Description
Study reports on Careers of skilled migrants: understanding the experiences of Malagasy physicians in France, A skilled worker is any worker who has some special skill, knowledge, or (usually acquired) ability in their work. A skilled worker may have attended a college, university or technical school. Or, a skilled worker may have learned their skills on the job. An example of a skilled labor job is game making and computer manufacturing.
Study Reports on Careers of Skilled Migrants: Understanding the Experiences of Malagasy Physicians in France
Abstract
Purpose - France is a country that widely relies on a skilled labour force. Nevertheless, very little is written in the management literature on the career experiences of skilled migrants, in particular from developing countries, in France. This paper argues that in order to understand the management of skilled migrants in France, there is a need to better understand their career experiences. Therefore, the objective of this paper is to fill this knowledge gap by offering an enhanced understanding of the career experiences of Malagasy migrant physicians in France. Design/methodology/approach - Based on the life story of 17 Malagasy migrant physicians and an interview with a Malagasy director of a private clinic who recruited Malagasy physicians to work in France, the paper sheds light on their career choices and challenges that they face in the French job market. Findings - The results clearly highlight two career profiles: firstly, those who succeeded in working as physicians either directly upon their graduation, or throughout an "interstitial" career in nursing, a way to eventually reach their profession of physician. Second, findings show that there were participants who definitively switched to a nursing profession. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. Originality/value - While literature on international careers frequently describe international mobility as being beneficial for skilled migrants, the findings yield limited support for this assumption. Instead, human capital was insufficient in explaining the career outcome of migrant physicians in France. Beyond the assumption that human capital is sufficient for undertaking a successful international experience, the paper contribute's to the literature on international careers by focusing on an under-researched group (i.e. Malagasy physicians in France) and demonstrating the complex nature of their career experiences. Keywords International careers, Skilled migration, Career development, Malagasy physicians, France, Talent waste Paper type Research paper
Journal of Management Development Vol. 31 No. 2, 2012 pp. 116-129 r Emerald Group Publishing Limited 0262-1711 DOI 10.1108/02621711211199467
1. Introduction A key assumption in the literature on international careers is that skilled migrants endowed with human capital can successfully advance their careers (Al Ariss and Ozbilgin, 2010). By shedding light on the career experiences of Malagasy physicians ¨ (i.e. medical doctors) in France, we contribute to the literature by showing the complex nature of international careers for migrants relocating from developing to developed countries. Our results point to two career profiles: first, Malagasy physicians who
succeeded in working in their profession either directly upon their graduation, or throughout an "interstitial" career in nursing. Second, there were participants who had to switch to nursing professions. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. The paper is structured as follows: First, we review the literature on international careers. Our review points to two important issues: (1) (2) the literature frequently assumes that human capital is a key determinant of career outcome for skilled migrants, leading to their career success; and the same literature is silent in respect to the career experiences of Malagasy skilled migrants.
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For instance, a ProQuest search for academic papers using the terms "Malagasy migrants" yields very little relevant papers (if any). Next we briefly introduce the context of Malagasy migration to France. Context is important in setting the scene for our study. Following this, we present the research methods used. Our qualitative data are based on the life stories of 17 Malagasy migrant physicians and an interview with a Malagasy private clinic director who recruits physicians from Madagascar to work in France. Finally we conclude by discussing our results and pointing out practicalimplications for policy making, organisations and skilled migrants. 2. A review of the literature on international careers The issue of international careers has generated a significant body of research, in particular in the literature on migration and self-initiated expatriation (SIE). We review this literature on international careers in an attempt to identify key theoretical opportunities and knowledge gaps. While migration literature focuses on the macro-level of migration, SIE emphasises international career experiences at an individual level. Skilled migration literature discusses brain drain and brain gain (Baruch et al., 2007; Al Ariss and Syed, 2011). On one hand, studies on brain drain propose that the sending countries lose their human capital when their skilled individuals relocate to another country on a permanent basis (Beine et al., 2008). It is suggested that these countries pay the cost of educating and training these emigrants without benefiting from their skills. On the other hand, studies on brain gain suggest that individuals who relocate benefit their countries by helping to decrease the rates of unemployment (Bardak, 2005). Furthermore, when migrants return to their home countries they transfer their knowledge and skills acquired abroad and therefore benefit local organisations. The overall assumption in this literature is that human capital alone is enough for migrants to advance their careers whether abroad or upon their return to their home country. Beyond the brain drain/brain gain issues of skilled migrants, their career experiences and challenge strategies when relocating to the host countries are underexplored (Collings et al., 2007; Al Ariss and Syed, 2011). For example, in an article on the growing need to recruit nurses in the UK, Bach (2007) argues that migration literature provides an incomplete view of their recruitment and migration experiences. Overall/in summary, migration studies focus on brain gain and brain drain at a macro-level. Nevertheless, migrants' career experiences are underinvestigated at a micro-individual level. In light of this omission, we examine the SIE literature that seems to offer a better understanding than migration studies on the careers of individuals who undertook international mobility.
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SIE focuses on the careers of persons from developed countries who are undertaking on their own initiative (as opposed to corporate expatriates sent by their companies) an international experience (Suutari and Brewster, 2000). For example, Jokinen et al. (2008) discuss the work experiences of professionals from Finland. Inkson and Myers (2003) focus on "Big Oes", that is to say overseas experiences undertaken mainly by young people from New Zealand. Using a sample of 563 expatriates (almost half of them SIEs while the others are corporate expatriates), Cieri et al. (2009) studied the intention of Australian professionals to repatriate. Their findings show that SIEs are likely to be more open to the prospect of remaining overseas than corporate expatriates. SIE research remains underdeveloped in respect to understanding the international career experiences of ethnic minorities from developing countries (Syed, 2008; Syed and Pio, 2010; Al Ariss, 2010). In particular, career barriers and opportunities for ethnic minorities undertaking international careers are underresearched (Al Ariss and Syed, 2011). Instead, skilled people undertaking an international experience are frequently conceptualised as endowed with human capital and therefore free to cross organisational and national borders (Cerdin and Le Pargneux, 2010). There is less focus on the barriers that constrain their career choices (Richardson, 2009). For example, Zikic et al. (2010) examine the boundary crossing experiences and adaptation of 45 migrant professionals in Canada, Spain and France. The same authors indicate the problem of non-recognition of migrants' credentials and of discounting their foreign experience in Canada. In New Zealand, by interviewing 80 recruitment specialists, Coates and Carr (2005) found that while migrants are granted entry depending on their knowledge of the English language and based on their qualifications, they are often offered jobs that are incompatible with their qualifications. Migrants can also face discrimination in accessing jobs and advancing in their careers. In the context of France, Al Ariss (2010) shows how legal barriers and discrimination can lead to skilled migrants' underemployment. Underemployment is defined here as underutilisation of the individuals' skills and expertise. This causes job dissatisfaction and a low level of job involvement (Lee, 2005). In summary/overall, literature on international careers underexplores the experiences of skilled individuals relocating from developing to developed countries. Instead, research considers skilled individuals undertaking international careers as a relatively homogenous group endowed with human capital and expected to have successful career outcomes (Howe-Walsh and Schyns, 2010). Second, this literature does not sufficiently explore the career barriers imposed on this group of migrants. This section exposes the two gaps in this same order. Drawing on the themes noted above and in an attempt to fill these gaps, this paper discusses the careers profiles of Malagasy physicians in France. 3. The context of Malagasy physicians' migration of to France In Madagascar, Queen Ranavalona II's conversion to Christianity in 1868 during the precolonial period marked a historic milestone in the abandonment of traditional medicine in favour of western medicine (Aubry and Rakotobe, 2000). With the inauguration of the first official medical college in Antananarivo, top students were awarded scholarships to study in France. Among the pioneers, Rasamimanana earned his medical degree in France in 1891 and became the personal physician to Queen Ranavalona II, shortly before the beginning of the colonial era (Bergougniou et al., 2001). Since then, throughout the precolonial (1870-1895), colonial (1895-1960), post-colonial periods (1960-1971) and up until now, generations of scholarship-holding
physicians return to the Great Island to hone their skills after three to four years of specialisation in a French faculty of medicine. In the past few decades, a large number of Malagasy physicians have definitively migrated to France, thereby departing from the traditional abovementioned pattern. On one hand, Madagascar is characterised by an unstable political situation and extreme poverty, which seems to encourage the "brain drain" outside Malagasy borders, i.e. the "push" effect. On the other hand, France is faced with a significant labour shortage, notably in the medical sector, resulting in a "pull" effect and a "brain gain" phenomenon. With all the current talk about selective immigration, several Malagasy physicians seem entranced by the "siren call". Immigration procedures for skilled migrants coming to France are known to be selective and complex for non-European Union (EU) citizens (Al Ariss, 2010). In his study of skilled migration to France, Al Ariss (2010) explains how prospective employers are required to demonstrate that no other person in France can fill the vacancy in question. Moreover, two types of jobs are available for non-EU citizens in France, i.e., regulated and unregulated professions. Medical professions are regulated. Thus, in regulated professions, the institutionalisation of various barriers such as the state requiring migrants to acquire French citizenship, applying for complicated tests, providing probation and temporary work permits, and restricting their employment spectrum such as by not allowing them to fully practise their profession, can result in either delay or failure to enter the job market (Al Ariss and Ozbilgin, 2010). Therefore, ¨ migrant physicians in France must pass through a complex selection procedure, run by the French state, before being allowed to practice. Drawing on the themes noted above, this paper will therefore investigate how Malagasy physicians manage their career in France. Now that we have outlined the theoretical framework of our study, we will specify our research methodology.
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4. Research method Our exploratory research relies on a survey recounting the life stories (Bertaux, 1997) of 17 Malagasy migrant physicians in France. An additional interview was conducted with the director of a private clinic who recounted the experience of Malagasy physicians he recruited. During this exploratory phase, we collected primary data via semi-directive faceto-face or telephone interviews of one hour on average. Our participants were constituted with the support of the informal network of contacts of the Malagasy migrant community in France. The first author who conducted the interviews is a Malagasy man who lives in France. Although this allowed for privileged research access, researching migration in France is a contentious topic (Al Ariss and Syed, 2011) and therefore it was not always easy to find interviewees. In light of the sensitivity of the information collected, we have preserved the respondents' anonymity and therefore pseudonyms have been systematically used in this paper. This ensures confidentiality. Table I provides demographic details about the participants. The interviews were mainly conducted in French knowing that Malagasy and French are the two official languages of Madagascar. We have translated the phrases in Malagasy occasionally mentioned by respondents. For the purpose of this paper, quotes were translated from French to English. Detailed notes were taken during the interviews. The following issues were discussed during the interviews. First, background information of the participants such as age, period of stay in France, current job, citizenship(s), marital status and number of children. Additionally,
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Table I. Malagasy migrant physicians' demographic profiles Sex Male Female Male by authorisation by by by by by by by by by by by by by by PAE PAE PAE PAE PAE PAE PAE nursing nursing nursing nursing nursing nursing nursing Female Male Female Male Female Male Female Male Male Female Female Male Male Female Arrival to France in Degree Works in his/her profession Access to profession Direct Direct Interstitial 197 197 7 200 7 4 198 199 0 6 199 199 7 199 8 199 8 200 9 200 0 2 200 200 2 2 200 200 3 200 2 200 8 8 degree degree degree degree degree degree degree French physician French physician Malagasy physician, followed to practise procedure (PAE) Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Ye Ye s Ye s s Ye Ye s s Ye Ye s Ye s Ye s Ye s N s o N N o o N N o N o N o o Interstitial Interstitial Interstitial Interstitial Interstitial Interstitial Interstitial Switched to Switched to Switched to Switched to Switched to Switched to Switched to nursing nursing nursing nursing nursing nursing nursing
#
Pseudonym
Age in 201 0
1 2 3
460 460 30s
4 5 6 7 8 9
1 1 0 1 1 2 3 1 1 4 1 5 1 6 7
Michel Mireille Ja o Felana Rivo Mamy Rado Noro Rija Soa Setra Feno Miora Henintsoa Liva Hary Landy
460 50s 40s 40s 40s 50s 50s 40s 30s 30s 40s 30s 50s 30s
open-ended questions were asked regarding themes that include participants' reasons and strategies for leaving Madagascar, their choices of migrating to France, family integration in France, possible plans to return to Madagascar. Other questions were included regarding participants' education and career experiences in France, whether there was an adequate match between the participants' qualifications (i.e. as physicians) and their current jobs, experiences of discrimination against them (if any) such as in terms of ethnicity or a pay-gap between French and Malagasy doctors, their experiences of integrating in the French job market, as well as their future career plans. In this exploratory qualitative study, although the analysis was driven predominantly by the data, they were also informed by the authors' reading of the literature (Fendt and Sachs, 2008). Each life story was read several times. Although this approach to analysis was time consuming, it encouraged in-depth examination of the data. After several interviews were conducted and as analysis was progressing, key themes began to emerge regarding participants' difficulties in integrating in the French job market and in particular for working in their profession of origin. Experiences of underemployment and unemployment were clearly emerging. We will now examine the initial findings of our research. 5. Findings This section presents the career experiences of 17 Malagasy physicians who succeeded (ten participants) or not (seven participants) in practising their "profession of origin" in France. Our results clearly highlight two career profiles: first, those who succeeded in working as physicians either directly upon their graduation (two), or throughout an "interstitial" career as a nurse (eight) who eventually reached their profession of origin. Migration turns to be rather beneficial for the career development of this first group; second, those who definitively turn to the nursing (seven) or the nursing auxiliary professions. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. 5.1 Malagasy physicians who succeeded in working in their profession of origin 5.1.1 Direct access to the physician profession (two participants). The first case concerns Malagasy physicians with a French degree, who did not suffer from the constraints of the "foreign qualification". Having benefited from a scholarship from the French government, Michel arrived in France in 1964 at the age of 20 to continue his medical studies in a college in the south of France. He met a Malagasy dental student, Mireille, whom he subsequently married in 1968, before the couple returned to Madagascar in 1972 after having earned their French degree. However, Madagascar was experiencing a serious political crisis that year. The couple's professional exploration stage in Madagascar was short lived due to unsatisfactory local working conditions. Therefore, Michel and Mireille, concerned about their children's future, decided to return to France with their three children in 1977. In France, at first, the couple needed to find their bearings. Thanks to their French degrees, amongst other things, this couple, who later became French citizens, is the embodiment of fully successful socio-professional integration. Registered with the French Doctors' Guild (Ordre National des Medecins), a pre-requisite step for a ´ practising medical doctor in France, Michel had an exemplary career as he was appointed head physician in his specialised medical field in 1982. When asked about the key factors of his success, Michel puts it down to "his ability to prove himself". His cutting-edge professional skills and field experience consolidated his legitimacy
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and reputation amongst his colleagues and patients. Mireille, for her part, was the first "black woman" to successfully open a private dental practice in 1983; she is still working and is due to retire soon. Founding her own private practice helped her find the best balance between her professional and family life. According to the interviews, the couple's career experiences were marked by no significant discrimination with regard to age, gender or ethnic origin, even though the initial contacts sometimes required an adaptation phase. Michel and Mireille both have typically French first names. Michel points out that the Malagasy generally enjoy a good reputation, in particular in the medical sector: "During my studies, I was the first Malagasy intern in the service, followed by many others after my departure". The kindness, attention and empathy inherited from Malagasy culture, combined with professionalism and technical skills, contributed to the couple's socioprofessional success. 5.1.2 Interstitial access to the physician profession (eight participants). The following cases describe the experience of Malagasy physicians faced with the constraints of their "foreign physician qualifications", who initially came to France for specialisation studies. They subsequently decided to stay in France, and undertook the function of "acting nurse" as a professional springboard for them to achieve their goals. These eight participants followed relatively similar career paths. This path consists of: first, studying for the specialisation degree in France for several years; second, working for three years as an "acting nurse" insofar as the foreign qualification is not recognised, with the contract likely to be renewed as appropriate; third, passing the examination open to any foreign physician to comply with the "Authorisation to Practice Procedure" Procedure d'Autorisation d'Exercice (PAE); The PAE is a procedure that ´ authorises non-EU citizens who hold a diploma from a member state of the EU or the European Economic Area to practise the professions of medical doctor, dentist, midwife and pharmacist for; fourth, become an "associate practitioner" for a probationary period of three years; finally, be allowed to practise in the same capacity as a French physician after being registered with the French Doctors' Guild. The grandson of a physician and son of the first Malagasy associate professor of medicine in his specialised field, Jao became a doctor of medicine in Madagascar in 2000, having validated his sixth and seventh years of study in France. Subsequently, he met a Franco-Japanese woman and married her in 2004 in Madagascar, at age 30. Following their marriage, the couple decided to settle in France. In France, Jao studied for two specialisation degrees while working as an "acting nurse" intern. In 2007, he passed the examination open to foreign physicians, i.e. the PAE, which allowed him to work as an "associate physician" in one of his two elected fields. When recalling his experience, Jao stated: "Both my grandfather and my father returned home out of patriotism [y] it is different for me as I am married to a foreigner; financial security prevails [ y] Compared with other foreigners, the Malagasy are well accepted [y] what is unfortunate is that there is no mutual assistance between the Malagasy, it's every man for himself [y] which does not at all reflect the fihavanana (solidarity) that the Malagasy claim to be so proud of [y]". When asked about discrimination, he mentions that sometimes patients refuse to be treated by him, without, however, specifying whether it is because of his appearance or his age. Singled out by one of her French thesis supervisors during the presentation of her medical doctorate thesis in Madagascar in 1979, Felana left the country in 1980 at age 30 to enrol on a specialisation course in France with a view to becoming a lecturer and researcher-physician in Madagascar. Simultaneously enroled on two courses, she stayed in France and, eight years later, presented a second doctoral thesis in a
medically related field. In France, she worked as a university lecturer in her medical field and also passed the PAE. She has been a practising physician since 1998. She believes that the Malagasy's migrant strengths are that "they reach out, they are adaptable, do not like confrontation or to complain, which can sometimes be a negative point". Rivo and Mamy (couple), Rado and Noro (couple), as well as Rija and Soa (couple) are physician couples who had already practised in Madagascar before moving to France. They now work in various French regions as "associate practitioners" before being able to practise in the same capacity as a French physician. Rivo arrived in France in 1996 at age 35 to study for his specialisation degree, with his wife Mamy joining him in 1997 to study for hers. The couple left their children, aged 9 and 4, in the care of their grandparents back home. Before the family was reunited in 1998, "it was heartbreaking, it was so hard for me, I cried practically every night" recalls the deeply affected Mamy. The couple subsequently worked as acting nurses, acquiring French nationality in the meantime and, after two failed attempts in 1998 and 2004, Rivo passed his PAE in 2007, followed by Mamy in 2008. According to Mamy, "wisdom, great respect for hierarchy and the fact that we are not constantly complaining" are points in the Malagasy's favour, "even if people sometimes take advantage of this". These words reflect Malagasy culture. Her integration was a success, despite isolated cases of xenophobia suffered via the words of certain patients. Rado and Noro, married without children, arrived in France together in 1998, both aged 30, to study for their specialisation degrees for four years. They followed roughly the same path as the previous couple, except for the fact that both their children were born in France, in 2000 and 2002. This couple deliberately opted for specialisations not chosen by French nationals due to arduous working conditions but, as a result, highly sought after in France. Having acquired French nationality, Rado points out that being "unassuming French-speaking individuals" set them apart from other foreign physicians. The story of Rija and Soa is similar to that of the two previous couples despite a different initial story. Rija arrived in France at age 40 to study for his specialisation degree in 1999. In 2000, his wife Soa and their three children aged 15, 5 and 2 joined him. Soa was a homemaker until 2007, when she sat and passed the PAE exam. "Naturally devoting time to patients and treating them as people" enables Soa (who returned to work in 2007) to work more efficiently. She emphasises that she is finding it more difficult to balance professional and personal life and claims she has not been discriminated against, unlike her husband who sometimes complains of xenophobia in the workplace. Concern about the children's future is the number one source of motivation to stay in France, unanimously acknowledged by the three couples. 5.2 Downward career mobility: switching from physician to nursing profession In view of France's considerable shortage of nurses and nursing auxiliaries in the past few decades, a number of Malagasy physicians voluntarily moved to France and definitively switched to this profession because of the difficulty in practising their profession of origin. The following cases outline the experience of Malagasy physicians faced with the constraints of the "foreign qualification" who deliberately "made the switch" to the nursing role. In 2002, Setra decided to move to France at age 40 to study for a three-year specialisation degree as a foreign physician. He was subsequently an acting nurse for
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the maximum legal period of three years. In 2009, he took a five-month course to validate his French degree as State-registered nurse, which allowed him to practise this profession indefinitely. As he is older, Setra no longer aims to practise as a physician via the PAE. In 2005, his wife and their three children aged 13, 9 and 7 joined him in France. When asked about their choice of staying in France despite the fact that the couple were not fully working in their professions of origin, material comfort, the children's development, rewards such as holidays back home or a substantial salary, the possibility of saving but also the inextricable situation in Madagascar were mentioned as main reasons why they made these choices. Similarly, Feno and Miora (couple), two physicians in their 30s, arrived in France together in 2002 to study for their medical degree. Their "foreign doctorate in medicine" allowed them to practise as nurses for three years while they were still studying. After these three years, they validated their French degree as Stateregistered nurses in 2006 in a nursing schooland had their first child in 2007. Their motivations are similar to those of the previous couple. Henintsoa, a physician who moved to France in 2003 at age 32, followed almost the same professional path as Feno and Miora. Before being reunited with her husband in 2006, Henintsoa suffered from loneliness because of the separation, notably during the adaptation phase. She was thinking of taking the PAE exam by 2010. However, she is happy to be a State-registered nurse at present, as she is currently pregnant. Professionally speaking, her smile and natural kindness have endeared her to the patients. The professional career of Liva, a physician who moved to France in 2002 at age 29, is completely identical to that of Henintsoa . He returned to Madagascar in 2004 and married a Franco-Malagasy woman, then became a father in 2005 before going back to France with his family. Having validated his nursing degree, he is now working in a private clinic in the south of France, where he feels appreciated by his colleagues and patients. In January 2008, a new regulation abolished the authorisation for foreign physicians to automatically work as nurses for three years; it offers, however, the possibility of working as a nursing auxiliary. Hary, a divorced male physician with three dependent children, arrived in France in 2008 at age 52 and Landy, a female physician who moved to France in 2008 at age 34, were compelled to directly prepare for their nursing degree while they were studying. Landy's husband, also a physician, is about to be reunited with his wife in France to follow the same career path. Malagasy physicians compensate for the "professional demotion" from the status of physician to that of nurse with the substantial remuneration and material comfort. It should be noted that the political crisis of 2002, which led to Madagascar's President Ratsiraka's exile to France, markedly increased the migration of many members of the Malagasy elite, with a relatively strong "push" effect. This trend was amplified by the "pull" effect of coming to France. 5.3 Recruiting physicians from Madagascar to France: a "win-win" system? Haja, originally from Madagascar, has managed a chain of French private clinics for 23 years. This graduate in economics told us about his experience in recruiting Malagasy physicians who came to France between 2001 and 2002 to work as nurses. In 2001, a clinic in the Vosges (east of France) region was faced with a nursing staff problem (a shortage of 25 nurses); after an initial failed attempt to recruit nurses from Madrid due to language and cultural barriers, Haja proposed to recruit Malagasy physicians from Madagascar. As mentioned above, this legislation authorised foreign
physicians to work as nurses for three years, after which they had to validate the French degree of State-registered nurse. Haja, a Malagasy himself with French citizenship, initiated the expatriation of four cohorts of Malagasy physicians during the 2001-2002 period. Haja travelled to Madagascar to recruit the first five applicants: two men and three women. It should be pointed out that in 2002, Madagascar was in the throes of a serious political crisis, which facilitated Haja's search for competent candidates, ready to swap their physician status for that of a nurse. Malagasy physicians were well accepted, trained and their socio-professional integration was an immediate success even though their acclimatisation to the Vosges weather was far from easy. Four of them managed, after three years, to validate their French degree of State-registered nurse and brought their family over, while a fifth failed the tests and returned home. Encouraged by this success, the experience was renewed in 2002, using the same process. This time, a second wave of five Malagasy physicians was supposed to be posted to one of the clinics of the chain in France. This experience was doomed to fail as, upon the arrival of the Malagasy physicians on site, the local physicians organised large-scale protests. The management failed to predict this rejection, having assumed a repeat of the Vosges success: unrealistic expectations and a lack of communication led to deadlock. In the end, the trip of the five Malagasy physicians was short lived; they were not allowed to prove themselves during a probationary period. One of them returned home, psychologically affected by "this rejection"; the other four were later redeployed to the Vosges site by the management. Having subsequently earned their nursing degree, two of them are still working there and have brought their family over; the third moved to Guadeloupe, while the last got married and moved to the south of France. News of the Vosges success encouraged the director of a clinic in Martinique to call upon Haja for the recruitment of Malagasy physicians. This is how a third wave of five Malagasy migrant physicians moved to Martinique. The experience was a success in terms of socioprofessional integration, as with the Vosges experience. Solicited by the director of a clinic in the Centre region of France, Haja recommended a couple of Malagasy physicians willing to work in the nursing profession in France. The director contacted them and brought them over to France, accompanied by their two children, aged 12 and 7. Having also earned their nursing degree, the couple's professional integration was a success. 6. Discussion Several themes emerge from this exploratory study. First, our results highlight the professional challenges imposed upon migrant physicians who want to practise in France. For instance, except for the two participants who did all of their medical studies in France and later got the French citizenship, practising as a physician in France was instead a very challenging task and sometimes even impossible. Bach (2007) argues that migration literature does adequately address the role of the States, throughout their migration policies, on influencing the career outcomes for skilled migrants. In the case of Malagasy physicians in France, they faced the French legislative constraints of their "foreign physician qualifications", although many of them undertook further medical specialisations in France. Coupled with this, there was the challenge of having French citizenship in order to be able to register with the French Doctors' Guild. When the participants subsequently decided to stay in France, they undertook the function of "acting nurse" as a professional springboard for them to earn their living and also eventually achieve their goals. For those who were able to
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practise as physicians, they had to undertake long procedures including first, studying for the specialisation degree in France for several years; second, working for three years as an "acting nurse"; third, passing the examination granting them PAE; fourth, becoming "associate practitioners" for a probationary period of three years; and finally being allowed to practise after registering with the French Doctors' Guild. Our literature review has demonstrated how the literature on migrants' international mobility focuses on brain gain/brain drain issues, assuming therefore that migrants will be able to use their human capital (Beine et al., 2008; Bardak, 2005). Our findings suggest that beyond the brain drain/brain dilemmas, research on skilled migration needs to better emphasise the career experiences of skilled migrants as these face serious challenges that remain largely underexplored (Al Ariss and Syed, 2011), as in the case of the Malagasy in France. Our literature review has shown how international careers are frequently conceptualised as without boundaries and helpful for career development with less focus on the barriers that constrain their career choices (Richardson, 2009; Al Ariss, 2010; Zikic et al., 2010). In our study, seven Malagasy physicians were completely discouraged by these procedures and ultimately worked as nurses, undertaking therefore downward career mobility. Furthermore, the interview with the private clinic director showed how France has also benefited from physicians who were explicitly brought with the aim of giving up their profession of origin and embarking on downward career mobility by practising as nurses. In line with Coates and Carr (2005), findings from France show that while Malagasy physicians were granted entry based on their qualifications, they were not offered jobs that are compatible with their qualifications. It is important to mention that participants in this study were made up of the elites of the Malagasy migrants who come to France. Numerous were the determinants which explained their migration choice and their readiness to give up, in many cases, their professions: first, the desire to provide their children with a better future; second, the economic reasons making it possible to achieve this goal, most often implicitly evoked; third, the possibility of being able to ultimately practise as a physician in France, even if chances were limited; fourth, the "pull" effect of the medical sector corresponding with a labour demand in terms of nurses and associate physicians in France; fifth, the "push" effect of the political and insecurity in Madagascar; and also sixth the family factors for those reunited with their spouse in France. Regardless of whether they practised physician or nursing professions, they mentioned several attributes that helped them integrate into French culture, including respect for authority, attentiveness, empathy, sociability, work ethics and discretion. 7. Conclusions Our literature review has shown that the field of international careers has generated a significant body of research, in particular in the literature on migration and SIE. We identified two main gaps in the literature on international careers: first, an overall assumption in this literature is that human capital alone is enough for migrants to advance their careers with very little written on the barriers to career development that skilled migrants face. Second, the literature underexplores the experiences of skilled individuals relocating from developing to developed countries. This study fills a knowledge gap by demonstrating how human capital alone is rather insufficient in the context of migrant Malagasy physicians in France.
This study has implications for practice at the policy, organisational and individual levels. At the policy level, in order to benefit from the skills and knowledge of skilled migrants who are legally accepted to live and work in France, the French authorities need to provide better equality and inclusion measures. This is possible by revisiting the migration policies that deliberately exclude skilled migrants from employment opportunities pushing them therefore into underemployment and unemployment. In the same way, the Malagasy authorities should take measures to provide decent living conditions for Malagasy physicians and more generally, to their elite individuals who can contribute to the advancement of the country. This requires political and economic stability, yet the situation in Madagascar seems intractable to date. At the organisational level, pay practices should evolve to greater equity under current legislation in France, avoiding therefore an "exploitation" of skilled migrants from developing countries such as Madagascar. Furthermore, the failed work experience of the Malagasy migrants who were expatriated from Madagascar to France, as reported by the clinic director interviewee, is also worth mentioning here. Such a situation points to a need for organisations in France to have significant awareness and communication efforts amongst their native employees, to ensure successful socio-professional integration of the skilled migrants. At the individual level, Malagasy physicians who wish to relocate to France should be aware that under the current French migration policies and professional regulations for migrant physicians, it is very challenging (if not impossible in some cases as we have shown in this study) to have the same social and professional recognition as they might have in Madagascar. Consequently, their salaries will probably be significantly lower than that of a French colleague. Discrimination is also something they would need to cope with as in some cases discussed in this study. More importantly, there is a significant chance of experiencing downward career mobility as we show in the case of physicians who had to switch to nursing professions. There are limitations to this exploratory research in terms of the size of the sample. Nevertheless, the size remains very acceptable compared to other qualitative studies on the topic of skilled migration. This qualitative study provides promising potential for comparative research, to be conducted on a broader sample, targeting other industries or other immigrant ethnic and cultural communities. This could be helpful in understanding the nature of international careers (Suutari and Taka, 2004).
References Al Ariss, A. (2010), "Modes of engagement: migration, self-initiated expatriation, and career development", Career Development International, Vol. 15 No. 4, pp. 338-58. Al Ariss, A. and Ozbilgin, M. (2010), "Understanding self-initiated expatriates: career ¨ experiences of lebanese self-initiated expatriates", Thunderbird International Business Review, Vol. 54 No. 4, pp. 275-85. Al Ariss, A. and Syed, J. (2011), "Capital mobilization of skilled migrants: a relational perspective", British Journal of Management, Vol. 22 No. 2, pp. 286-304. Aubry, P. and Rakotobe, P. (2000), "La formation medicale a Madagascar de 1870 a nos jours", ´ ` ` Revue de Medecine Tropicale, Vol. 60 No. 4, pp. 345-7. ´ Bach, S. (2007), "Going global? The regulation of nurse migration in the UK", British Journal of Industrial Relations, Vol. 45 No. 2, pp. 383-403.
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Bardak, U. (2005), Migration Trends in MEDA and a Discussion on the Links Between Migration and Educational Systems, European Training Foundation, Turin. Baruch, Y., Budhwar, P.S. and Khatri, N. (2007), "Brain drain: inclination to stay abroad after studies", Journal of World Business, Vol. 42 No. 1, pp. 99-112. Beine, M., Docquier, F. and Rapoport, H. (2008), "Brain drain and human capital formation in developing countries: winners and losers", The Economic Journal, Vol. 118 No. 528, pp. 631-52. Bergougniou, J.M., Clignet, R. and David, P. (2001), Villages noirs et autres visiteurs africains malgaches et africains en France et en Europe (1870-1940), Editions Karthala, Paris. ´ Bertaux, D. (1997), Les recits de vie, Nathan, Paris. ´ Cerdin, J.-L. and Pargneux, M.L. (2010), "Career anchors: a comparison between organizationassigned and self-initiated expatriates", Thunderbird International Business Review, Vol. 52 No. 4, pp. 287-99. Cieri, H.D., Sheehan, C., Costa, C., Fenwick, M. and Cooper, B.K. (2009), "International talent flow and intention to repatriate: an identity explanation", Human Resource Development International, Vol. 12 No. 3, pp. 243-61. Coates, K. and Carr, S.C. (2005), "Skilled immigrants and selection bias: a theory-based field study from New Zealand", International Journal of Intercultural Relations, Vol. 29 No. 5, pp. 577-99. Collings, D.G., Scullion, H. and Morley, M.J. (2007), "Changing patterns of global staffing in multinational enterprise: challenges to the conventional expatriate assignment and emerging alternatives", Journal of World Business, Vol. 42 No. 2, pp. 198-213. Fendt, J. and Sachs, W. (2008), "Grounded theory method in management perspective. Users' perspectives", Organizational Research Methods, Vol. 11 No. 3, pp. 430-55. Howe-Walsh, L. and Schyns, B. (2010), "Self-initiated expatriation: implications for HRM", The International Journal of Human Resource Management, Vol. 21 No. 2, pp. 260-73. Inkson, K. and Myers, B.A. (2003), "The big OE: self-directed travel and career development", Career Development International, Vol. 8 No. 4, pp. 170-81. Jokinen, T., Brewster, C. and Suutari, V. (2008), "Career capital during international work experiences: contrasting self-initiated expatriate experiences and assigned expatriation", The International Journal of Human Resource Management, Vol. 19 No. 6, pp. 979-98. Lee, C.H. (2005), "A study of underemployment among self-initiated expatriates", Journal of World Business, Vol. 40 No. 2, pp. 172-87. Richardson, J. (2009), "Geographic flexibility in academia: a cautionary note", British Journal of Management, Vol. 20 (S1), pp. S160-S170. Suutari, V. and Brewster, C. (2000), "Making their own way: international experience through self-initiated foreign assignments", Journal of World Business, Vol. 35 No. 4, pp. 417-36. Suutari, V. and Taka, M. (2004), "Career anchors of managers with global careers", Journal of Management Development, Vol. 23 No. 9, pp. 833-47. Syed, J. (2008), "Employment prospects for skilled migrants: a relational perspective", Human Resource Management Review, Vol. 18 No. 1, pp. 28-45. Syed, J. and Pio, E. (2010), "Veiled diversity? Workplace experiences of Muslim women in Australia", Asia Pacific Journal of Management, Vol. 27 No. 1, pp. 115-37. Zikic, J., Bonache, J. and Cerdin, J.-L. (2010), "Crossing national boundaries: a typology of qualified immigrants' career orientations", Journal of Organizational Behavior, Vol. 31 No. 5, pp. 667-86.
About the authors Lovanirina Ramboarison-Lalao lectures and researches on Human Resource Management at Ecole de Management Strasbourg, France. He has written on diversity and migration matters in the context of France. He has published several papers such as "Etre femme ou homme dans les organisations: contributions a l'eclosion de l'economie de la connaissance, Lyvie Gueret-Talon `´ ´ ´ et Floran Sala, Editions Conception et Dynamique des organisations, Juin 2010"; "Gender and diversity: for a situational approach?", XIVe Workshop, Strategic Human Resource Management, ` EAISM, Brussels, Mars 2009. Akram Al Ariss is Head of the Human Resource Management Department at Champagne School of Management (France). He is affiliated with DECEre, Norwich Business School, University of East Anglia (United Kingdom) and with the Pennsylvania State University (USA). Originally from Lebanon, he has a PhD in Management from Norwich Business School, University of East Anglia (UK). Akram Al Ariss is interested in interdisciplinary approaches to teaching and researching IHRM. His interests include Diversity, Career, and Expatriation/ Migration matters. He has written in journals such as Academy of Management Learning and Education, Thunderbird International Business Review, British Journal of Management, Career Development International, Work Employment and Society, and Personnel Review. Akram is member of the Editorial Board of Equality, Diversity, and Inclusion as well as Journal of World Business. Akram Al Ariss is the corresponding author and can be contacted at: [email protected] Isabelle Barth is Professor of Management Sciences and Head of the CESAG Research Center in France. She is a member of several associations such as Association Franc¸aise du Marketing, Association en Gestion des Ressources Humaines, Association pour le Developpement de la ´ Responsabilite Sociale de l'Entreprise, and Institut Psychanalyse et Management. She is a ´ member of the editorial board of journals such as Decisions Marketing, Management et Avenir, ´ Revue Franc¸aise de Marketing, Negociation. ´
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Study reports on Careers of skilled migrants: understanding the experiences of Malagasy physicians in France, A skilled worker is any worker who has some special skill, knowledge, or (usually acquired) ability in their work. A skilled worker may have attended a college, university or technical school. Or, a skilled worker may have learned their skills on the job. An example of a skilled labor job is game making and computer manufacturing.
Study Reports on Careers of Skilled Migrants: Understanding the Experiences of Malagasy Physicians in France
Abstract
Purpose - France is a country that widely relies on a skilled labour force. Nevertheless, very little is written in the management literature on the career experiences of skilled migrants, in particular from developing countries, in France. This paper argues that in order to understand the management of skilled migrants in France, there is a need to better understand their career experiences. Therefore, the objective of this paper is to fill this knowledge gap by offering an enhanced understanding of the career experiences of Malagasy migrant physicians in France. Design/methodology/approach - Based on the life story of 17 Malagasy migrant physicians and an interview with a Malagasy director of a private clinic who recruited Malagasy physicians to work in France, the paper sheds light on their career choices and challenges that they face in the French job market. Findings - The results clearly highlight two career profiles: firstly, those who succeeded in working as physicians either directly upon their graduation, or throughout an "interstitial" career in nursing, a way to eventually reach their profession of physician. Second, findings show that there were participants who definitively switched to a nursing profession. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. Originality/value - While literature on international careers frequently describe international mobility as being beneficial for skilled migrants, the findings yield limited support for this assumption. Instead, human capital was insufficient in explaining the career outcome of migrant physicians in France. Beyond the assumption that human capital is sufficient for undertaking a successful international experience, the paper contribute's to the literature on international careers by focusing on an under-researched group (i.e. Malagasy physicians in France) and demonstrating the complex nature of their career experiences. Keywords International careers, Skilled migration, Career development, Malagasy physicians, France, Talent waste Paper type Research paper
Journal of Management Development Vol. 31 No. 2, 2012 pp. 116-129 r Emerald Group Publishing Limited 0262-1711 DOI 10.1108/02621711211199467
1. Introduction A key assumption in the literature on international careers is that skilled migrants endowed with human capital can successfully advance their careers (Al Ariss and Ozbilgin, 2010). By shedding light on the career experiences of Malagasy physicians ¨ (i.e. medical doctors) in France, we contribute to the literature by showing the complex nature of international careers for migrants relocating from developing to developed countries. Our results point to two career profiles: first, Malagasy physicians who
succeeded in working in their profession either directly upon their graduation, or throughout an "interstitial" career in nursing. Second, there were participants who had to switch to nursing professions. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. The paper is structured as follows: First, we review the literature on international careers. Our review points to two important issues: (1) (2) the literature frequently assumes that human capital is a key determinant of career outcome for skilled migrants, leading to their career success; and the same literature is silent in respect to the career experiences of Malagasy skilled migrants.
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For instance, a ProQuest search for academic papers using the terms "Malagasy migrants" yields very little relevant papers (if any). Next we briefly introduce the context of Malagasy migration to France. Context is important in setting the scene for our study. Following this, we present the research methods used. Our qualitative data are based on the life stories of 17 Malagasy migrant physicians and an interview with a Malagasy private clinic director who recruits physicians from Madagascar to work in France. Finally we conclude by discussing our results and pointing out practicalimplications for policy making, organisations and skilled migrants. 2. A review of the literature on international careers The issue of international careers has generated a significant body of research, in particular in the literature on migration and self-initiated expatriation (SIE). We review this literature on international careers in an attempt to identify key theoretical opportunities and knowledge gaps. While migration literature focuses on the macro-level of migration, SIE emphasises international career experiences at an individual level. Skilled migration literature discusses brain drain and brain gain (Baruch et al., 2007; Al Ariss and Syed, 2011). On one hand, studies on brain drain propose that the sending countries lose their human capital when their skilled individuals relocate to another country on a permanent basis (Beine et al., 2008). It is suggested that these countries pay the cost of educating and training these emigrants without benefiting from their skills. On the other hand, studies on brain gain suggest that individuals who relocate benefit their countries by helping to decrease the rates of unemployment (Bardak, 2005). Furthermore, when migrants return to their home countries they transfer their knowledge and skills acquired abroad and therefore benefit local organisations. The overall assumption in this literature is that human capital alone is enough for migrants to advance their careers whether abroad or upon their return to their home country. Beyond the brain drain/brain gain issues of skilled migrants, their career experiences and challenge strategies when relocating to the host countries are underexplored (Collings et al., 2007; Al Ariss and Syed, 2011). For example, in an article on the growing need to recruit nurses in the UK, Bach (2007) argues that migration literature provides an incomplete view of their recruitment and migration experiences. Overall/in summary, migration studies focus on brain gain and brain drain at a macro-level. Nevertheless, migrants' career experiences are underinvestigated at a micro-individual level. In light of this omission, we examine the SIE literature that seems to offer a better understanding than migration studies on the careers of individuals who undertook international mobility.
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SIE focuses on the careers of persons from developed countries who are undertaking on their own initiative (as opposed to corporate expatriates sent by their companies) an international experience (Suutari and Brewster, 2000). For example, Jokinen et al. (2008) discuss the work experiences of professionals from Finland. Inkson and Myers (2003) focus on "Big Oes", that is to say overseas experiences undertaken mainly by young people from New Zealand. Using a sample of 563 expatriates (almost half of them SIEs while the others are corporate expatriates), Cieri et al. (2009) studied the intention of Australian professionals to repatriate. Their findings show that SIEs are likely to be more open to the prospect of remaining overseas than corporate expatriates. SIE research remains underdeveloped in respect to understanding the international career experiences of ethnic minorities from developing countries (Syed, 2008; Syed and Pio, 2010; Al Ariss, 2010). In particular, career barriers and opportunities for ethnic minorities undertaking international careers are underresearched (Al Ariss and Syed, 2011). Instead, skilled people undertaking an international experience are frequently conceptualised as endowed with human capital and therefore free to cross organisational and national borders (Cerdin and Le Pargneux, 2010). There is less focus on the barriers that constrain their career choices (Richardson, 2009). For example, Zikic et al. (2010) examine the boundary crossing experiences and adaptation of 45 migrant professionals in Canada, Spain and France. The same authors indicate the problem of non-recognition of migrants' credentials and of discounting their foreign experience in Canada. In New Zealand, by interviewing 80 recruitment specialists, Coates and Carr (2005) found that while migrants are granted entry depending on their knowledge of the English language and based on their qualifications, they are often offered jobs that are incompatible with their qualifications. Migrants can also face discrimination in accessing jobs and advancing in their careers. In the context of France, Al Ariss (2010) shows how legal barriers and discrimination can lead to skilled migrants' underemployment. Underemployment is defined here as underutilisation of the individuals' skills and expertise. This causes job dissatisfaction and a low level of job involvement (Lee, 2005). In summary/overall, literature on international careers underexplores the experiences of skilled individuals relocating from developing to developed countries. Instead, research considers skilled individuals undertaking international careers as a relatively homogenous group endowed with human capital and expected to have successful career outcomes (Howe-Walsh and Schyns, 2010). Second, this literature does not sufficiently explore the career barriers imposed on this group of migrants. This section exposes the two gaps in this same order. Drawing on the themes noted above and in an attempt to fill these gaps, this paper discusses the careers profiles of Malagasy physicians in France. 3. The context of Malagasy physicians' migration of to France In Madagascar, Queen Ranavalona II's conversion to Christianity in 1868 during the precolonial period marked a historic milestone in the abandonment of traditional medicine in favour of western medicine (Aubry and Rakotobe, 2000). With the inauguration of the first official medical college in Antananarivo, top students were awarded scholarships to study in France. Among the pioneers, Rasamimanana earned his medical degree in France in 1891 and became the personal physician to Queen Ranavalona II, shortly before the beginning of the colonial era (Bergougniou et al., 2001). Since then, throughout the precolonial (1870-1895), colonial (1895-1960), post-colonial periods (1960-1971) and up until now, generations of scholarship-holding
physicians return to the Great Island to hone their skills after three to four years of specialisation in a French faculty of medicine. In the past few decades, a large number of Malagasy physicians have definitively migrated to France, thereby departing from the traditional abovementioned pattern. On one hand, Madagascar is characterised by an unstable political situation and extreme poverty, which seems to encourage the "brain drain" outside Malagasy borders, i.e. the "push" effect. On the other hand, France is faced with a significant labour shortage, notably in the medical sector, resulting in a "pull" effect and a "brain gain" phenomenon. With all the current talk about selective immigration, several Malagasy physicians seem entranced by the "siren call". Immigration procedures for skilled migrants coming to France are known to be selective and complex for non-European Union (EU) citizens (Al Ariss, 2010). In his study of skilled migration to France, Al Ariss (2010) explains how prospective employers are required to demonstrate that no other person in France can fill the vacancy in question. Moreover, two types of jobs are available for non-EU citizens in France, i.e., regulated and unregulated professions. Medical professions are regulated. Thus, in regulated professions, the institutionalisation of various barriers such as the state requiring migrants to acquire French citizenship, applying for complicated tests, providing probation and temporary work permits, and restricting their employment spectrum such as by not allowing them to fully practise their profession, can result in either delay or failure to enter the job market (Al Ariss and Ozbilgin, 2010). Therefore, ¨ migrant physicians in France must pass through a complex selection procedure, run by the French state, before being allowed to practice. Drawing on the themes noted above, this paper will therefore investigate how Malagasy physicians manage their career in France. Now that we have outlined the theoretical framework of our study, we will specify our research methodology.
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4. Research method Our exploratory research relies on a survey recounting the life stories (Bertaux, 1997) of 17 Malagasy migrant physicians in France. An additional interview was conducted with the director of a private clinic who recounted the experience of Malagasy physicians he recruited. During this exploratory phase, we collected primary data via semi-directive faceto-face or telephone interviews of one hour on average. Our participants were constituted with the support of the informal network of contacts of the Malagasy migrant community in France. The first author who conducted the interviews is a Malagasy man who lives in France. Although this allowed for privileged research access, researching migration in France is a contentious topic (Al Ariss and Syed, 2011) and therefore it was not always easy to find interviewees. In light of the sensitivity of the information collected, we have preserved the respondents' anonymity and therefore pseudonyms have been systematically used in this paper. This ensures confidentiality. Table I provides demographic details about the participants. The interviews were mainly conducted in French knowing that Malagasy and French are the two official languages of Madagascar. We have translated the phrases in Malagasy occasionally mentioned by respondents. For the purpose of this paper, quotes were translated from French to English. Detailed notes were taken during the interviews. The following issues were discussed during the interviews. First, background information of the participants such as age, period of stay in France, current job, citizenship(s), marital status and number of children. Additionally,
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Table I. Malagasy migrant physicians' demographic profiles Sex Male Female Male by authorisation by by by by by by by by by by by by by by PAE PAE PAE PAE PAE PAE PAE nursing nursing nursing nursing nursing nursing nursing Female Male Female Male Female Male Female Male Male Female Female Male Male Female Arrival to France in Degree Works in his/her profession Access to profession Direct Direct Interstitial 197 197 7 200 7 4 198 199 0 6 199 199 7 199 8 199 8 200 9 200 0 2 200 200 2 2 200 200 3 200 2 200 8 8 degree degree degree degree degree degree degree French physician French physician Malagasy physician, followed to practise procedure (PAE) Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Malagasy physician, followed Ye Ye s Ye s s Ye Ye s s Ye Ye s Ye s Ye s Ye s N s o N N o o N N o N o N o o Interstitial Interstitial Interstitial Interstitial Interstitial Interstitial Interstitial Switched to Switched to Switched to Switched to Switched to Switched to Switched to nursing nursing nursing nursing nursing nursing nursing
#
Pseudonym
Age in 201 0
1 2 3
460 460 30s
4 5 6 7 8 9
1 1 0 1 1 2 3 1 1 4 1 5 1 6 7
Michel Mireille Ja o Felana Rivo Mamy Rado Noro Rija Soa Setra Feno Miora Henintsoa Liva Hary Landy
460 50s 40s 40s 40s 50s 50s 40s 30s 30s 40s 30s 50s 30s
open-ended questions were asked regarding themes that include participants' reasons and strategies for leaving Madagascar, their choices of migrating to France, family integration in France, possible plans to return to Madagascar. Other questions were included regarding participants' education and career experiences in France, whether there was an adequate match between the participants' qualifications (i.e. as physicians) and their current jobs, experiences of discrimination against them (if any) such as in terms of ethnicity or a pay-gap between French and Malagasy doctors, their experiences of integrating in the French job market, as well as their future career plans. In this exploratory qualitative study, although the analysis was driven predominantly by the data, they were also informed by the authors' reading of the literature (Fendt and Sachs, 2008). Each life story was read several times. Although this approach to analysis was time consuming, it encouraged in-depth examination of the data. After several interviews were conducted and as analysis was progressing, key themes began to emerge regarding participants' difficulties in integrating in the French job market and in particular for working in their profession of origin. Experiences of underemployment and unemployment were clearly emerging. We will now examine the initial findings of our research. 5. Findings This section presents the career experiences of 17 Malagasy physicians who succeeded (ten participants) or not (seven participants) in practising their "profession of origin" in France. Our results clearly highlight two career profiles: first, those who succeeded in working as physicians either directly upon their graduation (two), or throughout an "interstitial" career as a nurse (eight) who eventually reached their profession of origin. Migration turns to be rather beneficial for the career development of this first group; second, those who definitively turn to the nursing (seven) or the nursing auxiliary professions. For this second group, migration emerges as a challenging experience leading to talent waste and therefore to downward career mobility. 5.1 Malagasy physicians who succeeded in working in their profession of origin 5.1.1 Direct access to the physician profession (two participants). The first case concerns Malagasy physicians with a French degree, who did not suffer from the constraints of the "foreign qualification". Having benefited from a scholarship from the French government, Michel arrived in France in 1964 at the age of 20 to continue his medical studies in a college in the south of France. He met a Malagasy dental student, Mireille, whom he subsequently married in 1968, before the couple returned to Madagascar in 1972 after having earned their French degree. However, Madagascar was experiencing a serious political crisis that year. The couple's professional exploration stage in Madagascar was short lived due to unsatisfactory local working conditions. Therefore, Michel and Mireille, concerned about their children's future, decided to return to France with their three children in 1977. In France, at first, the couple needed to find their bearings. Thanks to their French degrees, amongst other things, this couple, who later became French citizens, is the embodiment of fully successful socio-professional integration. Registered with the French Doctors' Guild (Ordre National des Medecins), a pre-requisite step for a ´ practising medical doctor in France, Michel had an exemplary career as he was appointed head physician in his specialised medical field in 1982. When asked about the key factors of his success, Michel puts it down to "his ability to prove himself". His cutting-edge professional skills and field experience consolidated his legitimacy
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and reputation amongst his colleagues and patients. Mireille, for her part, was the first "black woman" to successfully open a private dental practice in 1983; she is still working and is due to retire soon. Founding her own private practice helped her find the best balance between her professional and family life. According to the interviews, the couple's career experiences were marked by no significant discrimination with regard to age, gender or ethnic origin, even though the initial contacts sometimes required an adaptation phase. Michel and Mireille both have typically French first names. Michel points out that the Malagasy generally enjoy a good reputation, in particular in the medical sector: "During my studies, I was the first Malagasy intern in the service, followed by many others after my departure". The kindness, attention and empathy inherited from Malagasy culture, combined with professionalism and technical skills, contributed to the couple's socioprofessional success. 5.1.2 Interstitial access to the physician profession (eight participants). The following cases describe the experience of Malagasy physicians faced with the constraints of their "foreign physician qualifications", who initially came to France for specialisation studies. They subsequently decided to stay in France, and undertook the function of "acting nurse" as a professional springboard for them to achieve their goals. These eight participants followed relatively similar career paths. This path consists of: first, studying for the specialisation degree in France for several years; second, working for three years as an "acting nurse" insofar as the foreign qualification is not recognised, with the contract likely to be renewed as appropriate; third, passing the examination open to any foreign physician to comply with the "Authorisation to Practice Procedure" Procedure d'Autorisation d'Exercice (PAE); The PAE is a procedure that ´ authorises non-EU citizens who hold a diploma from a member state of the EU or the European Economic Area to practise the professions of medical doctor, dentist, midwife and pharmacist for; fourth, become an "associate practitioner" for a probationary period of three years; finally, be allowed to practise in the same capacity as a French physician after being registered with the French Doctors' Guild. The grandson of a physician and son of the first Malagasy associate professor of medicine in his specialised field, Jao became a doctor of medicine in Madagascar in 2000, having validated his sixth and seventh years of study in France. Subsequently, he met a Franco-Japanese woman and married her in 2004 in Madagascar, at age 30. Following their marriage, the couple decided to settle in France. In France, Jao studied for two specialisation degrees while working as an "acting nurse" intern. In 2007, he passed the examination open to foreign physicians, i.e. the PAE, which allowed him to work as an "associate physician" in one of his two elected fields. When recalling his experience, Jao stated: "Both my grandfather and my father returned home out of patriotism [y] it is different for me as I am married to a foreigner; financial security prevails [ y] Compared with other foreigners, the Malagasy are well accepted [y] what is unfortunate is that there is no mutual assistance between the Malagasy, it's every man for himself [y] which does not at all reflect the fihavanana (solidarity) that the Malagasy claim to be so proud of [y]". When asked about discrimination, he mentions that sometimes patients refuse to be treated by him, without, however, specifying whether it is because of his appearance or his age. Singled out by one of her French thesis supervisors during the presentation of her medical doctorate thesis in Madagascar in 1979, Felana left the country in 1980 at age 30 to enrol on a specialisation course in France with a view to becoming a lecturer and researcher-physician in Madagascar. Simultaneously enroled on two courses, she stayed in France and, eight years later, presented a second doctoral thesis in a
medically related field. In France, she worked as a university lecturer in her medical field and also passed the PAE. She has been a practising physician since 1998. She believes that the Malagasy's migrant strengths are that "they reach out, they are adaptable, do not like confrontation or to complain, which can sometimes be a negative point". Rivo and Mamy (couple), Rado and Noro (couple), as well as Rija and Soa (couple) are physician couples who had already practised in Madagascar before moving to France. They now work in various French regions as "associate practitioners" before being able to practise in the same capacity as a French physician. Rivo arrived in France in 1996 at age 35 to study for his specialisation degree, with his wife Mamy joining him in 1997 to study for hers. The couple left their children, aged 9 and 4, in the care of their grandparents back home. Before the family was reunited in 1998, "it was heartbreaking, it was so hard for me, I cried practically every night" recalls the deeply affected Mamy. The couple subsequently worked as acting nurses, acquiring French nationality in the meantime and, after two failed attempts in 1998 and 2004, Rivo passed his PAE in 2007, followed by Mamy in 2008. According to Mamy, "wisdom, great respect for hierarchy and the fact that we are not constantly complaining" are points in the Malagasy's favour, "even if people sometimes take advantage of this". These words reflect Malagasy culture. Her integration was a success, despite isolated cases of xenophobia suffered via the words of certain patients. Rado and Noro, married without children, arrived in France together in 1998, both aged 30, to study for their specialisation degrees for four years. They followed roughly the same path as the previous couple, except for the fact that both their children were born in France, in 2000 and 2002. This couple deliberately opted for specialisations not chosen by French nationals due to arduous working conditions but, as a result, highly sought after in France. Having acquired French nationality, Rado points out that being "unassuming French-speaking individuals" set them apart from other foreign physicians. The story of Rija and Soa is similar to that of the two previous couples despite a different initial story. Rija arrived in France at age 40 to study for his specialisation degree in 1999. In 2000, his wife Soa and their three children aged 15, 5 and 2 joined him. Soa was a homemaker until 2007, when she sat and passed the PAE exam. "Naturally devoting time to patients and treating them as people" enables Soa (who returned to work in 2007) to work more efficiently. She emphasises that she is finding it more difficult to balance professional and personal life and claims she has not been discriminated against, unlike her husband who sometimes complains of xenophobia in the workplace. Concern about the children's future is the number one source of motivation to stay in France, unanimously acknowledged by the three couples. 5.2 Downward career mobility: switching from physician to nursing profession In view of France's considerable shortage of nurses and nursing auxiliaries in the past few decades, a number of Malagasy physicians voluntarily moved to France and definitively switched to this profession because of the difficulty in practising their profession of origin. The following cases outline the experience of Malagasy physicians faced with the constraints of the "foreign qualification" who deliberately "made the switch" to the nursing role. In 2002, Setra decided to move to France at age 40 to study for a three-year specialisation degree as a foreign physician. He was subsequently an acting nurse for
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the maximum legal period of three years. In 2009, he took a five-month course to validate his French degree as State-registered nurse, which allowed him to practise this profession indefinitely. As he is older, Setra no longer aims to practise as a physician via the PAE. In 2005, his wife and their three children aged 13, 9 and 7 joined him in France. When asked about their choice of staying in France despite the fact that the couple were not fully working in their professions of origin, material comfort, the children's development, rewards such as holidays back home or a substantial salary, the possibility of saving but also the inextricable situation in Madagascar were mentioned as main reasons why they made these choices. Similarly, Feno and Miora (couple), two physicians in their 30s, arrived in France together in 2002 to study for their medical degree. Their "foreign doctorate in medicine" allowed them to practise as nurses for three years while they were still studying. After these three years, they validated their French degree as Stateregistered nurses in 2006 in a nursing schooland had their first child in 2007. Their motivations are similar to those of the previous couple. Henintsoa, a physician who moved to France in 2003 at age 32, followed almost the same professional path as Feno and Miora. Before being reunited with her husband in 2006, Henintsoa suffered from loneliness because of the separation, notably during the adaptation phase. She was thinking of taking the PAE exam by 2010. However, she is happy to be a State-registered nurse at present, as she is currently pregnant. Professionally speaking, her smile and natural kindness have endeared her to the patients. The professional career of Liva, a physician who moved to France in 2002 at age 29, is completely identical to that of Henintsoa . He returned to Madagascar in 2004 and married a Franco-Malagasy woman, then became a father in 2005 before going back to France with his family. Having validated his nursing degree, he is now working in a private clinic in the south of France, where he feels appreciated by his colleagues and patients. In January 2008, a new regulation abolished the authorisation for foreign physicians to automatically work as nurses for three years; it offers, however, the possibility of working as a nursing auxiliary. Hary, a divorced male physician with three dependent children, arrived in France in 2008 at age 52 and Landy, a female physician who moved to France in 2008 at age 34, were compelled to directly prepare for their nursing degree while they were studying. Landy's husband, also a physician, is about to be reunited with his wife in France to follow the same career path. Malagasy physicians compensate for the "professional demotion" from the status of physician to that of nurse with the substantial remuneration and material comfort. It should be noted that the political crisis of 2002, which led to Madagascar's President Ratsiraka's exile to France, markedly increased the migration of many members of the Malagasy elite, with a relatively strong "push" effect. This trend was amplified by the "pull" effect of coming to France. 5.3 Recruiting physicians from Madagascar to France: a "win-win" system? Haja, originally from Madagascar, has managed a chain of French private clinics for 23 years. This graduate in economics told us about his experience in recruiting Malagasy physicians who came to France between 2001 and 2002 to work as nurses. In 2001, a clinic in the Vosges (east of France) region was faced with a nursing staff problem (a shortage of 25 nurses); after an initial failed attempt to recruit nurses from Madrid due to language and cultural barriers, Haja proposed to recruit Malagasy physicians from Madagascar. As mentioned above, this legislation authorised foreign
physicians to work as nurses for three years, after which they had to validate the French degree of State-registered nurse. Haja, a Malagasy himself with French citizenship, initiated the expatriation of four cohorts of Malagasy physicians during the 2001-2002 period. Haja travelled to Madagascar to recruit the first five applicants: two men and three women. It should be pointed out that in 2002, Madagascar was in the throes of a serious political crisis, which facilitated Haja's search for competent candidates, ready to swap their physician status for that of a nurse. Malagasy physicians were well accepted, trained and their socio-professional integration was an immediate success even though their acclimatisation to the Vosges weather was far from easy. Four of them managed, after three years, to validate their French degree of State-registered nurse and brought their family over, while a fifth failed the tests and returned home. Encouraged by this success, the experience was renewed in 2002, using the same process. This time, a second wave of five Malagasy physicians was supposed to be posted to one of the clinics of the chain in France. This experience was doomed to fail as, upon the arrival of the Malagasy physicians on site, the local physicians organised large-scale protests. The management failed to predict this rejection, having assumed a repeat of the Vosges success: unrealistic expectations and a lack of communication led to deadlock. In the end, the trip of the five Malagasy physicians was short lived; they were not allowed to prove themselves during a probationary period. One of them returned home, psychologically affected by "this rejection"; the other four were later redeployed to the Vosges site by the management. Having subsequently earned their nursing degree, two of them are still working there and have brought their family over; the third moved to Guadeloupe, while the last got married and moved to the south of France. News of the Vosges success encouraged the director of a clinic in Martinique to call upon Haja for the recruitment of Malagasy physicians. This is how a third wave of five Malagasy migrant physicians moved to Martinique. The experience was a success in terms of socioprofessional integration, as with the Vosges experience. Solicited by the director of a clinic in the Centre region of France, Haja recommended a couple of Malagasy physicians willing to work in the nursing profession in France. The director contacted them and brought them over to France, accompanied by their two children, aged 12 and 7. Having also earned their nursing degree, the couple's professional integration was a success. 6. Discussion Several themes emerge from this exploratory study. First, our results highlight the professional challenges imposed upon migrant physicians who want to practise in France. For instance, except for the two participants who did all of their medical studies in France and later got the French citizenship, practising as a physician in France was instead a very challenging task and sometimes even impossible. Bach (2007) argues that migration literature does adequately address the role of the States, throughout their migration policies, on influencing the career outcomes for skilled migrants. In the case of Malagasy physicians in France, they faced the French legislative constraints of their "foreign physician qualifications", although many of them undertook further medical specialisations in France. Coupled with this, there was the challenge of having French citizenship in order to be able to register with the French Doctors' Guild. When the participants subsequently decided to stay in France, they undertook the function of "acting nurse" as a professional springboard for them to earn their living and also eventually achieve their goals. For those who were able to
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practise as physicians, they had to undertake long procedures including first, studying for the specialisation degree in France for several years; second, working for three years as an "acting nurse"; third, passing the examination granting them PAE; fourth, becoming "associate practitioners" for a probationary period of three years; and finally being allowed to practise after registering with the French Doctors' Guild. Our literature review has demonstrated how the literature on migrants' international mobility focuses on brain gain/brain drain issues, assuming therefore that migrants will be able to use their human capital (Beine et al., 2008; Bardak, 2005). Our findings suggest that beyond the brain drain/brain dilemmas, research on skilled migration needs to better emphasise the career experiences of skilled migrants as these face serious challenges that remain largely underexplored (Al Ariss and Syed, 2011), as in the case of the Malagasy in France. Our literature review has shown how international careers are frequently conceptualised as without boundaries and helpful for career development with less focus on the barriers that constrain their career choices (Richardson, 2009; Al Ariss, 2010; Zikic et al., 2010). In our study, seven Malagasy physicians were completely discouraged by these procedures and ultimately worked as nurses, undertaking therefore downward career mobility. Furthermore, the interview with the private clinic director showed how France has also benefited from physicians who were explicitly brought with the aim of giving up their profession of origin and embarking on downward career mobility by practising as nurses. In line with Coates and Carr (2005), findings from France show that while Malagasy physicians were granted entry based on their qualifications, they were not offered jobs that are compatible with their qualifications. It is important to mention that participants in this study were made up of the elites of the Malagasy migrants who come to France. Numerous were the determinants which explained their migration choice and their readiness to give up, in many cases, their professions: first, the desire to provide their children with a better future; second, the economic reasons making it possible to achieve this goal, most often implicitly evoked; third, the possibility of being able to ultimately practise as a physician in France, even if chances were limited; fourth, the "pull" effect of the medical sector corresponding with a labour demand in terms of nurses and associate physicians in France; fifth, the "push" effect of the political and insecurity in Madagascar; and also sixth the family factors for those reunited with their spouse in France. Regardless of whether they practised physician or nursing professions, they mentioned several attributes that helped them integrate into French culture, including respect for authority, attentiveness, empathy, sociability, work ethics and discretion. 7. Conclusions Our literature review has shown that the field of international careers has generated a significant body of research, in particular in the literature on migration and SIE. We identified two main gaps in the literature on international careers: first, an overall assumption in this literature is that human capital alone is enough for migrants to advance their careers with very little written on the barriers to career development that skilled migrants face. Second, the literature underexplores the experiences of skilled individuals relocating from developing to developed countries. This study fills a knowledge gap by demonstrating how human capital alone is rather insufficient in the context of migrant Malagasy physicians in France.
This study has implications for practice at the policy, organisational and individual levels. At the policy level, in order to benefit from the skills and knowledge of skilled migrants who are legally accepted to live and work in France, the French authorities need to provide better equality and inclusion measures. This is possible by revisiting the migration policies that deliberately exclude skilled migrants from employment opportunities pushing them therefore into underemployment and unemployment. In the same way, the Malagasy authorities should take measures to provide decent living conditions for Malagasy physicians and more generally, to their elite individuals who can contribute to the advancement of the country. This requires political and economic stability, yet the situation in Madagascar seems intractable to date. At the organisational level, pay practices should evolve to greater equity under current legislation in France, avoiding therefore an "exploitation" of skilled migrants from developing countries such as Madagascar. Furthermore, the failed work experience of the Malagasy migrants who were expatriated from Madagascar to France, as reported by the clinic director interviewee, is also worth mentioning here. Such a situation points to a need for organisations in France to have significant awareness and communication efforts amongst their native employees, to ensure successful socio-professional integration of the skilled migrants. At the individual level, Malagasy physicians who wish to relocate to France should be aware that under the current French migration policies and professional regulations for migrant physicians, it is very challenging (if not impossible in some cases as we have shown in this study) to have the same social and professional recognition as they might have in Madagascar. Consequently, their salaries will probably be significantly lower than that of a French colleague. Discrimination is also something they would need to cope with as in some cases discussed in this study. More importantly, there is a significant chance of experiencing downward career mobility as we show in the case of physicians who had to switch to nursing professions. There are limitations to this exploratory research in terms of the size of the sample. Nevertheless, the size remains very acceptable compared to other qualitative studies on the topic of skilled migration. This qualitative study provides promising potential for comparative research, to be conducted on a broader sample, targeting other industries or other immigrant ethnic and cultural communities. This could be helpful in understanding the nature of international careers (Suutari and Taka, 2004).
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Bardak, U. (2005), Migration Trends in MEDA and a Discussion on the Links Between Migration and Educational Systems, European Training Foundation, Turin. Baruch, Y., Budhwar, P.S. and Khatri, N. (2007), "Brain drain: inclination to stay abroad after studies", Journal of World Business, Vol. 42 No. 1, pp. 99-112. Beine, M., Docquier, F. and Rapoport, H. (2008), "Brain drain and human capital formation in developing countries: winners and losers", The Economic Journal, Vol. 118 No. 528, pp. 631-52. Bergougniou, J.M., Clignet, R. and David, P. (2001), Villages noirs et autres visiteurs africains malgaches et africains en France et en Europe (1870-1940), Editions Karthala, Paris. ´ Bertaux, D. (1997), Les recits de vie, Nathan, Paris. ´ Cerdin, J.-L. and Pargneux, M.L. (2010), "Career anchors: a comparison between organizationassigned and self-initiated expatriates", Thunderbird International Business Review, Vol. 52 No. 4, pp. 287-99. Cieri, H.D., Sheehan, C., Costa, C., Fenwick, M. and Cooper, B.K. (2009), "International talent flow and intention to repatriate: an identity explanation", Human Resource Development International, Vol. 12 No. 3, pp. 243-61. Coates, K. and Carr, S.C. (2005), "Skilled immigrants and selection bias: a theory-based field study from New Zealand", International Journal of Intercultural Relations, Vol. 29 No. 5, pp. 577-99. Collings, D.G., Scullion, H. and Morley, M.J. (2007), "Changing patterns of global staffing in multinational enterprise: challenges to the conventional expatriate assignment and emerging alternatives", Journal of World Business, Vol. 42 No. 2, pp. 198-213. Fendt, J. and Sachs, W. (2008), "Grounded theory method in management perspective. Users' perspectives", Organizational Research Methods, Vol. 11 No. 3, pp. 430-55. Howe-Walsh, L. and Schyns, B. (2010), "Self-initiated expatriation: implications for HRM", The International Journal of Human Resource Management, Vol. 21 No. 2, pp. 260-73. Inkson, K. and Myers, B.A. (2003), "The big OE: self-directed travel and career development", Career Development International, Vol. 8 No. 4, pp. 170-81. Jokinen, T., Brewster, C. and Suutari, V. (2008), "Career capital during international work experiences: contrasting self-initiated expatriate experiences and assigned expatriation", The International Journal of Human Resource Management, Vol. 19 No. 6, pp. 979-98. Lee, C.H. (2005), "A study of underemployment among self-initiated expatriates", Journal of World Business, Vol. 40 No. 2, pp. 172-87. Richardson, J. (2009), "Geographic flexibility in academia: a cautionary note", British Journal of Management, Vol. 20 (S1), pp. S160-S170. Suutari, V. and Brewster, C. (2000), "Making their own way: international experience through self-initiated foreign assignments", Journal of World Business, Vol. 35 No. 4, pp. 417-36. Suutari, V. and Taka, M. (2004), "Career anchors of managers with global careers", Journal of Management Development, Vol. 23 No. 9, pp. 833-47. Syed, J. (2008), "Employment prospects for skilled migrants: a relational perspective", Human Resource Management Review, Vol. 18 No. 1, pp. 28-45. Syed, J. and Pio, E. (2010), "Veiled diversity? Workplace experiences of Muslim women in Australia", Asia Pacific Journal of Management, Vol. 27 No. 1, pp. 115-37. Zikic, J., Bonache, J. and Cerdin, J.-L. (2010), "Crossing national boundaries: a typology of qualified immigrants' career orientations", Journal of Organizational Behavior, Vol. 31 No. 5, pp. 667-86.
About the authors Lovanirina Ramboarison-Lalao lectures and researches on Human Resource Management at Ecole de Management Strasbourg, France. He has written on diversity and migration matters in the context of France. He has published several papers such as "Etre femme ou homme dans les organisations: contributions a l'eclosion de l'economie de la connaissance, Lyvie Gueret-Talon `´ ´ ´ et Floran Sala, Editions Conception et Dynamique des organisations, Juin 2010"; "Gender and diversity: for a situational approach?", XIVe Workshop, Strategic Human Resource Management, ` EAISM, Brussels, Mars 2009. Akram Al Ariss is Head of the Human Resource Management Department at Champagne School of Management (France). He is affiliated with DECEre, Norwich Business School, University of East Anglia (United Kingdom) and with the Pennsylvania State University (USA). Originally from Lebanon, he has a PhD in Management from Norwich Business School, University of East Anglia (UK). Akram Al Ariss is interested in interdisciplinary approaches to teaching and researching IHRM. His interests include Diversity, Career, and Expatriation/ Migration matters. He has written in journals such as Academy of Management Learning and Education, Thunderbird International Business Review, British Journal of Management, Career Development International, Work Employment and Society, and Personnel Review. Akram is member of the Editorial Board of Equality, Diversity, and Inclusion as well as Journal of World Business. Akram Al Ariss is the corresponding author and can be contacted at: [email protected] Isabelle Barth is Professor of Management Sciences and Head of the CESAG Research Center in France. She is a member of several associations such as Association Franc¸aise du Marketing, Association en Gestion des Ressources Humaines, Association pour le Developpement de la ´ Responsabilite Sociale de l'Entreprise, and Institut Psychanalyse et Management. She is a ´ member of the editorial board of journals such as Decisions Marketing, Management et Avenir, ´ Revue Franc¸aise de Marketing, Negociation. ´
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