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Professional Experiences of International Medical Graduates Practicing Primary Care in the United States

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Abstract

Background

International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited.

Objective

To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US.

Design

Qualitative study based on in-depth in-person interviews.

Participants

Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut.

Approach

A standardized interview guide was used to explore professional experiences of IMGs.

Key Results

Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of “the deal”; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace.

Conclusions

Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs’ experiences may also improve the experiences of an increasingly diverse healthcare workforce.

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Acknowledgements

The authors would like to thank the Robert Wood Johnson Foundation Clinical Scholars Program and the Robert Wood Johnson Foundation for funding and support; the American Medical Association IMG section for assistance in recruiting; the Educational Foundation for Foreign Medical Graduates for helpful comments; and all the international medical graduates whose participation made this study possible. MNS is supported in part by the Yale Center for Clinical Investigation and the Association of American Colleges Nickens Faculty Fellowship. Some of the information reported in this manuscript was presented at the Robert Wood Johnson Foundation Clinical Scholars 2008 National Meeting (Washington DC, November 20, 2008); the American Association of Medical Colleges 2009 Workforce Conference (Washington DC, May 30, 2009); and the Academy Health 2009 Annual Research Meeting (Chicago IL, June 28, 2009).

Conflict of Interest

MNS has received honoraria from Pfizer and Astro-Zeneca in conjunction with speaking at the American Osteopathic Association October, 2009 national meeting. PGC, LAC, DB, SMB and AG have no conflicts of interest to report.

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Correspondence to Peggy Guey-Chi Chen MD, MSc.

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Chen, P.GC., Nunez-Smith, M., Bernheim, S.M. et al. Professional Experiences of International Medical Graduates Practicing Primary Care in the United States. J GEN INTERN MED 25, 947–953 (2010). https://doi.org/10.1007/s11606-010-1401-2

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  • DOI: https://doi.org/10.1007/s11606-010-1401-2

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