The trans-Tasman migration of New Zealand medical practitioners: a qualitative mixed methods case study

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 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.