Tiago Villanueva: Can doctors become “transnational” professionals?

Tiago_VillanuevaA recent BBC article about the globalisation of work and people, written by Lynda Gratton, professor of management practice, argues that there will be more professionals called “transnationals,” as the job and education market become increasingly globalised.

Gratton defines a transnational as a “worldwide group of people who are able to relocate at any time, making decisions based on relative global employment and investment opportunities,” “with hybrid associations among multiple cultures and societies,” and who are “able to speak more than one language and often carrying dual citizenship, will be able to adapt to the sort of cross-cultural communication that is so important for global organisations.”

Heavily enforced regulation of the medical profession between countries, even within the borders of the European Union, precludes health professionals from being deployed around the world quickly (with the exception of medical evacuation or humanitarian workers). If you live in an EU country, try figuring out the process involved in registering as a doctor in another EU country. In terms of paperwork, document translation and authentication, cost, and time, the effort is enormous.

In comparison, think how easily a multinational company deploys professionals to an office in a different country or how a government deploys their military to the other side of the world. There’s also the issue of local language proficiency, which is usually not expected or required in a global corporate environment, as knowledge of the English language will usually suffice . But most doctors work in a clinical environment in hospitals or local surgeries, where they will be required to speak the local language.

There are increasing signs that the current generation of medical students and junior doctors wish to become more mobile. Carrying out exchange programmes and training stints during medical school and specialist training is a run-of-the mill thing these days. As medical students become more and more exposed to other cultures, and more knowledgeable about foreign languages, they are naturally ending up better prepared to carry out transnational work. But I still think that most doctors end up staying in the countries they trained in not because they don’t want to move elsewhere, but because it’s always easier to navigate the local job market, and they often don’t know how to find the best sources of information about medical work overseas.

A career in clinical medicine is probably not the best way to develop a career as a “transnational” doctor, and I think this will be the case for the next few years. Nevertheless, a European Network of Medical Competent Authorities was set up not long ago, and the European legislation concerning mobility of healthcare and other professionals is to be revamped soon. It is likely that the process of recognition of medical qualifications in the EU will be smoother and quicker once the modernisation of Directive 2005/26/EC comes into force.

If you still think medicine is a lost cause as a  “transnational” career, just have a look at the mileage Filipino doctor Natasha Reyes has racked up in the last few years working for Médecins sans Frontières. She’s been to Afghanistan, Colombia, India, Kenya, Libya, Pakistan, Philippines, and South Sudan.

When my father travelled from Lisbon, on the edge of western Europe, to the Philippines, on the eastern edge of Southeast Asia, in the early 70’s, it took him several days and around five or six stops. Nowadays, you can do the trip in less than 24 hours with only one stop. As work and people become increasingly mobile and globalised, the time for “transnational” doctors as the rule rather than the exception is closer than ever.

Tiago Villanueva is a GP based in Portugal, and former BMJ Clegg Scholar, and editor, Student BMJ.

  • Andrew Wilner, MD, FACP, FAAN

    I agree that there is enormous potential for “transnational physicians” in the new global marketplace. However, as you point out, current licensing regulations make this extremely difficult.

    In the United States for example, doctors must still be licensed in EACH STATE in which they practice, and EACH STATE has different requirements. In my view, there should be a federal license that allows doctors to practice in any state. I am licensed in 3 states, and it is a big job keeping up with the various arbitrary requirements.

    To date, no one has demonstrated any significant physiologic differences between people in different states that would warrant specific state licensing.

    Ultimately, a global license (good for anywhere on planet earth) would be the goal. Maybe the new generation of doctors will help speed this process along. I hope to live long enough to see it happen…