Does a host country capture knowledge of migrant doctors and how might it? A study of UK doctors in New Zealand

Robin Gauld,  Simon Horsburgh whose paper won the HSRAANZ Award for the best New Zealand paper discuss their research,

Doctor migration and the reliance in many countries on International Medical Graduates (IMGs) to maintain a stable and balanced medical workforce are ubiquitous. This reliance affects some countries and parts of the world more than others, especially low- and medium-income countries who find it difficult to compete in a global workforce market.

One response is to seek the services of international medical graduates (IMGs) who have specific desired skills or may be willing to work in hard to staff areas. Yet, in the New Zealand case, IMGs are not a solution to workforce shortages. New Zealand data show a revolving door with such doctors often staying for a limited time.

Amongst higher income countries, New Zealand may be an extreme example owing to its experiences, but important for various reasons. Most important among these is the proportion of IMGs in New Zealand’s doctor workforce, at 44%, is the highest of any OECD country and this proportion has been growing over time. New Zealand is also amongst the highest per capita doctor exporting countries in the OECD, with local graduates routinely going abroad in search of new opportunities. Second, while New Zealand has long relied on IMGs, its health system would not function without them meaning there is a structural shortage of locally trained doctors.

IMGs present a potentially strong source of knowledge for health systems, including both technical knowledge and experiential knowledge brought from health systems in which they have worked.

With these points in mind, IMGs from the UK registered with the New Zealand Medical Council who had arrived within the decade to 2014 were surveyed (n = 1357). The main outcome measures were respondent perceptions of host country receptivity to their potential knowledge contribution, and mechanisms through which knowledge might be shared. The survey response rate was 47% (n = 632). 82% of respondents agreed colleagues had been receptive to their knowledge contribution; 67% felt they had been encouraged to share professional knowledge gained abroad; 60 %agreed they had been encouraged to share knowledge of the UK or other health systems. Only 45% believed there were clear mechanisms in place for knowledge sharing. Statistically significant differences by age and professional practice designation were found.

An important finding was that knowledge transfer in the New Zealand context appeared to be relatively ad hoc. Our article concludes in suggesting options for improving knowledge transfer if policy makers are interested in this – and they should be. These include formal organisational arrangements, use of knowledge brokers, and building communities of practice in different professional and geographic areas.

Gauld, R. & Horsburgh, S. Int J Public Health (2016) 61: 1. doi:10.1007/s00038-015-0770-z


Robin Gauld is Professor of Health Policy in the Department of Preventive and Social Medicine, and Director of the Centre for Health Systems—that spans the School of Business and the Dunedin School of Medicine.

He was a Senior Fellow at the Boston University Health Policy Institute from 2009–2013, and a Commonwealth Fund Harkness Fellow in 2008–2009, working with colleagues from Boston University and Harvard University. In 2014, he was NZ-UK Link Foundation Visiting Professor at the School of Advanced Study, University of London.

Past positions include lecturing and research posts at the University of Hong Kong and City University of Hong Kong, and teaching at the University of Texas and Harvard University.

Current research interests include: comparative health policy, health system and quality improvement, clinical governance, primary care, population based health funding formulas, and health information technology.

On 1 Dec 2016 he took up a new role at the University of Otago as Pro-Vice-Chancellor Commerce and Dean of the School of Business.


Dr Simon Horsburgh is a senior lecturer in Epidemiology in the Department of Preventive and Social Medicine at the University of Otago.

His primary research focus is pharmacoepidemiology, particularly in the area of using routinely-collected data to study medicines utilisation and access. He has also collaborated with Professor Gauld to examine health workforce issues such as clinical leadership and workforce migration. Dr Horsburgh is a founding member of the Pharmacoepidemiology Research Network, as well as an associate of the Centre for Health Systems. He serves as an associate editor for BMC Health Services Research