academic journal article Health Sociology Review

Degrees of Difference: The Politics of Classifying International Medical Graduates

Article excerpt

There is a scene in Stephen Frears' 2002 movie Dirty Pretty Things, where two men, in scrubs, are walking down a hospital corridor. One of the characters, Okwe, is a Nigerian doctor working in London as a taxi driver during the day and at the front desk of a hotel at night. The other man, Guo Yi, is working as an orderly in the London hospital and we can only imag- ine what his previous occupation was in China. Okwe has uncovered an illegal organ traffick- ing trade operating within the hotel where he works and has become enmeshed in the drama. He needs to steal some surgical equipment from the hospital. Guo Yi hands Okwe his identifica- tion badge to aid the hospital disguise and the Nigerian doctor looks at the Chinese orderly's ID with a confused look on his face. Guo Yi shrugs; 'black is black'.

In this cinematic moment, the orderly can be seen to be referring both ironically, and stra- tegically, to the pervasive 'othering' of migrant staff in places such as hospitals. This article also focuses on migrant hospital staff, specifically doc- tors, and the ways in which they are classified in Australia. Migrant doctors are usually referred to as 'international medical graduates', a term commonly abbreviated to IMG. In Australia, IMGs are doctors who have received their pri- mary medical qualifications outside of Australia or New Zealand (NZ). Often employed to fill areas of workforce shortage, IMGs make up a substantial and growing proportion of the healthcare workforce not only in Australia, but also in other resource rich countries such as Canada, the United Kingdom (UK), the United States of America (USA) and NZ (Organisation for Economic Co-Operation and Development, 2007).

The acronym IMG is the most recent of a long string of names assigned by politicians, researchers, bureaucrats and hospital staff to doc- tors migrating, or moving, to Australia. These groups have also named IMGs 'new Australian doctors', 'alien medical practitioners' and 'dis- placed doctors' (Haszler, 1967; Kunz, 1975; Maxwell, 1939, p. 919). When I worked as a medical intern in an Australian hospital in 2002, doctors educated 'elsewhere' were known by staff as 'OTDs' which stood for 'overseas trained doctors'. This term was occasionally explicitly derogatory, but more often than not, used as a way of referring to one of the many foreign doc- tors in the hospital in an offhand, generalising way. Gradually the term OTD was replaced by IMG, although the reason for this name change is not clear. The terms 'trained' and 'graduate' have their own connotations, with 'trained' potentially implying vocational experience and skills, whereas 'graduate' could be read to imply newly qualified, a term often associated with a first degree. Regardless of their various conno- tations, both terms work as a way of describing doctors as one homogeneous group, eliminat- ing difference. Recognising this limitation of the more recent term 'IMG', I will nonetheless con- tinue to use it in this article, problematising my use of this terminology in the conclusion.

Often, the gross generalisation embedded in terminology applied to doctors trained 'else- where' implies inferiority and works to deni- grate the doctors. For example, articles about IMGs in the Australian media, following infa- mous malpractice cases and terrorist claims (e.g., Crawford & Hudson, 2007; Parnell & Hart, 2007; Wijesinha, 2005) help to publically tarnish IMGs, as a group, with a brush of incompetence and suspicion. Negative connotations circulate and become institutionally embedded amongst staff in hospitals and clinics (Hawthorne & Birrell, 2002, p. 63; Srivastava & Green, 2004). However much they are claimed to be needed, IMGs are also constructed as a 'problematic' group by national governments, medical organ- isations, and some associations concerned with the 'integration' and 'assimilation' of IMGs. Finally, negative assumptions about IMGs can be found in research which makes implicit assumptions in research questions (e. …

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