‘To Stay or Not to Stay’: Migration Decisions and Professional Mobility of South African Educated Physicians in Rural Alberta

Abstract

Introduction: Rural communities in Alberta, Canada have faced physician shortages for decades. Attracting internationally educated physicians, including many South African physicians, is one way to address this problem. While much of the research on internationally educated physicians focuses on attraction and retention, I bring a fresh approach, framing the decision to stay in light of migration decisions and professional mobility, all within a life course perspective. Methods: Data was collected via semi-structured virtual interviews with 29 South African educated physicians who have practiced family/general medicine across Alberta. Many participants were white men, while physicians of colour and women were notable minorities. This qualitative research was guided by abductive grounded theory, a methodology that encourages theory building and contributions to ongoing debatesw. Data was transcribed verbatim and analysed using open thematic coding. Findings: South African educated physicians made the decision to leave South Africa and to come to Canada to pursue the prestige and opportunity that was inaccessible in South Africa. Instead of freely making decisions about where to live and the sort of medicine they wanted to practice, physicians were limited to work as rural generalists. This perceived lower prestige professional work meant South African physicians occupied low status positions while more prestigious work was reserved for Canadian educated physicians. The outcome of this stratification played an important role in South African physicians’ ability to achieve what they were looking for and the professional opportunities that were available if they stayed in a rural community or migrated elsewhere. Conclusion: Findings suggest that migration, or in this case physician attraction and retention, is an outcome of aspiration and capability, contingent on prestige and professional status. South African educated physicians have successfully and creatively managed their perceived lower status work, finding ways to bring their aspirations to life in rural communities and stay. Alternatively, when unable to stay in rural practice, South African educated physicians’ decisions to relocate to an urban centre was a matter of lifestyle over professional prestige.