Geography and credentialism: the assessment and accreditation of overseas-trained doctors.

ABSTRACT

The traditional stronghold of medical dominance, and thus the construction of the medical labour market, has been challenged by a number of contemporary trends. While the social, economic and cultural trends driving this shift have been explored, the significance of geography as a key determinant in the construction of the medical labour market has yet to be addressed in detail. This paper examines how geographical arrangements have shaped the credentialist requirements for overseas-trained doctors and thus the nature and shape of the stratified medical labour market. The research traces the assessment and accreditation of overseas-trained general practitioners in NSW, focusing specifically on the registration process defining the last decade. Throughout this period the process has been significantly transformed: in the 1990s there was only one pathway to assessment, registration and subsequent entry to the labour market, there are now multiple pathways. An examination of this historical change illustrates how credentialist requirements are negotiated and renegotiated by the various stakeholders in light of shifting spatial demands.

KEY WORDS

sociology; overseas-trained doctors; geography; spatial arrangements; resident status; credentialism; stratification

Introduction: Geography, credentialism and labour market stratification

This research explores how overseas-trained doctors gain access to different labour market spaces and how these spaces are renegotiated over time with a specific focus on the last decade. To date, literature examining the construction of the medical labour market, and power brokers within it, has focused on the social, economic and cultural factors underscoring the credentialist requirements restricting or facilitating entry (Crompton 1990; Dent 1993; Freidson 1970, 1975, 1994; Gardner 1989; Iredale 1987; Kunz 1988; Larson 1977; Parry and Parry 1976; Saks 1995; Scotton 1967; Turner 1992; Willis 1989). To build on this body of work, attention is drawn to the inherent spatiality in the construction of the medical labour market whereby geography influences the actions of the players within it and thus the labour market outcomes. As argued by Clark (1983:2):

 
   ... local labour markets are man-made, not 
   natural, and are structured according to power, 
   not neutral rules of demand and supply.