Study as work : the role of 'training' in the lives of medical migrants to the UK

1.  Study as work: the role of 'training' in the lives of medical migrants to the UK Leroi Henry, Parvati Raghuram, Joanna Bornat 48th Congress of the European Regional Science Association 27 – 31 August 2008, Liverpool, UK

2. Structure • South Asian Geriatricians project • How doctors’ mobility and narratives of career were shaped by Empire • The tensions inherent in the integration of study and work for migrants • Migrants vulnerability to changes in the regulatory environment

3. South Asian Geriatricians project • Two year ESRC funded project • Supported by British Geriatrics Society and British Association of Physicians of Indian Origin • 60 oral history interviews with retired and serving geriatricians trained in South Asia • 30 Completed • 23 Transcribed • http://www.open.ac.uk/hsc/research/research-projects/geriatric-medicine/home.php

4. Interviewees by country of origin

5. Interviewees by Deanery

6. Interviewees by age

7. Postcolonial ties and interests underpinning medical migration • Historical reliance of NHS on colonial and commonwealth labor • Postcolonial relations embedded in accreditation of qualifications and regulation of medical migration • Permits and the integration of work and training

8. Postcolonial ties, mobility and migrant doctors’ motivations • Institutional linkages in transnational socio-cognitive community • Narratives of post graduate training in the UK as markers of career success and being a good doctor • Temporary mobility for validating and updating skills

9. The integration of learning and work 1: the process of training in the workplace • Membership of the Royal Colleges and specialist training • Developing clinical practice and communication skills in the workplace through apprenticeship

10. The integration of learning and work 2: establishing oneself in the workplace • Demonstrating credentials as a competent doctor in a post colonial cognitive community • Adjusting to UK professional and organizational cultures • Deskilling to facilitate sponsorship relationships

11. The integration of learning and work 3: How junior doctors balance study and work • Long unsocial hours • Universal for junior doctors • Differential access to study leave • Mitigated by working time directive

12. The integration of learning and work 4: why medics remain • Family commitments • Commitment to socialized medicine • Resources to be a good doctor • Limited options at home • Questionable utility of migrants’ new skills in South Asia • Material factors not mentioned

13. The utility of migrants’ specialist skills for South Asia • Conflicting interests: • Fill gaps in UK medical labour market • Training in high status competitive specialty • Vulnerability of immigration status constrains scope for career choice • Perceived discrimination against migrant doctors • Entry into geriatrics as a response to marginalisation • Skills in geriatric medicine not marketable in South Asia

14. Changing regulation of learning spaces: visas • Abolition of permit free training • Self sufficiency and the nation as the primary space for arranging medical provision • The end of non-EU medical migration?

15. Regulating learning spaces: implications for migrant doctors • Expensive UK qualifications invalidated • Many migrants unable to complete their training • Uncertainty, unemployment, financial loss and no transferable skills

16. Conclusions • Migration for training within networks framed by postcolonial relationships • The blurring between work and learning can lead to a conflict of interests • In this form of migration for learning, medics are vulnerable to changes in immigration and medical training regulations • The skills developed by migrants are a consequence of their responses to UK labour market conditions