Introduction

Cross-border healthcare provision is being established as one of the policies of the European Union (EU). The free movement of goods, services and people – both patients and healthcare professionals – reflects the establishment of a single European market. The migration of healthcare workers is increasingly relevant in the provision of healthcare (Buchan, 2006). Although the EU aims to promote mobility, a number of structural and cultural barriers persist that impede the integration of foreign health professionals.

This chapter explores the obstacles to the mobility of healthcare professionals that exist in Portugal. The focus is on the existence of both formal and informal barriers to the professional mobility of doctors and nurses, taking different factors into account: the formal recognition of professional status, the process of socialisation and the negotiation of a professional identity in a culturally different workplace. The empirical material is taken from an ongoing qualitative research project with foreign nurses and doctors – from Spain and from outside the EU (the Republic of Moldavia, the Russian Federation, Ukraine and Romania, which at the time of the study had not joined the EU).

I argue that the healthcare sector creates a number of specific barriers to mobility and integration. Although the Bologna agreements harmonise the training system, country-specific competencies continue to matter. For instance, culture shapes the very concepts of disease, patient autonomy, confidentiality and multidisciplinary teamwork (Adel et al, 2004; Nicholas, 2006). It also shapes informal acknowledgement of diplomas and thus impacts on the level of trust that patients and colleagues put in foreign professionals. In addition, national regulation and regional policies have to be taken into account, such as shortage of doctors and long waiting lists for treatment in some countries. The examples highlight that the integration of foreign health professionals remains fundamentally an issue of the nation state and its cultural context. At the same time, however, the process of EU enlargement is producing its own dynamics.

The chapter starts with an overview of the debate on the migration of healthcare professionals. This is followed by statistical data on foreign human resources in the Portuguese National Health Service (NHS) – framing the macro level of the analysis – and micro-level analysis based on the findings from biographical interviews with physicians and nurses.