Collectively figuring it out: Foreign-trained health professionals and labor market integration

ABSTRACTBackground. Foreign-trained health professionals arrive in the United States and Canada to find a professional environment that is often unwelcoming and complex.Objectives. We examine the nature of information in foreign-trained health professionals' lives as they attempt to integrate into the North American labor market. We focus on the role that online discussion forums play in channeling the discussions: what functions do these online spaces support (e.g., informational, emotional, instrumental and phatic) and how information is shared (e.g., sharing stories, linking to/reposting resources, contextualizing and critiquing). Methods. Content analysis was carried out on a sample of postings directed at foreign-trained health professionals in five online forums: AllNurses and Trackitt in the United States; and Canadian Desi, LoonLounge and CanadaVisa in Canada.Results. The interactions in these forums include requesting guidance and clarification about the North American system, sharing experiences and stories, expressing visceral or affective reactions, offering opinions, and negotiating the norms and etiquette of the forum. The content of the postings mostly revolve around issues relating to the immigration process, certification and employability. Other issues identified can be grouped into three categories: information preparedness, information as support and informational practices.Conclusion. Foreign-trained health professionals are faced with a combination of unfamiliar healthcare system, terminology, information sources and informationseeking practices. Online communities supported by online discussion forums help these health professionals integrate into the local healthcare system.BACKGROUND AND CONTEXTIn an era of global migration, recruiting and retaining highly qualified professionals is critical. Indeed, immigration plays a key role in the workforce and economic development of many countries, with some professions facing a higher demand than others. In countries such as the United States or Canada, the demand for health professionals, in particular, has significantly increased in the past decades. The Organization for Economic Co-operation and Development (OECD) has estimated that more than one-third of physicians in the United States and Canada (34 and 32%, respectively) are over the age of 55 years, and are expected to retire over the next 10 years (OECD, 2013). Despite the demands for health professionals (and the associated ethical issue of "brain drain" that it raises (Lofters, Slater, Fumakia & Thulien, 2014), there is increased evidence that foreign-trained health professionals are facing significant challenges as they attempt to integrate into the labor market in their new country.Although information is increasingly available before one migrates to the new country (thanks to the Internet), finding career-related information, such as foreign credential recognition, recertification, bridging programs, and employability in the labor market remains a challenge. Buried under layers of challenges is the fact that even though highly educated, these individuals have to search for information in English (or French), which is often a second or foreign language for them. While high levels of domain knowledge have been shown to mitigate language-based difficulties in second- and foreign-language searching (Kralisch & Berendt, 2005), it remains an obstacle for many foreign-trained health professionals, along with a lack of familiarity with the information environment of the new country.The purpose of this study is to examine how foreign-trained (also known as internationally-educated) health professionals seek, use, and share health- and career-related information as they attempt to migrate and prepare for integrating the labor market in their new country. Despite demonstrated credentials, a large knowledge base, and a command of foreign language(s), foreign-trained health professionals in the US and Canada face numerous challenges when trying to gain work as health professionals after immigrating. …