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The Trans-Tasman Migration of New Zealand Medical Practitioners: a Qualitative Mixed Methods Case Study

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The Trans-Tasman Migration of New Zealand Medical Practitioners: a Qualitative Mixed Methods Case Study ResearchOnline@JCU This file is part of the following reference: Mpofu, Charles (2013) The trans-Tasman migration of New Zealand medical practitioners: a qualitative mixed methods case study. PhD thesis, James Cook University. Access to this file is available from: http://researchonline.jcu.edu.au/40101/ The author has certified to JCU that they have made a reasonable effort to gain permission and acknowledge the owner of any third party copyright material included in this document. If you believe that this is not the case, please contact [email protected] and quote http://researchonline.jcu.edu.au/40101/ The Trans-Tasman Migration of New Zealand Medical Practitioners: A Qualitative Mixed Methods Case Study Thesis Submitted by Charles MPOFU, MHSc (Hons) August 2013 for the Degree of Doctor of Medical Education in the School of Medicine and Dentistry James Cook University Acknowledgements I would like to thank my supervisors Professor Tarun Sen Gupta and Professor Richard Hays for their support and encouragement of my research. This study started as an overly ambitious work that lacked clear parameters but with their guidance it gradually evolved into an exciting research project. I am aware of the difficulties associated with supervising a student by distance. At times I contacted my supervisors during their family time or while they were on holidays for guidance and was grateful for their advice. I feel overly indebted to them for their input into this work. My sincere thanks also go to the James Cook University School of Medicine and Dentistry for releasing funds that supported the field research processes. I am also grateful to the School of Medicine and particularly extend my sincere thanks to Emma Tucker, their research coordinator. Emma provided invaluable advice to me as a new student to doctoral study procedures. My sincere thanks also go to the medical practitioners involved in this study. They are a special group of people that not only work long hours but also have an important job in looking after our sick and vulnerable. I appreciate them having given up their valuable time to this research. The majority of these participants used their break time and their private or family time to participate in this research. Special thanks also go to the leaders of various organisations at which my participants worked as they facilitated the distribution of questionnaires. I would also like to extend my sincere thanks to various ethics committees and organisational structures for scrutinising my questionnaires and giving me the necessary feedback before distributing it to participants. The time dedicated by Associate Professor Kenn Felicity and The Royal Australian and New Zealand College of Psychiatrists to providing feedback on my questionnaires and the research procedures is also acknowledged. In addition, special thanks go to particular individuals like Dr Sally Houliston of Hawkes Bay DHB and Dr Andrew Brant and Amanda Wheeler of Waitemata DHB who advised me of a novel way of distributing questionnaires effectively. Special thanks also go to corporate organisations and government agencies such as Statistics New Zealand, Australian Bureau of Statistics, the Medical Council of New Zealand and the Centre for Workforce Intelligence in the United Kingdom. There were individuals from these organisations who helped by either supplying workforce i information that could be legally released or by providing direction to sources where the required information could be found. Special thanks also go to friends such as Charles Sibenke and my immediate family members including my brother Prayer Mpofu for their support during the research process. Auckland University of Technology (AUT) work colleagues are also thanked for their encouragement and support particularly Trish Thomas, Deborah Hay, Helen Gaeta, Kitt Foreman, Robin Bellingham, Nick Boston, Sue McNaughton, Ailsa Haxell and Nicola Power. I would also like to thank and acknowledge the invaluable statistical advice given to me by biostatisticians at AUT, particularly Dr Nick Garrett. The Campus Services at AUT through their security coordinator Jesse Pye helped also by providing secure study space during the odd late hours on the university campus. I am grateful also the AUT Vice Chancellor’s Doctoral Study Leave Award Committee for granting me leave to complete this study. I thank my line manager Associate Professor Lindsey White also for granting study leave from time to time as required. I acknowledge the contribution of others to this work, especially the proof reading which was completed by Dr Mary Lincoln. In addition, I thank Jo Adams and Andrew Lavery who proof read specific aspects of this work such as referencing and heading styles. Sue Knox helped with tutorials for formatting tables and figures. I would also like to thank the copyright owners who generously allowed me to use part of their materials in this thesis. Every reasonable effort was made to gain permission and acknowledge the owners of copyright material used in this thesis, as can be seen in Appendix J. I would be pleased to hear from any copyright owner who has been omitted or incorrectly acknowledged. Lastly, I acknowledge the granting of ethical approval of this research by James Cook University Ethics Committee (H3793) and the AUT Ethics Committee (10/239) on 28 July 2010 and 22 October 2010 respectively. ii Abstract This research examined why medical practitioners are choosing either to stay in New Zealand or migrate, specifically to Australia. In addition, the study explored what potential exists to influence these choices by those concerned with workforce issues. A qualitative mixed method case study methodology involving a survey of participants in two different sub-projects was used. The first sub-project comprised 114 New Zealand- based medical practitioners and 15 workforce experts. The second sub-project involved 85 medical practitioners who migrated to work in Australia. Respondents either participated in both the survey and the in-depth interviews, or in one of the two. The study has shown that while the media consistently cite higher salaries as the predominant factor, reasons for migration to Australia are complex and broader than perceived in social spheres. These include factors related to research, training and career aspirations; remuneration and alternative pay packages; working conditions; management and collegial relationships; health system and government policy factors; and intervening factors. The latter are personal, social and environmental in nature. Retention strategies suggested by participants also pointed to the above factors. The motivation theories of Herzberg and Maslow provided a framework for conceptualising the reasons for migration. They were also used as a framework for justifying strategies for dealing with trans-Tasman migration of medical practitioners to Australia. Migration and motivation theories offer some insights in understanding the trans- Tasman migration of medical practitioners. When viewed individually however these theories leave gaps in explaining this phenomenon. An argument was therefore made that the factors for migration identified in this research can be represented in a comprehensive model that takes into consideration individual and contextual factors in both origin and destination countries. This calls for a model similar to Lee’s push-pull factor theory. Recommendations made in this research were in two broad categories which are; radical or transformational strategies and small incremental steps for action. The recommendations in the radical or transformational category include regional or coalition strategies and migration friendly policies. The recommendations in the small steps for action category are in the areas of workforce planning action, government or policy action, medical education, boosting loyalty, creating inertia, multi-stakeholder action, building and developing research evidence base and competing internationally in a sustainable way. The incremental approach was recommended as a preferred option iii given the need to be pragmatic and for sustainability of reforms. These reforms are necessary for achieving medical workforce adequacy when dealing with the trans- Tasman migration. It is recommended that workforce planners implement complex and multifaceted approaches aimed at both recruitment and retention, where recruitment drives factor in the global dynamics and competition for medical professionals. The evidence generated from this research provides a platform to provoke action and promote policy discussions. These responses could lead to formulation of sound economic, social and international policies to address this issue. Regional and other international policies are also seen as crucial to this complex context. The reason for their importance is the growing interdependence of economies globally and the available evidence that migration is not stagnant but continually becoming unpredictable and increasingly more complex. Until New Zealand adopts such bold actions as proposed, current migration trends are likely to continue to unprecedented levels. iv Dedication To Holly and Daniel v Contents Acknowledgements .................................................................................................................... i Abstract ..................................................................................................................................... iii Dedication .................................................................................................................................
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