Abstract
Healthcare worker migration and international student migration have received extensive attention in public, political and scholarly discourse. The COVID-19 pandemic highlighted Australia's fraught relationship with students and healthcare workers from overseas and these tensions persist. Despite these parallel tracks of concern, the connections between healthcare and education migration have been underexplored. Building on Robertson's ‘education−migration nexus’ and grounded in Wyss and Dahinden’s ‘entangled mobilities’ approach, the paper proposes the healthcare−education-migration nexus as a framework for understanding the interdependencies of international education and Australia's healthcare workforce. Drawing on in-depth interviews with overseas-trained healthcare workers, this paper presents five ‘exemplary entanglements’ between these two domains, often characterised as operating under different structural, regulatory and discursive regimes. The findings show that international education underpins the mobility pathways of healthcare workers in Australia. With policymakers proposing restrictions on student migration, this paper points to potential unintended consequences for Australia's struggling care economy.
Introduction
Since the late 1990s, international education has been explicitly linked to immigration policies in Australia, with policy discourses positioning international students as ideal immigrants (Brunner et al., 2025). Recently, however, international students have become problematised as part of broader political concerns about migration levels (Tran et al., 2025) despite their ostensible value to the Australian economy and higher education system (Australian Government, 2023, p. 61). Government spokespeople and policy documents have oscillated between describing international students as ‘untapped potential’ (O’Neil, 2023) who must be supported to transition into the labour market, or as ‘visa hoppers’ whose numbers must be limited (O’Neil, 2024). The latest Jobs and Skills Australia report on international students highlights the international education sector's ‘contribution to building Australia's skilled workforce over the medium to long term’ (Jobs and Skills Australia, 2025, p. 13). Yet multiple proposals have sought to reduce Australia's international student population, for example, by increasing student visa fees, restricting Temporary Graduate visas, and proposing caps on international student enrolments (Norton, 2024).
During this period of creeping concern about student migration, the issue of healthcare worker shortages has come to prominence. Four in five (82%) health occupations were in shortage in 2023 (Jobs and Skills Australia, 2023), including doctors, nurses and many allied health professions. A recent supply and demand study projects an undersupply of nearly 80,000 nurses by 2035, as increasing supply fails to keep up with increasing demand for services (Department of Health and Aged Care, 2024). The closed borders and strained healthcare system during the COVID-19 pandemic highlighted deep links between migration and healthcare worker retention/recruitment. In reviews of Australia's migration system and healthcare workforce, the Australian Government and other stakeholders have shown renewed acceptance of migration to alleviate healthcare worker shortages (Kruk, 2023; O’Neil, 2023), retreating from previous aspirations of reducing reliance on overseas-qualified workers (Department of Health, 2021). This has focused attention on the ‘complex, costly and slow’ process by which such workers migrate and gain approval to practise in Australia (Kruk, 2023, p. 7).
Disparities in the ways that international students and internationally qualified health professionals (IQHPs) are positioned in public, policy and scholarly discussions have obscured how these two domains of Australia's migration system are entangled and interdependent. Taking the experiences of healthcare workers as the starting point for examining the interactions between migration and education brings fresh insights into how current policy settings in relation to skilled migration and international education shape (potential) skilled migrants’ journeys. Starting with health professionals and tracing how, why and where their pathways intersect with international education, allows us to go beyond the ‘visa determinism’ (Azeredo & Casado, 2025) that characterises much of the scholarly and policy discourse around student mobility. The paper draws on Wyss and Dahinden's (2022) ‘entangled mobilities’ framework to explore the multiscalar intersections between skilled and student migration. By drawing on the narratives of 37 IHQPs who have migrated to Australia (or who plan to do so), this paper illuminates these entanglements, proposes the concept of the healthcare−education−migration nexus to encapsulate the interdependencies, and calls on policymakers to understand that adjusting policy settings in one domain may have unintended consequences on another. To highlight these interdependencies, the paper proposes five ‘exemplary entanglements’ of healthcare and international education, as seen from the perspective of IHQPs. In so doing, it responds to Brunner and colleagues’ call for ‘a more nuanced understanding of the interplay between higher education, migration and mobility’ (Brunner et al., 2023, p. 1). Overlooking these entanglements renders the experiences and perspectives of healthcare workers less visible. As a result, policy levers might be proposed or operationalised without an adequate understanding of the consequences.
Entangled Mobilities: A Relational Framework
Alongside sociological scholarship relating to student and skilled migration, this paper is grounded in the broader conceptual framework of ‘entangled mobilities’ (Wyss & Dahinden, 2022). This framework emphasises how human mobilities are intertwined and interdependent, ‘how they depend on, evolve out of or enable each other’ (Wyss & Dahinden, 2022, p. 4). Using entangled mobilities as an analytical entry point, Wyss and Dahinden argue, avoids simplistic categorisations of mobile people, helps identify how movements are embedded in social, political and economic relationships, and encourages a consideration of the historical dimensions of intersecting mobilities. This paper draws attention to connections between healthcare worker and student migration and examines how they are interdependent in contemporary Australia. In political discourse, it has been common to treat these types of migration as distinct and disparate. Or, rather, the links between them are often overlooked or treated inconsistently. It is widely accepted that many international students are motivated by the prospect of longer-term migration, yet, as the Jobs and Skills Australia report notes, the ‘Genuine Temporary Entrant condition’ on student visas (2011–2023) means that students openly admitting their intention to stay in Australia would have likely been denied a visa (Jobs and Skills Australia, 2025, p. 23). Grounded in the lived experiences of people navigating these intersecting pathways, this paper ‘reveals the interplay of regimes of mobility with individuals’ mobilities’ (Wyss & Dahinden, 2022, p. 5). Specifically, it examines the international education and skilled labour migration regimes through the lens of individuals’ migration biographies, and problematises the simplistic categorisations that separate students from skilled professionals or confines them to a linear progression (i.e., from student to skilled migrant). In addition to looking at the entanglements of these mobility regimes, this paper explores how individual mobilities intersect and affect each other, by including the experiences of IQHPs who have moved to Australia as dependents on their partner's student visa.
Moving up the scale of analysis, the paper is grounded in a relational understanding of Australia's healthcare system as globally connected via the movement of people, objects, knowledge and emotion (Williams Veazey et al., 2021; Kaspar et al., 2019). While this paper focuses on the experiences of healthcare workers in relation to Australian policy, they are also impacted by social, political and economic structures and events elsewhere. For these participants, such global factors included the 9/11 terrorist attacks on the United States (2001), the Global Financial Crisis (2007–2009) and the COVID-19 pandemic (2020–2022, and ongoing), as well as national migration policies, wars and other political upheavals. An entangled mobilities lens provides a framework for examining how these different scales of entanglement shape the experiences of skilled and student migrants in Australia.
Towards a Healthcare-Education-Migration Nexus
The entanglements between education and migration are well-explored in the sociological, higher education, and migration literatures. The ‘education−migration nexus’ is a framework for understanding the political and social processes by which educational and labour migration pathways intersect in the context of globalised labour and education markets (Robertson, 2013). As outlined by Robertson and Runganaikaloo, the education−migration nexus is driven by ‘the twin desires of nation-states to obtain highly skilled and locally trained foreign labour and to attract more of the lucrative international student market by offering post-study migration options’ (Robertson & Runganaikaloo, 2014, p. 208). The term ‘edugration’ (Brunner et al., 2025) is used to describe the student-to-migrant pathway, which has been observed in many contexts, including Australia, Canada, Germany, the United Kingdom and United States. From the destination countries’ perspective, international students provide funding and fit the profile of ‘desirable’ future labour migrants: young; adept in the local language; integrated in the local environment; and with locally-legible qualifications (Hawthorne, 2008).
Many explorations of the relationship between education and migration assume a linear, uni-directional process. The edugration pathway involves international students transitioning to permanent residents after graduation through targeted immigration pathways (Brunner et al., 2025). Even scholars who emphasise the multidirectionality and unevenness of migration journeys (Gomes, 2021) tend to assume that the international student experience is the start of a journey, leading to permanent residence, return or onward migration. Studies of international students as workers focus on their potential economic contributions after graduation (Coustere et al., 2024) or their precarious employment experiences during their studies (Hastings et al., 2021). One exception is Robertson's (2022) study of young Asian migrants to Australia, which opens with a vignette of a married South Korean couple – a qualified nurse and engineer – who both use student visas at different times along their migration journey. It is interesting to note, in the context of this paper, that the nurse in Robertson's example ultimately abandons her quest for full nursing registration in Australia. Rather than focusing on skilled workers as the end of an edugration pipeline, this paper argues that student visas provide a vital – if problematic – infrastructure facilitating the migration and settlement of healthcare workers who are already qualified in their professional field.
Taking the experiences of health professionals as the starting point for examining connections between migration and education facilitates an analysis of how such interdependencies affect Australia's quest to meet its healthcare needs through migration. As such, it extends the analysis presented in two recent papers published in the Journal of Sociology. Tran and colleagues (2025) propose an ‘education−work−migration nexus,’ emphasising that work has become an ‘integral component’ of the education−migration pathway. Building on this insight, this paper highlights the specific role of the highly regulated work of healthcare. Meanwhile, in their paper on ‘problematising “visa determinism,”’ Azeredo and Castedo call for migration researchers to go beyond visa categories, which are not neutral descriptors, but rather ‘actively constructed through policy decisions, media representations and academic practices’ (Azeredo & Castedo, 2025, p. 4) and prioritise the interests and perspectives of receiving states. Such ‘visa determinism,’ they argue, leads to a flattening of understandings about people on student visas, obscuring their ‘multiple, overlapping and shifting identities’ (Azeredo & Castedo, 2025, p. 3). They also criticise the tendency in policy discourse to differentiate between ‘genuine’ and ‘non-genuine’ students not based on their compliance with visa regulations but based on their (presumed) intentions and identities. In their study of Brazilian student visa holders in Australia, they found that highly skilled workers applied for student visas to ‘buy time’ to navigate skilled migration requirements. This finding resonates with the experiences of participants in this study.
Structural Barriers Facing IQHPs
Australia has attempted to improve the migration and registration pathways for IQHPs, particularly since the Lost in the Labyrinth Report (House of Representatives Standing Committee on Health and Ageing, 2012)
highlighted challenges facing overseas-trained doctors (Hawthorne, 2015). Yet substantial barriers remain, for doctors, nurses and allied health workers (Kruk, 2023). These barriers include costly, complex and convoluted registration processes involving multiple examinations, bureaucratic documentation, assessments of skills and experience and tough English language requirements. Many health professions have multiple pathways, depending on the country of qualification or level of experience, creating a confusing landscape. Expensive and protracted visa processes, characterised by delayed timescales and volatility in the rights and requirements associated with them, exacerbate these barriers (Australian Government, 2023; see also Harris & Guellemin, 2020 for an overview of the historical entanglements of visa systems and employment pathways for IQHPs).
In the era of skills-based managed migration in Australia, IQHPs are positioned as relatively unproblematic as immigrants, on the basis that their entry is managed in relation to the needs of the Australian population, via skilled occupation lists and employer-sponsored visas. Conversely, IQHPs are positioned as potentially problematic as professionals, presenting potential risks to patient safety if their qualifications, skills and experience are inadequately verified, of insufficient quality to meet Australian standards, or are otherwise unsuitable for the local context (e.g., cultural competence) (Sheehy et al., 2025). Professional bodies have been accused of protectionism, using restrictive regulation of migrant healthcare workers as a form of professional closure (Finotelli, 2014). The establishment of a single National Registration and Accreditation Scheme for registered health practitioners in 2008 represented an attempt to introduce consistent standards and processes, and to balance public protection with public interest (i.e., availability of healthcare) (Elkin, 2015). While all IQHPs must be granted approval to practise in Australia, there are multiple pathways to approval, with ‘expedited pathways’ restricted to IQHPs trained in a relatively small group of countries deemed ‘comparable jurisdictions.’ For nurses, these currently include the United Kingdom, United States, Ireland, Singapore, Spain and some Canadian provinces (Sheehy et al., 2025). IQHPs also encounter structural and interpersonal exclusion and discrimination in the workplace and broader society, based on racism, xenophobia and/or linguistic hegemony, which privilege whiteness, people born in Australia, and English-speakers with accents (Correa-Betancour et al., 2024). This tension between the publicly expressed demand for IQHPs and the rigid systems which restrict their entrance into the Australian workforce was a common theme in the interviews, with some expressing cynicism, suggesting that systems were designed less to ensure patient safety and more to extract money from IQHPs hoping to work in Australia.
Against this background of structural barriers, this paper offers critical insights into the role of the international education sector in the mobility pathways of internationally qualified healthcare workers, by focusing on five distinct examples of entanglement.
Methodology
This article draws on in-depth semi-structured interviews conducted with 37 IQHPs in 2024. Thirty-five interviewees lived in Australia at time of interview; two had begun the process of migrating. Interviews were part of a programme of qualitative research focused on Australia's migrant healthcare workforce, in the context of challenges in meeting Australia's growing need for health and social care.
After gaining ethics approval via the author's university human research ethics committee, study details were circulated via email newsletter and social media by community groups, peak bodies, networks, professional associations and the research team's networks. Potential participants were directed to the project's website for further information and to provide informed consent. Participants were offered the choice of online, telephone or face-to-face interviews to accommodate their working patterns and encourage participation from across Australia. Participants were invited to share study information with their networks.
Participants were recruited across a range of healthcare roles: seven doctors; 15 nurses; and 15 allied health workers (13 physiotherapists, one dentist and one pharmacist). Despite some differences in the specific requirements of the migration pathways for doctors, nurses and allied health professionals, they share common milestones relevant to this analysis. They require a visa that allows them to live and work in Australia, and they must successfully apply for registration with the Australian Health Practitioner Regulation Agency (AHPRA) via the national board for their profession (e.g., the Physiotherapy Board of Australia, the Medical Board of Australia, or the Nursing and Midwifery Board Australia). The AHPRA regulates 16 protected health professions under a single National Registration and Accreditation Scheme. Precedent for considering IQHPs as a group can be found in the Independent Review of Overseas Health Practitioner Regulatory Settings and resulting report (Kruk, 2023). The Review was commissioned by the Australian Government to examine ‘the regulatory settings for the registration and recognition of qualifications of internationally qualified health practitioners’ (Kruk, 2023, p.1). The Review notes that while there are variations specific to each profession, all IQHPs will engage in the common steps of: (a) registration (including assessment of qualifications, English language, recency of practice, proof of identity, further assessments or study as necessary); (b) migration (including skills assessment, criminal history check, English language test, medical examination, etc.); (c) Medicare (issuing of provider and prescriber numbers); (d) employment (employment offer, credentialing, onboarding and supervision); and (d) post-registration (compliance, audits, registration renewal, etc.) (Kruk, 2023, p. 27). The review found that ‘the end-to-end journey for IQHPs seeking registration in Australia can be complex, slow and costly’ (Kruk, 2023, p. 29). This context provides the structural conditions under which IQHPs become entangled in the international education system.
This paper heeds the call of Bialas and colleagues (2025) to critically engage with state-created categories and classification systems. Participants were recruited according to their professional identity and education, rather than their visa status or current employment. This facilitated an analysis of the various ways that the migration of health professionals is entangled in international education systems, whether through mobility across visa categories, the entangled mobilities of migrating couples, or the engagement of students in the healthcare workforce.
Participants originated from a range of countries, including the Philippines (10), India (10), Chile (6), the United Kingdom (2), Germany (2) and Uganda (1), with the remainder coming from other countries in Asia (4) and South America (2). Most resided in New South Wales (15), Queensland (10) and Victoria (5), with three in Western Australia, two in South Australia and two overseas. Participants had arrived in Australia between two months and 18 years prior to interview: half had arrived in the previous six years. Two-thirds were female, one-third male, and most (31) were aged between 25 and 44, reflecting a core age group for skilled migrants in Australia. Sixteen participants had children aged 18 or under.
Interviews were semi-structured and iteratively explored participants’ experiences of migration, education, work and relationships. Interviews were wide-ranging, incorporating elements of life history, perspectives on Australia's migration system and thoughts about the future. The interviews ranged from 28–88 min, were audio-recorded and transcribed in full. Five interviews were conducted face-to-face, one via phone and 34 via Zoom. All participants were offered an opportunity to review their transcripts prior to analysis. Participants have been de-identified and given pseudonyms to protect their anonymity.
Interview data were analysed using reflexive thematic analysis (Braun et al., 2022), involving familiarisation with the data via listening to recordings and reading transcripts; followed by multiple rounds of inductive coding, generation of themes and further reflexive analysis. Following the identification of education and student visas as key elements of many participants’ migration trajectories, I searched the data again, looking for overlooked, complex or dissenting perspectives to include in the analysis. This approach, starting with inductive analysis, ‘seeks to allocate interpretative primacy to the experiences, perspectives and so on expressed within the dataset’ (Braun et al., 2022), before incorporating existing concepts and literature to deepen the analytic interpretation.
Findings
More than half the interviewees had used, or considered using, student visas as part of their migration pathway in Australia. As all participants were qualified health professionals (doctors, nurses, physiotherapists, dentists and pharmacists), and Australia's managed migration regime professes to prioritise migrants with such skills, the significant role of student visas might seem surprising. While participants outlined multi-faceted and dynamic reasons for moving to Australia and for following particular pathways, when focusing on participants’ engagement with student visas, five ‘exemplary entanglements’ emerged. These entanglements showcase the varied ways in which domains of international education and skilled migration intersect, and illuminate the interdependencies of these two systems in Australia.
Entanglement 1: International Education as a Safety Net for IQHPs
In the context of complex, confusing and often-changing requirements for IQHPs to migrate and practice in Australia, student visas were positioned as a less precarious pathway to becoming a health professional in Australia, even if student pathways might be longer and more expensive than direct skilled migration pathways. These participants saw themselves primarily as skilled professionals but used international education as a safety net or holding framework to facilitate their migration as health professionals. For some participants, international education had replaced the skilled pathway altogether: for example, nurses who undertook a second undergraduate degree in nursing before seeking work and permanent residency post-graduation. More commonly, student visas provided a reliable and accessible period of residence in Australia, during which they could study and pursue the documentation, registration and qualifications necessary to practise their profession in Australia. This second group were often pursuing postgraduate study, such as master's degrees in public health. For people on this dual education−migration pathway, a student visa bought them time to successfully navigate the complicated and protracted skilled migration pathway (Azeredo & Casado, 2025).
Evelyn, a nurse trained in the Philippines, had passed the examination to work as a nurse in the United States but the Global Financial Crisis had closed that pathway. Her husband's relatives told them that it would be ‘really easy to get permanent residency’ in Australia after doing a nursing degree, so she chose to study for a second Bachelor of Nursing in Australia even though it meant leaving their baby with relatives in the Philippines and working part-time jobs well below their skill-level to pay tuition fees and living costs. Although the policy landscape has changed since Evelyn graduated in 2012, registered nurses show some of the highest rates of permanent residency within ten years of commencing their studies in Australia and also high rates of retention in their occupation (Jobs and Skills Australia, 2025). In this context, international education provides a safer – albeit lengthier and more costly – pathway than the skilled migration pathways designed for skilled professionals. For people with healthcare qualifications, student pathways appeared to provide an (almost) guaranteed route to permanent residency and professional employment. In contrast, skilled migration pathways, involving multiple steps of registration, qualification, examinations and documentation, appeared lengthy, costly and risky, with multiple points at which the attempt might fail. As Cherry, a young Filipina physiotherapist in the early stages of her migration journey, articulated: ‘If I take the student visa pathway, it's more expensive than taking the exam. But it's more risky if I take the exam: what if it's not a really good result? Yes, I also consider that.’ (Physiotherapist, F, 18–24, Philippines) ‘I took it in August and I failed. […] Of course I can try it again. I spent $4,000 and there I am now today. […]The question is will I spend $8,000 in total in a test which is like the lottery. I’m not really sure. […] There is a chance I’ll fail it again.’ (Nurse, F, 25–34, Chile) ‘I could be a registered nurse applying for my PR. Then I want to apply for the citizenship because I already spent five years here in Australia. […] But as I didn’t get it, now I’m in this bridging waiting for the student [visa].’
These health professionals’ engagement in international education contrasts with common portrayals of international students as mobile persons at the beginning of their professional journey. As Collins and Shubin (2017, p. 23) note, international students are often associated with ‘a distinct period of youth’ on a linear pathway to futures. It also highlights that, despite Australia's professed need for IQHPs, the tensions between this need, and the desire to tightly manage migration and health professional registration, lead to IQHPs becoming entangled in the (currently more open) international education system. This resonates with the experiences of the skilled migrants in Azaredo and Casado's (2025) study, who were compelled to use student visas to ‘buy time’ to navigate the complex pathways towards professional recognition and skilled visas. Restricting student visas, without tackling the labyrinthine complexity of skilled migration pathways, could endanger Australia's quest for overseas-trained workers to sustain its healthcare system.
Entanglement 2: International Education as Personal and Professional Development for IQHPs
Although this study sought out IQHPs, it emerged during interviews that many (had) held student visas, and described the primary purpose of their mobility as access to education, for personal and/or professional development. This aligns with the Australian Government's Migration Strategy which states that ‘the primary purpose of a student visa is to study’ (Australian Government, 2023, p. 38).
Nevertheless, these participants all held overseas qualifications as healthcare workers, many worked in health/care roles alongside their studies, and most also pursued registration and qualification processes either during or shortly after their studies. For them, the entangled education−migration systems provided an option to remain in Australia after their study, to work in their chosen career with the additional skills they had gained through their studies, or provided a back-up plan if their new chosen career failed to eventuate. Importantly, though, they saw themselves as international students and prioritised their studies. For example, Deki, a dentist from Bhutan explained: ‘I’ve got my assessment, so now I can register for the part-one exams. But the thing is, a master's degree is quite time-consuming. […] So, I will not do it while I’m doing my master's degree because I’m paying so much for my master's degree anyway.’ (Dentist, F, 25–34, Bhutan). ‘We know that we are competent enough but then the Australian government wants us to prove [it]. And, again, it's not like something that we could just like register and do it, and then be over it. It's like months of preparation then, again, a hefty amount of money to just do the assessment. […] And, again, they do it just two times a year for the written exams. So, they put a lot of barriers for us to even join the market. So, for now I don’t even know whether I want to do dentistry or not because it's such an investment.’
While the previous entanglement highlighted how the international education system had become a safety net for health professionals struggling to navigate skilled migration pathways, this second entanglement highlights how IQHPs seek education in Australia to pursue ‘life goals’ and academic interests, and to attempt career changes. This choice is influenced by personal ambitions, by frustrations with their career or local health system, or by the attractiveness of an Australian education (vigorously promoted by the Australian state and education sector as a key export). It is also entangled in global events, with the COVID-19 pandemic raising the profile of careers in public health. These participants could be firmly positioned within the education sector as examples of the ‘genuine’ students envisaged by policymakers as student visa-holders. Yet, their narratives expose multiple entanglements with the healthcare workforce, whether in their current roles as carers and assistants (working below their skill level) or as potential health professionals (subject to migration and registration processes). These entanglements and multiple positionalities are rendered invisible by an exclusive focus on their visa status. As Azeredo and Casado argue, this ‘visa determinism,’ leads to a flattening of understandings about people on student visas, obscuring their ‘multiple, overlapping and shifting identities’ (Azeredo & Casado, 2025, p. 3). Participants’ experiences suggest that the strict division between students and skilled workers does not hold and is not productive, and that skilled pathways are difficult to navigate even for highly qualified workers already living in Australia.
Entanglement 3: International Education as Vehicle for Mobility Desires
This third entanglement highlights the use of student visas by IQHPs primarily to facilitate migration to Australia, with education and pathways to professional employment as lower priorities. Some participants described student visas as a last resort if all other migration pathways failed, including skilled migration pathways. Others described using student visas to enter or prolong their stay in Australia, ‘testing the waters’ while they considered their future.
For Meenakshi, an Indian physiotherapist planning to migrate to Australia with her pharmacist husband, a student visa is a ‘last option’ if they fail the examinations to apply for skilled visas: ‘My husband is an industrial pharmacist. So he's also preparing for pharmacy exam. So we both can apply for 482 visa. We both think if somehow we aren’t able to clear the exam, then I can apply for student visa. But it's just the last option. […] I’ve been working here in India around nine years. So, the student visa is not exactly good. First option obviously is PR, permanent residency. If I take a student visa and do student visa in … anyhow I just want to go to Australia.’ (Physiotherapist, F, 25–34, India – emphasis added)
Mobility also drove Rosa's entanglement with the international education sector. A physiotherapist and English teacher from Paraguay, Rosa first applied for student visas to explore Australia: ‘I didn’t have much of an expectation to stay to be honest. I just was testing the waters. I actually liked it. I came here as a student, so it was the whole process of student visa to student visa to stay here. […] I started studying English which wasn’t too necessary because I was an English teacher back home. […] That was my first visa. Then to stay here I had to renew my visa with a Diploma of Business which has nothing to do with me but I just wanted to stay here and buy more time.’ (Physiotherapist, Paraguay, F, 35–44 – emphasis added) ‘Physio is something that I’m passionate about, that I was frustrated for not being able to practise here. I started going from courses to different courses, a year of teacher training, a diploma of that. After five years, last year I thought I should do the registration process because I already postponed it for long. Almost six years of postponing doing the actual process because it's very expensive. It's very hard.’
Entanglement 4: International Education as a Facilitator of an Ancillary Healthcare Workforce
Almost all participants who had spent time on student visas described how they worked in healthcare, or care-related, roles alongside their studies. Because international students in Australia are allowed to work a prescribed number of hours, and because these participants were already qualified healthcare workers but unable to work in roles commensurate with their qualifications, it was common for them to work in lower-status healthcare, or healthcare-adjacent roles.
As noted above, Deki worked as a dental assistant alongside her postgraduate studies. Evelyn and Gabriel worked as assistants in nursing while they completed their (second) degrees in nursing. Gabriel's role later led to visa sponsorship and his first job as a Registered Nurse. Rosa worked as an Allied Health Assistant while studying courses unrelated to physiotherapy. She found it frustrating but acknowledged that it provided time and money to pursue the registration pathway: ‘It's fine. It's what it is and it's what's giving me the opportunity of earning money to get my paperwork sorted and my registration sorted. So I’m grateful for that. But I wish I had the autonomy already, that's why I’m doing the limited registration path, that is under supervision. They haven’t accepted yet because I didn’t have a valid English test.’
While it is well documented that many skilled migrants work below their capabilities (Committee for Economic Development of Australia, 2024), migrants on student visas are often excluded from these analyses. Overgaard and colleagues (2022) note that over a third of overseas-born non-professional care workers entered Australia on student visas, with unknown numbers entering as secondary applicants (see below). Relatedly, but beyond the scope of this paper, some participants noted that their partners had taken up care work in Australia, having previously worked in professional roles, such as information technology, engineering or business. This provides further evidence that non-professional care roles are being filled by migrant labour through ‘ancillary forms of labour supply’ such as people on student visas, working holiday visas and secondary visa holders (Overgaard et al., 2022). For both healthcare workers and their partners, these experiences in lower-status health/care roles represent an important entanglement of healthcare, education and migration. They also point to a potential corollary of reducing international student numbers: restricting this ancillary labour supply.
Entanglement 5: A Relational Mobility Pathway for IQHP Partners of International Students
Currently, little attention is paid to the skills and employment of the 100,000 partners granted permanent residency in Australia (McDonald, 2024, but see O’Dwyer, 2022; Webb, 2015), and even less to partners of student and graduate visa-holders. An entangled mobilities approach draws attention to migration as a relational process, highlighting ‘co-dependent mobility patterns between individuals’ (Wyss & Dahinden, 2022, p. 9). This exemplary entanglement highlights the experiences of IQHPs who arrived as secondary migrants on their partner's student visa. Although their healthcare skills are needed in Australia, and they have the right to work, they were usually unable to practise their profession, due to complex, lengthy and expensive pathways and the demands of raising a family while one partner studies, exacerbated by the lack of support for temporary migrants with families.
Mateo came to Australia for his wife's master's degree. In Chile, he worked as a physiotherapist in a ‘highly specialised hospital […] for the most complex injuries in the country.’ When they arrived, he needed to find work quickly ‘because childcare was quite expensive.’ He recalled, ‘I had to work in pretty much anything […] in construction sites, as a waiter, cleaning toilets in construction sites, delivery driver.’ Keen to use his skills and move into higher-paid employment, Mateo investigated registering as a physiotherapist: ‘I tried to start the process of getting my qualifications straight away. The information was so unclear that I literally had to call them when I arrived. Still, the information was quite unclear. I started the process, and I realised it's so expensive. It will take me at least a year because even to get the date for the test would have taken me a year. I felt like I don’t have this timing, so I’ll do something else. With all the price and the cost, I just postponed that. That wasn’t a priority at that time.’ (Physiotherapist, M, 35–44 Chile) ‘I won’t be doing any clinical work. Maybe in the weekends I will go back to work as before, I don’t think so. Or maybe being able to work as a physio from time to time, I would love to do that. But mainly it's because I want to close this process.’
Laura, a nurse from Chile, accompanied her spouse for postgraduate studies and later applied for a student visa to extend her English studies. Her husband has since graduated and found work, and they have applied for permanent residence. Like Mateo, Laura expresses a passionate devotion to her profession. But she has not been able to work as a nurse in Australia. Alongside caring for her children, Laura works as an assistant in nursing in aged care and as a pathology collector: ‘[If] you want to do nursing, you have to do a big process. With the English test, you have to have a very high score and also NCLEX preparation practice test. It takes around one year or one year and a half. It's a big process. It's expensive as well.’ (Nurse, F, 35–44, Chile).
Both Laura and Mateo had been trapped in casual work despite their professional qualifications. Exacerbating the complexity and expense of healthcare migration pathways is the lack of support for migrants as parents. Recent migrants who are parents earn between 3% (fathers) and 5% (mothers) lower hourly wages than non-parent migrants (Committee for Economic Development of Australia, 2024, p. 25). Migrants educated in a licensed field (e.g., healthcare) but working in non-licensed roles have the biggest gap in wages compared to Australian-born workers (Committee for Economic Development of Australia, 2024, p. 29). This fifth exemplary entanglement draws attention to the often-overlooked skills of international students’ partners, and the needs of migrant parents. Addressing these issues could boost Australia's healthcare workforce.
Discussion
In emphasising the entangled mobilities in the healthcare-education−migration nexus, this paper highlights the tension between the ongoing demand for healthcare workers (and the desire of (many) IQHPs to work in Australia) and multiple structural barriers that inhibit their pathway to professional employment (Harris and Guellemin, 2020). In this context, the international education sector mitigates some of these structural barriers to successful skilled migration. While not all the healthcare-worker−migrant-students in this study used student visas primarily to assist them in navigating the extended temporalities and costs of the pathways to residence and registration, the barriers to migrating directly as skilled migrants were a key factor in entangling the two systems. Indeed, the systematic downgrading of qualifications obtained outside Australia may drive qualified professionals into the international education system (Tan & Cebulla, 2022).
This paper proposes five ‘exemplary entanglements’ where the systems of international education and healthcare worker migration intersect: as a safety net for IQHPs navigating complex pathways to professional employment; a pathway for professional development; a vehicle for mobility; a facilitator of an ancillary healthcare labour force; and a relational mobility pathway for overlooked yet qualified partners of international students. Across these five exemplary entanglements, the findings undermine the constructed categorisation (Bialas et al., 2025) of international students and IQHPs as separate and different. The analysis in this paper demonstrates that even the ‘genuine’ focus on education demanded of international students does not preclude the possibility of also being a skilled and qualified healthcare professional, with or without aspirations of permanent migration. It provides further evidence of the limitations of ‘visa determinism’ (Azeredo & Casado, 2025) as a lens for understanding the experiences of people engaging in the education sector. Work is, as Tran et al., (2025) argue, an integral component of the contemporary education−migration nexus. In the context of highly regulated professions such as healthcare, the significant role of the education sector in mediating and mitigating skilled migration pathways has been largely overlooked and is a critical contribution of this paper. Indeed, these findings suggest that policymakers need to move beyond linear understandings of the relationship between the international education sector and skilled migration. To the idea of international education as a ‘pipeline’ to skilled migration, should be added these more dynamic entanglements, to gain a fuller understanding of the phenomenon at hand, and to understand the potential impact of adjusting policy levers, in either domain, on the other.
Focusing on the various ways that health professionals engage with the international education sector along their mobility journeys has implications for understanding both skilled migration and student mobility, and the interconnections between them. For example, it facilitates a temporal reframing of student migration, beyond its usual association with youth mobility. In contrast to the common temporal framing of educational migration as a discrete period in a linear pathway to adulthood, career progression and/or permanent migration (Collins & Shubin, 2017), these findings highlight a range of relevant temporalities including buying time, simultaneous migration−education pathways and transient or liminal temporalities. Moreover, centring healthcare worker-migrant-students highlights that many international students already hold professional qualifications, have often worked for years in their profession, and may arrive in Australia with partners and children. The relational approach firmly positions international students and IQHPs as embedded in familial networks, interdependent migration journeys and entangled mobility regimes. This is most clearly illustrated in the experiences of partners of international students, whose mobility has been enabled by their partner's student visa, but whose career aspirations are limited by the cost and extended timeframes of the professional regulatory system and by the Australian Government's restrictions on support for childcare, schooling and vocational education for temporary migrants. Beyond the scope of this paper, but also important, are the entangled mobilities arising from colonial histories (visible in the ‘comparable jurisdictions’ of expedited pathways, for example), the influence of peer networks and the numerous examples of participants migrating to join siblings and cousins already settled in Australia.
The entangled mobility regimes of healthcare and education intersect at multiple scales and across varied contexts. In the current context in which politicians appear to be seeking to restrict student migration to assuage public concerns about immigration, it behoves policymakers to pay attention to the interconnections between these two migration pathways to avoid unforeseen and potentially negative impacts on skilled migration and Australia's care economy. These issues resonate beyond Australia, with many countries facing difficulties in the provision of (health)care and tertiary education funding, in a context of heightened concern about migration. Taking a relational approach and foregrounding the ways in which these systems are entangled, through the perspectives of people commonly categorised as either students or health professionals, provides fresh insights into these intersecting contemporary concerns.
Footnotes
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Australian Research Council, (Discovery Early Career Researcher Award DE24010007).
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.