Doctors Beyond Borders: The Transnational Migration of Physicians in the Twentieth Century by Laurence Monnais and David Wright (review)

Transnational migration is a crucial aspect of the internationalization of medicine, so the very diverse studies in this volume are in principle to be welcomed. But their sheer diversity poses problems of definition, analysis, and coherence. The brisk introduction is descriptive of the contents rather than providing any in-depth overview of the historiography and key literature, and analysis of common issues and concepts. The volume could have been better organized, as without a firm structural framework, the studies appear random in their diversity. The volume adopts a neutral and opaque concept of "medical migration," whereas there are clearly multiple types of migration ranging from escape from persecution and oppression to the search for overseas postgraduate training.

Two chapters deal with forced migration—by John Weaver on German Jew-ish refugees to Australia and New Zealand, and by Annika Berg on the refusal of Sweden to allow refugee doctors to practice. Berg overlooks wider international dimensions when Sweden made efforts to send refugee doctors to Britain and the United States, as well as Sweden's extensive medical contacts with Nazi Germany. Weaver's analysis of Australia covers regulations on admission to practice in dif-ferent states. His analysis of New Zealand is cursory although he correctly demar-cates the shift from individual admissions to the drawn out Otago requalification scheme. Weaver makes a commendable effort to address wider issues in South East Asia, and here the complex situation in Shanghai really merits a chapter to itself. Because Weaver is concerned with "the legal maze" of administrative procedures, individuals are only sporadically traced, and what is missing is a full scale biograph-ical reconstruction of the refugees. Oddly, Weaver makes no direct reference to the Dunera internees of 1940 and to those deported doctors who elected to remain in Australia once released, although there is a passing reference to internment camps in the wider context of South East Asia. Both Berg and Weaver mistakenly assume that the refugees were all Jewish, when in fact there were significant num-bers of non-Jews. While many refugees were indeed displaced because of the Nazi anti-Semitic measures and were Jewish, this was not wholly the case. Non-Jewish refugees found particular favor in Canada: a chapter on Second World War efforts by medical refugees to find refuge in Canada and Newfoundland with its special status is conspicuously absent despite deportations from the UK in 1940 and some doctors and medical students electing to remain in Canada. Possible synergies are not explored such as between racism and gender discrimination: refugees to New Zealand with specialist training encountered intense discrimination from a hostile indigenous profession, who we learn later in the volume were antagonistic also to women. Thematic and theoretical analysis is called for.

Professional protectionism could often cloak virulent racism. This is explored by Juanita de Barros on West Indians seeking medical training, and by Joanna Bornat, Parvati Raghuram and Leroi Henry in an innovative chapter on discrimi-nation against South East Asian practitioners in the UK and the development of geriatrics as a recognised medical specialism. Julian Simpson, Stephanie Snow and Anheez Esmail tackle the important issue of "migrant doctors" in the UK's National Health Service (NHS). While the NHS's shortage of staff has been chronic and long-term, no attempt is made in the volume to disentangle medical migration with medically qualified refugees, junior doctors from overseas seeking clinical experience, and economic migrants.

A cluster of chapters deals with inward migration to North America. Greta Jones' impeccably researched chapter deals with how the exclusion of the Republic of Ireland from the AMA's listing of approved medical schools was overcome in the 1950s; the issue was largely resolved by a shift to individual assessment. There is a fascinating study of "Draft Doctors" moving from the United States to Canada at the...