Physicians' attitudes toward political and health care policy issues in cross-national perspective: A comparison of FMGs and USMGs

Abstract

This paper addresses the question of whether objective sociopolitical differences in national health care system are reflected in the attitudes of physicians working in those systems. An approximation of a cross-national design is used: physicians in the United States who were raised and trained in foreign countries (“FMGs”) are compared with physicians raised and trained in the United States (“USMGs”) in their attitudes toward political and health care issues. The main hypothesis is that FMGs hold more “liberal” attitudes than USMGs because of the more progressive features of most foreign health care system relative to that of the United States. Data were collected in the Spring of 1973 from nationally representative samples of physicians, including housestaff, in the United States. On three of the four attitude areas examined—economic-welfare liberalism, federal government involvement in health care, and national health insurance—the findings support the general hypothesis: FMGs are more liberal in their thinking than are USMGs. The differences are larger among housestaff than among “senior” physicians. On the fourth issue, support for peer reviews of physicians' work, there are no differences between FMGs and USMGs among senior physicians, but among housestaff, USMGs are slightly more favorable. This latter finding, a reversal in the dominant pattern of greater liberalism among FMGs, is interpreted in light of the debate over the competence of FMGs, especially housestaff, and their presumed sense of vulnerability to peer reviews. Alternative explanations of the general findings, such as the operation of selective factors in the migration of FMGs to the United States, are examined and rejected.