One in four actively practicing physicians in the United States is a graduate of an international medical school. International medical graduates (IMGs) account for one-quarter of all visits to office-based physicians in the United States and are more likely than U.S. medical graduates to practice in primary care shortage areas outside of metropolitan statistical areas. IMGs fill critical gaps in the U.S. health system. However, the authors maintain that IMGs face important challenges in transitioning to the U.S. health system. Most debate surrounding IMGs' transition focuses on overcoming cultural and linguistic barriers. Little attention has been paid to the influence of educational and practice socialization of IMGs on their medical encounters and other aspects of their U.S. clinical practice. The existing credentialing requirements do not prepare individuals for unique challenges-presented by the U.S. health system-that IMGs may not be exposed to during medical training or practice in their home countries or countries of training.Anecdotal evidence of the vastly disparate ways in which pain is approached and managed in major source countries of IMGs is a case in point. Using pain treatment as an exemplar, the authors contrast the capacity and emphasis placed on pain treatment in the United States and in major source countries of IMGs to illustrate the special clinical challenges faced by IMGs in their transition to U.S. practice. The authors conclude with recommendations to close this transitional gap, emphasizing the need for targeted assessment and training for IMGs.
[Show abstract][Hide abstract] ABSTRACT: Background. Pain is strongly associated with significant personal and societal costs. A crucial element of any initiative on pain must focus on eliminating pain care disparities that are pervasive throughout the United States health care settings.
Objectives. This report focuses on macro-level factors related to pain care disparities in the United States that may be amenable to policy interventions.
Methods. We identify concrete opportunities for achieving equity in pain care, especially those occasioned by recent legislative changes in the United States health care system. An aggressive policy, advocacy, and research agenda is synthesized in five domains: 1) structural/system; 2) policy and advocacy; 3) workforce; 4) provider; and 5) research.
Results. Inequities in pain care remain an important and neglected health policy concern. Many direct and indirect provisions within the Affordable Care Act (ACA) and other national initiatives that leverage on ACA offer opportunities to achieve equity in pain care. These include changes in insurance, in public, provider, and legislative education, in primary care and pain specialist training, improving workforce diversity, achieving uniformity in race/ethnicity data collection, emphasizing patient-centered outcomes research, and encouraging focus on pain care disparities within the comparative effectiveness research paradigm.
Conclusions. Recent national legislative initiatives within ACA are expected to generate multilevel efforts that will impact the flow of funding to address the pervasive issue of disparities. It is an opportune time for the pain community to take a lead in implementing a concerted agenda on pain care disparities in order to leverage these national initiatives.
[Show abstract][Hide abstract] ABSTRACT: The large-scale emigration of physicians from sub-Saharan Africa (SSA) to high-income nations is a serious development concern. Our objective was to determine current emigration trends of SSA physicians found in the physician workforce of the United States.
We analyzed physician data from the World Health Organization (WHO) Global Health Workforce Statistics along with graduation and residency data from the 2011 American Medical Association Physician Masterfile (AMA-PM) on physicians trained or born in SSA countries who currently practice in the US. We estimated emigration proportions, year of US entry, years of practice before emigration, and length of time in the US. According to the 2011 AMA-PM, 10,819 physicians were born or trained in 28 SSA countries. Sixty-eight percent (n = 7,370) were SSA-trained, 20% (n = 2,126) were US-trained, and 12% (n = 1,323) were trained outside both SSA and the US. We estimated active physicians (age ≤70 years) to represent 96% (n = 10,377) of the total. Migration trends among SSA-trained physicians increased from 2002 to 2011 for all but one principal source country; the exception was South Africa whose physician migration to the US decreased by 8% (-156). The increase in last-decade migration was >50% in Nigeria (+1,113) and Ghana (+243), >100% in Ethiopia (+274), and >200% (+244) in Sudan. Liberia was the most affected by migration to the US with 77% (n = 175) of its estimated physicians in the 2011 AMA-PM. On average, SSA-trained physicians have been in the US for 18 years. They practiced for 6.5 years before US entry, and nearly half emigrated during the implementation years (1984-1999) of the structural adjustment programs.
Physician emigration from SSA to the US is increasing for most SSA source countries. Unless far-reaching policies are implemented by the US and SSA countries, the current emigration trends will persist, and the US will remain a leading destination for SSA physicians emigrating from the continent of greatest need. Please see later in the article for the Editors' Summary.
PLoS Medicine 09/2013; 10(9):e1001513. DOI:10.1371/journal.pmed.1001513 · 14.43 Impact Factor
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