In the case of physicians, there is a common assumption that their knowledge and skills are transnational, spatially unbound and easily transferable from one organizational setting to another. But though the human body is seen as “universal”, the national and local health-care organizations are cultural units. They are characterized by ideas and norms about “proper” diagnosis and treatments or a “correct” professional performance. A migrating doctor may soon feel a pressure of implicit expectations on how to perform as a (male or female) professional, how to signal the right social stratum, how to perform authority, what treatments and techniques are the most acclaimed ones etc. In Sweden, there are a growing number of immigrant physicians. In our study, we focus on Polish doctors, who are one of the largest non-Scandinavian groups. Based mainly on in-depth interviews, we analyze how Polish doctors who are working in Sweden talk about their professional migration with a kind of “ethnographic sensibility”, a keen attentiveness to organizational details and cultural differences.
For many Polish physicians, migration initially created a feeling of de-skilling and confusion, not only due to language problems, but also because of the implicit social codes, e.g. the ”right” way of performing class and gender in the organizational context. In their endeavor to make sense of the implied standards and become a culturally viable professional subject, they applied what we call the “ethnographic sensibility”, observing an analyzing the processes they have been emerged in. They describe idiosyncratic organizational characteristics of the Swedish workplaces (and, by contrast, their former Polish ones), the explicit and implicit demands and know-how of a cultural setting. They also present their strategies for adjusting or resisting adjustment, and trying to make a difference in the organizational culture.
The migrant doctors tell us that theoretical research and such “hands-on”- skills, where good results can be quickly observed (e.g. in surgery or anesthesiology) get easily appreciated and embraced in the new organization. However, other kinds of experiential and more “culturally specific” knowledge (e.g. communication with patients or colleagues, strategies for treatment or health-care organizing) are often encountered with disinterest, suspicion or get “lost in translation”. Some Polish doctors state that the Swedish colleagues treat the Swedish health-care as superior in every aspect and show little interests in learning from the former East Europeans’ experience – even if their organizational knowledge may be far more complex.
The skills required of a doctor are thus often much wider than just medical or even administrative. When the Polish doctors get recruited, it is on the basis of “transnationally” valued diplomas and professional practice; i.e. the expert knowledge is supposed to be unbound and objectively judged. But then the doctors encounter tangible national and local medical practices, expectations and know-how, coexisting with these transnational standards. The Swedish clinics or district health centers inhabit complex power dimensions and cultural assumptions on the competences, proficiencies, appearance, communication etc. that fit the “proper” image of a doctor. The Polish doctors encounter a complex set of class- and gender-specific norms and traditions of social behavior, life-style, body language, tone of voice etc., considered appropriate for a doctor in Sweden. The embodied cultural capital should be marked by “right” eloquence, “right” body language, “right” taste, viable expressions of emotions and opinions etc. All of these prerequisites influence a migrating doctor’s possibility to perform a culturally valued professional role and to get respect in the organization.
One important aspect is the demand on the “right” gender and class performance. In the doctors’ “ethnographic” accounts, there is the notion of emotional control as an important Swedish mark of class and professionalism. Raising your voice or showing irritation towards the personnel is seen as a serious liability. Some women doctors dwell also on how the “feminine” image that used to be an esteemed part of their professional identity in Poland – e.g. short skirts, high heels, elegant blouses, make-up, “feminine” body language etc. – is suddenly very inappropriate in Sweden. Here, this kind of dress code and performance may be treated as unprofessional and unrefined, signaling wrong social stratum. Many informants perceive the Swedish professionalism (especially in the north) as resolutely gender-neutral, e.g. with the obligatory unisex uniforms, and signaling class through other means than elegance. Some male doctors were initially appalled by the rather disheveled and creasy look of their otherwise highly competent male colleagues.
The Polish doctors thus observe and reflect upon “cultural differences” in their struggles to comprehend, navigate among, adapt to, challenge or negotiate implicit, situated requirements of the doctor’s role, which lie beyond the strictly medical sphere, but still highly influence their professional authority. For some, these “ethnographic” observations and interpretations are a tool for cultural “passing” and doing things “the Swedish way”, e.g. acting along the class- gender-, nationally etc. specific expectations. But some choose the role of a colorful foreign doctor, especially if they possess unique medical competences, which are of value to the local organization.
8th Organization Studies Summer Workshop Organization Studies and the Day to Day Life of Cultures and Communities 23-25 May 2013, Mykonos, Greece