Constitutive and Contradictory intersections of marginality and privilege: Elite migration and south Asian migrant doctors’ experiences in the workplace in the UK

Leroi Henry (Working Lives Research Institute London Metropolitan University), Joanna Bornat and Parvati Raghuram (The Open University)

ESRC Seminar Series : The impact of migrant workers on the functioning of labour markets and industrial relations

17 June 2010

Background: Overseas trained doctors and the NHS

NHS dependence on and devalued migrant doctors since inception

Institutionalised discrimination against migrant doctors (Esmail & Carnall, 1997; Coker, 2001; Kyriakides and Virdee, 2003 ) – Career progression– Locality– Specialities– Remuneration and status

Background: Geriatrics as a Cinderella specialty

Marginalised specialty (Smith 1980; Jefferys 2000; Thane 2002)

Low professional status and lower remuneration

Expansion and staffing crises Disproportionate numbers of migrant

doctors clustered in Geriatrics (Goldacre et al. 2004).

Intersectionality

Critiques of feminist and anti-racist theories (Hooks 1981)

Analysis of multiple axes of power “the complex, irreducible, varied,

and variable effects which ensue when multiple axis of differentiation…intersect in historically specific contexts.” Brah and Phoenix (2004)

Key contributions of Intersectionality

The de-essentialisation of group memberships

The intersection of multiple axes of power as constitutive processes

The de-essentialisation of group memberships

Contesting “naturalising discourses that artificially homogenise social groups” Yuval Davis (2006)

Highlighting diversity and difference within groups

Not privileging one dimension of identity above others

Historically situated intersections

Beyond dual burden models: the intersection of multiple axes of power as constitutive processes

“For example, while race and gender are commonly analyzed together, to assume that race and gender play equal roles in all political contexts, or to assume that they are mutually independent variables that can be added together to comprehensively analyze a research question, violates the normative claim of intersectionality that intersections of these categories are more than the sum of their parts.” Hancock (2007)

Single oppressions cannot be analysed in isolation then added together

Emergent properties of intersections across these axes are historically contingent and fluid

Limitations: contradictoriness and transferability

The co-existence of privilege and marginality within groups and individuals

How movement transforms privilege and disadvantage

The co-existence of privilege and marginality within groups and individuals

Focus on the intersection of multiple forms of disadvantage rather than privilege

Is intersectionality a tool to understand the operation of oppression or a more general theory of identity (Nash 2008)

Are relatively privileged brown men intersectional subjects?

“individuals cannot be boiled down to one kind of societal categorization, and individual experience, by definition, has the potential to include experiences of marginalization and privilege simultaneously.” (Bedolla 2007)

Invaders in white consecrated spaces? (Puwar 2004)

Experiences of non whites and women in the professional and institutional niches created by and for elite white men

Outsiders juxtaposed with somatic norm of upper class white males

Interplay of race, class and gender in imprinting habitus and meeting somatic norm

Success dependent on utilising the appropriate social codes

Invaders in white consecrated spaces? (Puwar 2004)

”race, class and gender don’t simply interact with each other. They can cancel each other out…and in fact one can compensate for the others.” (Puwar 2004:127)

How the race, class and gender reconstitute each other

How mobility remakes the interactions between marginality and privilege

Overseas-trained South Asian doctors and the development of geriatric medicine

Two year ESRC funded project to undertake oral history interviews with working and retired geriatricians trained in South Asia in order to explore their experiences and contribution to the development of the care of older people in the UK.

http://www.open.ac.uk/hsc/research/research-projects/geriatric-medicine/home.php

ESRC RES-062-23-0514

Methods

60 oral history interviews with retired and serving geriatricians

Secondary analysis of 70 interviews with pioneers of geriatric medicine carried out by Professor Margot Jefferys in 1991.

Analysis of documents retrieved through purposive searches of archives

Data Analysis

Who defines when, where and which of these differences are rendered important in particular conceptions, and which are not?

Exploring narratives and focusing on self-presentation and the categories of difference such as education, profession, class and ethnicity introduced by subjects of research. (Ludvig 2006; McCall 2005)

The mobility of privilege

informants high status high achievers members of transnational epistemic

community with roots in the UK “I sent job applications with my reference from

consultant and so on and didn’t work at all, you know, when I first came. I sent lots of applications with copies of my glowing reference from my consultant in Sri Lanka, didn’t help at all.” (P021)

limited transferability of advantages to the UK medical labour market.

Becoming a geriatrician

It was difficult to get jobs in those days, understandably, because wherever you went there was a British graduate for the job you were applying. They obviously were given preference...the local graduates had a better chance of getting it. P023

I knew that I will never get a job in general medicine, it is highly competitive and the preference is given to the local population...I said “Whatever the job I get I’ll take geriatric medicine and then see how it is” L025

Posts in high status specialties reserved for “locals” or the right sort of chap

I still would know…in my own department who I don’t want and I’ll make sure I don’t get that person. Or who I want, I will try and see if I can make sure I get that person. It’s nothing personal but I think you need to make judgements for the future of your departments… medical careers are for life pretty much and if you going to appoint a consultant, for example, you got to work with the guy for the next twenty years. Well you don’t want just the fact that the brightest person only, you want the brightest person who also can work as a team. So those are quite important. It’s like marriages. L031

Becoming a consultant geriatrician

Because my consultant, who was exactly like me, I know him now, he was a trained cardiologist and then there were openings in geriatrics so he quickly moved into that area and he said “Look if you want to go through the fast track up then this is a less crowded road. You could do geriatrics and you could do cardiology and you could, it would be a good way up rather than waiting in the queue” L023

Accommodations and reconstituted marginalisation

Compromise over specialty, locality and type of hospital

Niche in a relatively marginalised segment of the elite largely vacated by white men

Merit awards 1970s-1990s

Significant material benefit Indication of esteem and status Under-representation of:

BME groups (Esmail 2004) Geriatricians (BGS and GMC)

Restricted access to resources Exclusion

Merit awards 1970s-1990s

And so it was relatively difficult…I think the main reason...is that the geriatricians had a hard, heavy, workload, clinical workload and had little time left to do other extra work, like research, publications and in terms of giving awards these other aspects were given more importance than the guy who was providing sort of a bread and butter service, working hard from morning till evening. I think that’s the main reason really. And without trying to be cynical, maybe old schoolboy ties and that sort of thing. (laughs) can play a part. But I better not say anything more than that. (laughs) L037 C merit award

…whether it is just the club situation… there’s a combination you see, you had working in less popular specialities, or unattractive specialities, usually there are not many award holders there who sit on these committees. … then suppose the ethnic thing does come in...I think the other thing is probably some people are very good at blowing their own trumpet. Unfortunately I don’t have the gift of the gab...Don’t go to parties or socialise. So that way, although I had very good working relationship with all colleagues…but it still didn’t have that other buddyism (laughs). If you don’t drink together and whatever, you know, and so it does affect. L027 C Merit award

Disadvantage and south Asian geriatricians in merit awards

Professional disadvantage for Geriatricians – low status and lack of resources

Outsider status and lack of clubability of Asian Geriatricians often marginalized from patronage networks

Limited transparency and near universal perception of unfairness

Intersections of low professional status and race

the prejudice against geriatric hospital is well entrenched here. Geriatricians are not considered as real consultants, or doctors even. You try to go and sit in the consultants’ dining room, you get ignored, (laughs)?…I am talking in 1986. You get completely ignored. You don’t know how to … partly I think it’s a complex reasons for that, one you are new. The other consultants they knew each other, they have been working here for a long time. Second you are an Asian, ok. And you haven’t got a lot of common subjects to talk to at that time. You knew very little of people. Even though you are a consultant sitting in the room. You don’t know the politics of the hospital (laughs) So there was many issues were there . (L025)

Addressing the disadvantage of south Asian geriatricians

Gradually I understood…and I could talk to most of the consultants … it took me about three years by then. It was hard…I need to reach out all the time you see. One you need to establish that you are medically competent. The moment you say geriatrician “Oh he’s useless, he doesn’t know medicine” ...So you need to break that concept. The only way you could do that is present some challenging cases in the meetings and discuss about them. So you have to win that respect...It took me about two or three years to get that level. L025

Addressing the disadvantage of south Asian geriatricians

And again language is such a thing that must you continuously communicate with people… even today I don’t think that I communicate very well, but (laughs) at least it is ok now... But I wasn’t to this level when I started as a consultant you see. So there were problems there. Language, culture and the local politics. Everything you need to learn…even talking to people there is a barrier there isn’t there? It just blocks you there. You can’t reach there. Try to go out and sit in the pub and talking to people to understand how they talk, their accents and the subjects they talk. And buying even drinks for the strangers just to understand what’s going on here you see. But still there is limitations. Partly because a lot of things I don’t understand what they are talking. I have nothing to contribute. L025

Conclusions

Constitutive and contradictory nature of the different axes of power and social inequality

 Intersectionality must address its blindspots to become a theory of identity  privilege and marginalisation accommodations as well as resistance.

Importance of developing cultural attributes deemed appropriate by dominant sectors

Variable transferability of privilege secured elsewhere   Interplay of privilege and marginalisation within the

variable racilaised niches in the labour market and other historical contexts such as immigration and equality legislation.