Professional Challenges of Non-US-Born International Medical Graduates and Recommendations for Support During Residency Training

Division of Health Policy and Administration, Yale University School of Public Health, New Haven, Connecticut 06520-8088, USA.
Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 09/2011; 86(11):1383-8. DOI: 10.1097/ACM.0b013e31823035e1
Source: PubMed


Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training.
In a qualitative study conducted between March 2008 and April 2009, the authors contacted 27 non-U.S.-born IMGs with the goal of conducting qualitative interviews with a purposeful sample. The authors conducted in-person, in-depth interviews using a standardized interview guide with potential probes. All participants were primary care practitioners in New York, New Jersey, or Connecticut.
A total of 25 IMGs (93%) participated. Interviews and subsequent analysis produced four themes that highlight challenges faced by IMGs: (1) Respondents must simultaneously navigate dual learning curves as immigrants and as residents, (2) IMGs face insensitivity and isolation in the workplace, (3) IMGs' migration has personal and global costs, and (4) IMGs face specific needs as they prepare to complete their residency training. The authors used these themes to inform recommendations to residency directors who train IMGs.
Residency is a period in which key elements of professional identity and behavior are established. IMGs are a significant and growing segment of the physician workforce. Understanding particular challenges faced by this group can inform efforts to strengthen support for them during postgraduate training.

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    • "In both countries, roughly 20-25% of practising physicians have been trained abroad (CIHI, 2012; National Board ofHealth and Welfare, 2010). Traditionally, IMGs are offered positions in their destination countries in areas that are undesirable to local medical graduates; this can create a sense of social exclusion among IMGs (Bernstein and Shuval, 1998;Bourgeault et al., 2010;Chen et al., 2011). While local health care systems depend on immigrant physicians, the interplay between the ideology of nationalism and racism sets a context in which IMGs must establish their professional status and path to belonging to their new nation (Kyriakides and Virdee, 2003). "
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    ABSTRACT: This paper explores the othering processes and feelings of belonging among international medical graduates (IMGs) who seek to practise medicine in Canada and Sweden. Building on the theoretical literature on othering, belonging, and the conceptualisation of status dilemmas, we explore how IMGs in Canada and Sweden negotiate their professional identity, how they cope with being othered and how they establish a path to belonging. Analysing qualitative interviews with 15 Swedish and 67 Canadian immigrant physicians, who are either practising medicine or are in the process of professional integration, we demonstrate that the construction of professional identity among IMGs necessitates constant comparison between the differences and similarities among ‘us’ –immigrant physicians, and ‘them’ –local doctors. In this process, one’s ethnicity, gender, and professional status are intertwined with the experience of being seen as ‘the Other’. We also show that in negotiating their professional status, IMGs actively interpret the meaning of being a Canadian/Swedish physician. We conclude that feelings of belonging to a professional group (Canadian or Swedish) do not seem to be static but rather fluid, ephemeral and changing, depending on the context. Our analysis suggests that more attention should be paid to the social context in which experiences of processes of being othered and feeling belonging are being constructed and interpreted by people themselves.
    Full-text · Article · Nov 2015
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    • "However, the opposite is demonstrated by the findings of Baer et al. [13]. An earlier study conducted in the USA found that foreign-born GPs were less satisfied with primary health care work than native GPs [14]. A previous Finnish study found that the intent to leave a job is more prevalent among foreign-born GPs than Finnish GPs [15]. "
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    ABSTRACT: Background In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors). Methods Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis. Results The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an ‘active’ job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful. Conclusions Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland’s GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.
    Full-text · Article · Aug 2014 · Human Resources for Health
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    • "The patient-centred approach emphasised in the UK can be at odds with the focus of regulators in many countries (Rand 2009), with doctors' own cultural values and experience (Manderson & Allotey 2003; Hall et al. 2004; Jaffrey & Faroqui 2005; Hamilton 2009; Slowther et al. 2009; Chen et al. 2011; Dahm 2011; Slowther et al. 2012) and with patients' expectations of consultations or the physician-patient power dynamic (Dorgan et al. 2009; Hamilton 2009). Communicating emotional support for patients can be a challenge for doctors who have graduated overseas (Fiscella et al. 1997; Hawken 2005). "
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    ABSTRACT: Background: Historically, overseas-qualified doctors have been essential for meeting service needs in the UK National Health Service (NHS). However, these doctors encounter many cultural differences, in relation to training, the healthcare system and the doctor-patient relationship and training. Aim: To examine whether Hofstede's cultural model may help us understand the changes doctors from other countries experience on coming to work in the UK, and to identify implications for supervisors and clinical teams. Method: Telephone interviews were conducted with overseas medical graduates before starting work as a Foundation Year One (F1) doctor, followed up after four months and 12 months; and with educational supervisors. Data were analysed using a confirmatory thematic approach. Results: Sixty-four initial interviews were conducted with overseas doctors, 56 after four months, and 32 after 12 months. Twelve interviews were conducted with educational supervisors. The changes doctors experienced related particularly to Hofstede's dimensions of power distance (e.g. in relation to workplace hierarchies and inter-professional relationships), uncertainty avoidance (e.g. regarding ways of interacting) and individualism-collectivism (e.g., regarding doctor-patient/family relationship; assertiveness of individuals). Conclusion: Hofstede's cultural dimensions may help us understand the adaptations some doctors have to make in adjusting to working in the UK NHS. This may promote awareness and understanding and greater 'cultural competence' amongst those working with them or supervising them in their training.
    Full-text · Article · Jun 2013 · Medical Teacher
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