Power Plays and Intersecting Inequalities: The International Medical Graduate Experience of Medical Dominance in Australia

Author: Vicki Pascoe

Pascoe, Vicki, 2017 Power Plays and Intersecting Inequalities: The International Medical Graduate Experience of Medical Dominance in Australia, Flinders University, Flinders Law School

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This thesis uncovers, explores and analyses Australia’s medical culture through the positioning of International Medical Graduates (IMGs). There is currently a health workforce shortage. Australia, while hoping to produce sufficient Australian trained medical doctors to service the population in the future, actively recruits doctors from overseas. Despite Australia’s need for IMGs, the process journey they encounter in this country makes accreditation of qualifications and registration a particularly arduous and lengthy ordeal. The justification for such intense scrutiny is unconvincingly linked to the perceived need for Australia to maintain a high standard of health care. The result for some IMGs is to join the medical unemployed and Australian communities miss out on their skills and experience. The Australian medical profession is the provider of expert medical knowledge and as a result, retains the status of an elite profession. This thesis argues that IMGs however are not assigned the same status. IMGs are ‘othered’, presented as problematic and less qualified. IMGs are positioned as an underclass. The maintenance of a self-interest agenda drives the need to ‘other’ IMGs. Intersecting inequalities of Class, Race and Nation validate and reinforce their positioning.

The innovative work of Evan Willis (1989) on medical dominance, comprehensively explains how medical dominance is created and maintained. The original contribution to knowledge offered by this thesis delves beyond to why it exists and continues. Much of the research and literature on medical dominance argues that it is being challenged and changing shape. Nevertheless, its dominance remains.

The research presented in the thesis chapters has a broad scope and for this reason, has taken a multidisciplinary approach. An anti-oppressive theoretical framework allows for the voices of lived experience to penetrate throughout and a social justice platform engages the participants and the reader into the interwoven conversations. The data set reveals rich and sometimes shocking evidence to paint a stark picture. Other medical voices from outside the data join the thesis via media responses to revelations of experiences not only from IMGs but also from Australian trained doctors. Coverage has exposed a toxic culture endemic with bullying and sexual harassment.

This thesis argues that the positioning of IMGs is organised through the dimensions of Structural Power, Hegemonic Power and Interpersonal Power. These dimensions allow for an exploration of power relations between the structures of the health system, the Australian medical profession and the agency of IMGs. The Australian narrative presented to the world espouses a community of social justice and human rights. Instead, an historical lens traces the formation and persistence of difference represented in ethnocentrism, racism and xenophobia from 1788 to the present.

The original contribution to knowledge made by this thesis confirms the positioning of IMGs as an underclass within Australia’s powerful yet toxic medical culture where jealousy, conflict of interests, commercial gains and market share drive a power/knowledge nexus of unethical, discriminative and uncompetitive behaviours. While there are many decent, ethical medical doctors within the profession, clearly there are also many who are not.

Keywords: IMGs, Medical Dominance, Racism, Ethnocentricism, Xenophobia, Immigration

Subject: Law thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: Flinders Law School
Supervisor: Professor Steve Redhead