Born abroad, studied here: a historical and psychological account of migrant doctors integrating

Abstract

Integration of newcomers into existing communities has been an ongoing process throughout the ages. And yet, understanding and improving this process has turned out to be challenging. To this day, migrants report not feeling at home in their country of destination, and psychological evidence of discrimination against migrants abounds. To tackle this ongoing issue, the current dissertation takes a novel approach, by combining historical studies with contemporary psychological experiments. This allows for a broader analysis of the integration process, and for the discovery of novel mechanisms of integration. The focus is on a specific group of newcomers: migrant doctors, who are studied in two distinct historical settings. Their integration is defined as acceptance between them and their social surroundings on three analytical levels: the institution, group, and individual. In four empirical chapters, this dissertation thus addresses the following question: What are the institutional-, group-, and individual-level aspects of the process leading to mutual acceptance between migrant doctors and their social surroundings? The first two chapters take a historical approach, and focus on the integration of skilled workers in 18th century Holland. The Amsterdam Surgeons’ Guild takes centre stage, and how its institutional conditions facilitated migrants to become full-fledged surgeons. While the Guild maintained an open stance towards migrants, it also placed heavy emphasis on local education, resulting in the finding that migrants had a good chance to make career as a surgeon in Amsterdam, but only if they had been educated there within the guild. Taking this finding to the 21st century, the latter two chapters investigate how receiving education in the country of destination affects the way in which migrant doctors perceive themselves, and how they are perceived by patients. The results indicate that migrant doctors develop a specific image of what it means to be a doctor during their education in the country of destination. Patients, in turn, recognise that a doctor’s place of education likely affects their competence, and are thus more willing to accept migrant doctors who have been educated in the country of destination. In conclusion, by combining findings from history and psychology, the current dissertation was able to uncover how institutional arrangements like place of education could impact psychological processes at the group and individual level, which together determine the ease with which migrant doctors can integrate into the professional sphere of their country of destination. With this insight, this dissertation steers the debate about integration away from tried explanations such as place of birth or cultural distance. Instead, it offers a new explanation revolving around the importance of place of education. If not just the place where a doctor was born determines how easily they can become accepted, but also the place where they were educated, this opens the door to policy aimed at making medical educational institutions more accessible for migrant doctors. Meanwhile, targeted psychological interventions aimed at conveying the professional status of migrant doctors to patients might help to convince them that migrant doctors can indeed be trusted.