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Workplace segmentation and Indian-origin male doctors well-being

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					Mechanisms of workforce segmentation
and Indian-origin male doctors’ well-being


             Anu Garg, MSc, DIA, PhD
              Lancaster University, UK



(Inaugural Professions Network Conference, Lancaster
University, 19 Dec 2008)
Organisation
    Background
    NHS hospital medical workforce: segmentation explained

    My study

    Segmentation (Mechanisms/how?)
    Institutional racism (IR) – closure

    Effects
    Psychological well-being (psych w-b)

    Conclusion

    What next?/Possible collaborations
Anu Garg                                                 2
Workforce segmentation

It ‘refers to the process[es] whereby
many visible minority employees are
relegated to less desirable jobs in terms
of prestige, power and chances of career
advancement’ (Forman 2003).
Background: Medical hierarchy (hospitals)

                            Consultant

(PMETB)                                  Exit qualification
               1993 Visa
               regulation
               changes
Middle-grade                Specialist Training
(staff grade
                            (SpR/StR) Only NTN
+ associate                              holders
specialist
+…)                         Basic medical training
                            (PRHO + SHO/FY1 + FY2)

Anu Garg                                                      4
Background: SpR training - NTN distribution

                                                                         Country % SpR          % with
                       North West Deanery data for SpR training
                                                                         qualified trainees     NTN
                               2001 (Young et al. 2003,
                                   footnote 9, p 32)                     Non-EEA    33          12

                 150
  P e r c e n ta g e




                 100                                 % with NTN          UK         59.4        78.46
                       50                            % of SpR trainees
                        0                                                EEA        6.44        7.85
                            Non-    UK      EEA
                            EEA
                            Undergaduate training
                                                                         75% of non-EEA migrant doctors
                                  location                               are Indians (Decker, 2001)

Anu Garg                                                                                                  5
Background: Hospital medical workforce by
ethnicity and grade

                                                                                                       Asian SAS =
                                        (Public Health Medicine and Community Health                  15.9% of the total
                                         Services Medical and Dental Staff in England,                Asian (including
                                                     1993-2003 (DH, 2004)                             British Asians)
                                                                                                        White SAS = 5.9%
N u m b e r o f d o c t o rs




                               50,000                                                                 of the total
                               40,000
                               30,000                                              White
                               20,000                                              Asian or As Brit
                               10,000
                                    0
                                           rM O



                                                                                                       66% of the staff
                                                     O
                                            ns f f




                                                     p
                                          a f p ec
                                              sS t


                                             g e




                                                    Gr
                                          A s l ta n




                                                    H
                                                  SH
                                         C o s ta




                                         R e rad
                                                  ou




                                               i d.



                                                                                                      grades non-EU
                                               gr
                                               u


                                             fG
                                  ed
                                 m




                                        he
                                       St




                                                                                                       61% associate
                                     Ot




                                                 Medical career grades                                specialists non-EU
                                                                                                      (DH, 2004)

Anu Garg                                                                                                                   6
My study

Racism at work: Indian-origin doctors’ and their
wives’ well-being
Methods:
    Qualitative design
    Sampling: Advertising (BAPIO) + snowballing
    Sample: 8 Indian-origin couples
    In-depth separate interviews (H + W): 32
    Analyses: Thematic (Dualistic conceptualisation of well-
    being)
Theories: Cognitive mediational stress theory (Lazarus &
Folkman, 1984) + Afro-centric feminist epistemology (Collins,
1990)

Anu Garg                                                        7
Sample details
Participants    Geo location       Medical sp      Career grade

 6 couples     England         1 general med, 1 2 SpRs + 3
                               A & E, 4 surgical middle-grade
                                                 (1 had exit
                                                 qual.)
 1 couple      Scotland        surgical         middle grade




 1 couple      Wales           surgical         middle grade




Anu Garg                                                          8
Segmentation (How?):IR at work

    Desirable posts denied
    Active discouragement
    Biased application of dept. guidelines
    Favouritism in appointments
    Visa regulation changes


    Learning opportunities
    (restricted/denied)
    In-house + external training



Anu Garg                                     9
IR at work: Active discouragement
“I was discouraged by my consultants saying, ‘You should
try for a stable staff grade job rather than trying to go
higher up. This is the best career move for you. People
like you have no chance of getting the NTN. Things are
really difficult, even for the local[s].’ ”
(Raj)




Erecting psychological barriers (Vera & Feagin, 2004) + Role
assignment (Banton, 1991, , 2005)



Anu Garg                                                    10
IR at work: Favouritism in
appointments
“All of us knew that this is the guy who’s going to get the
job because we talked about it. The Nigerian guy was a
locum registrar the consensus was that this is the guy [a
white doctor] who will get the job. We were just there for
The fulfilment of equal opportunities [requirements] and
funnily enough that’s what happened. I mean the job was
Probably pre-decided.”
(Sunil)



Essed and Goldberg 2002; BMA 2004; CRE 1996

Anu Garg                                                      11
IR at work: Visa regulation changes
“At the end of 4 years, the Deanery said,
‘They couldn’t apply for extension; they would not
recommend extension.’ ”
(Silver)




UK Migration and Nationality Laws - tools for
discriminating especially against the New-Commonwealth
Labour – legitimises RD (Sivanandan 1982; , 2005)


Anu Garg                                                 12
IR at work: Learning opportunities denied

    In-house
“The Consultants will make all the efforts to train
them [White doctors], take them through
surgeries, give them opportunities for research,
whereas we were always considered just
separate, no opportunities, nothing!”
(Tom)




Anu Garg                                              13
Effects: Doctors’ psych w-b
     Short-term (ST) effects

           Career anxiety - progress

           ”     ”         - deskilling

           Irritability & anger


Anu Garg                                  14
ST effects: Career anxiety - progress

“I was not sure whether I will be able to progress.
There were thoughts like I am not white, [so] I
have a very slim chance.”
(Dr A)


“If there is no progress, it eats [into] you.”
(Harry)

(ERI) High effort & low reward (Siegrist 1996; Peter &
Siegrist 1997)

Anu Garg                                                 15
ST effects: Career anxiety - deskilling
“They have taken away almost all [my] theatre
sessions; I am mainly doing clinics. I keep
telling [them], ‘I am a surgeon. I will lose all my
surgical skills, if I don’t operate.’ ”
(Tom)




(DCS) Passive job          loss of skills + motivation
(Karaskek & Theorell 1990)


Anu Garg                                                 16
Long-term (LT) effects: Doctors’ psych w-b

     Perpetual quest           Feelings of exhaustion +
                               disenchantment with
                               medicine
     Inferiority               Low self-esteem

     Unfulfilled goal          A sense of grief

     Breach of colonial exp.   Mental dissonance & …

     ‘Coloured eye’            Edgy fighting attitude

Anu Garg                                                17
LT effects: Perpetual quest …
“Your merits are not
recognised so you have to go
an extra mile. You will be
okay for few extra miles for
few years; it takes a lot out of
you.”
(Raj)




ERI, Overcommitment (de
Jonge et al. 2000)

Anu Garg                           18
LT effects: Inferiority….
“My contemporaries were saying that you are good so you
should be able to get it [an SpR post]. But, they were
getting the posts, I wasn’t. The logical thinking tells you,
they must be better than you. You feel inferior.”
(Harry)




Evident success of others …. (Bandura 1982)




Anu Garg                                                       19
  LT effects: Unfulfilled goal ….




(Janoff-Bulman 1989; Parkes 1971)

  Anu Garg                          20
LT effects: Breach of colonial expectations
and mental dissonance …
“My background is like that, my mother used to teach
English literature, my father taught all his life and you have
a different concept about what the UK is about. [But] when
you come here, it gets all upturned. You live in East Hill for
the first 8 months and that itself [is] a bit of [a] shocker
then you come to a place where you think that you’ll be
judged on your merit and you find there are many other
criteria as well. You lose confidence in your environment.”
(Raj)

Middle-class & English-medium educated Indians
(Tully 1997; Varma 1998)
Anu Garg                                                     21
LT effects: ‘Coloured eye’…

“I look at everything with
a ‘coloured eye’ now. I
want to know why
something [negative] is
happening, ‘Is it because
of [my] colour?’ ”
(Tom)

(Post & Weddington, 2000;
Nunez-Smith et al., 2007)

                             Feldman Barret & Swim 1998

Anu Garg                                             22
Conclusion
IR           ‘Clipped’ careers       Workforce
at work                              segmentation


             Doctors’ poor psych w-b

             ST effects:
             Career anxieties – progress &
             deskilling, and irritability & anger

             LT effects:
             Perpetual quest …, Inferiority …,
             Unfulfilled goal…, Breach … and
             ‘Coloured eye’…
Anu Garg                                            23
What next?
    Underachievement of equally qualified BME
    students in the HE sector
    Comparison with other professions
    Clinical academics: Costs and benefits (CA,
    patients, colleagues, & mgt/organisations
    …
    …



Anu Garg                                          24
Dr Anu Garg
Research Fellow
Division of Health Research
Lancaster University
Lancaster
UK
Tel: + 44 (0)1524 592715
Email: a.garg@lancaster.ac.uk
Legislations + DoH publications & initiatives

    Legislations
           Race Relations Act, 1976
           Race Relations Amendment Act, 2000


    DH publications & initiatives
           The Vital Connection (DH, 2000)
           Equal Value – Equal outcome (NHS Employers, 2005)
           Leadership and race equality plan (Crisp, 2004)
           Pacesetter (Akhtar, 2006)
           Race Equality Schemes (since 2002 every 3 yrs)


Anu Garg                                                  26
 Publications
    Garg, A. (2008). Sampling hurdles: 'Borderline illegitimate' to legitimate
    data. International Journal of Qualitative Methods, In press.
    Garg, A. (2008). Researching ethnicity, racism-related stress at work,
    and professionals' well-being. Diversity in Health and Social Care, 5(2),
    165-166.
    Garg, A. (2006). My experience of interviewing a "crusader participant":
    Tips for fellow researchers. International Journal of Qualitative Methods,
    5(4, Article 6),
    http://www.ualberta.ca/~ijqm/backissues/5_4/pdf/garg.pdf.
    Garg, A. (2005). Interview reflections: A first generation migrant Indian
    woman researcher interviewing a first generation migrant Indian man.
    Journal of Gender Studies, 14(2), 147-152.
Under review
    Garg, A. (2008). Medical workforce segmentation and Indian-origin male
    doctors' well-being. Diversity in Health and Care.
    Garg, A. (2008). Racism at work: Stress and strain transfer in Indian-
    origin medical marriages. Community Work & Family.
 Anu Garg                                                                  27

				
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