'Everything was just getting worse and worse': deteriorating job quality as a driver of doctor emigration from Ireland
'Everything was just getting worse and worse': deteriorating job quality as a driver of doctor emigration from Ireland
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DOI：
10.1186/s12960-019-0424-y
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发表时间：
2019-12-09
影响因子：
4.5
通讯作者：
Matthews, A.
中科院分区：
文献类型：
--
作者：
Humphries, N.;McDermott, A. M.;Matthews, A.
背景：医学是一种高地位、高技能的职业，传统上提供了高质量的工作和相对较高的工资。在爱尔兰，历史性的资金不足和与紧缩相关的削减对工作质量产生了负面影响，以至于医院的医疗工作已经开始类似于极端的工作。极端工作结合了高质量工作的组成部分--高薪、高工作控制力、挑战性要求，以及低质量工作--工作时间长、工作量大。工作质量的恶化和极端工作的正常化正在推动医生从爱尔兰移民，并阻碍他们回国。方法：对40名自2008年以来从爱尔兰移民到澳大利亚的爱尔兰移民医生进行了半结构化的定性访谈。采访在2018年7月至8月进行。结果：受访者反映了他们在爱尔兰医疗系统工作的经历，描述了医院工作场所人手不足、超负荷运转，极端工作已成为常态，特别是在工作时间长、工作节奏快、用更少的钱做更多事情以及与消极气氛作斗争方面。借鉴赫希曼(1970)的《退出、声音和忠诚》一书，作者认为医生的迁出是一种退出，并在迁出之前呈现了声音的回应经验。只有14/40的移民医生打算回到爱尔兰工作。讨论：医疗工作质量的恶化和极端工作的正常化是医生从爱尔兰移民并阻止返回的关键驱动因素。爱尔兰训练有素的医院医生移居澳大利亚，以获得高质量的工作，一旦获得这些工作，他们越来越有可能留在国外。为了提高医生的留任率，卫生系统和雇主必须减轻医疗保健领域出现的极端工作的影响。员工的声音(关于工作条件，关于病人安全等)应鼓励并利用这一点为卫生系统改进提供信息，并减少退出。
Background: Medicine is a high-status, high-skill occupation which has traditionally provided access to good quality jobs and relatively high salaries. In Ireland, historic underfunding combined with austerity-related cutbacks has negatively impacted job quality to the extent that hospital medical jobs have begun to resemble extreme jobs. Extreme jobs combine components of a good quality job-high pay, high job control, challenging demands, with those of a low-quality job-long working hours, heavy workloads. Deteriorating job quality and the normalisation of extreme working is driving doctor emigration from Ireland and deterring return.Methods: Semi-structured qualitative interviews were conducted with 40 Irish emigrant doctors in Australia who had emigrated from Ireland since 2008. Interviews were held in July-August 2018.Results: Respondents reflected on their experiences of working in the Irish health system, describing hospital workplaces that were understaffed, overstretched and within which extreme working had become normalised, particularly in relation to long working hours, fast working pace, doing more with less and fighting a climate of negativity. Drawing on Hirschman's work on exit, voice and loyalty (1970), the authors consider doctor emigration as exit and present respondent experiences of voice prior to emigration. Only 14/40 respondent emigrant doctors intend to return to work in Ireland.Discussion: The deterioration in medical job quality and the normalisation of extreme working is a key driver of doctor emigration from Ireland, and deterring return. Irish trained hospital doctors emigrate to access good quality jobs in Australia and are increasingly likely to remain abroad once they have secured them. To improve doctor retention, health systems and employers must mitigate a gainst the emergence of extreme work in healthcare. Employee voice (about working conditions, about patient safety, etc.) should be encouraged and used to inform health system improvement and to mitigate exit.