Republication: International medical graduate perceptions of health policy: A pilot study

Abstract

Introduction: International Medical Graduates (IMGs) have been a significant proportion of the American physician workforce since the 1960s. Nearly, one-fourth of practicing physicians today are IMGs, and the total number of IMGs in graduate medical education is increasing. The purpose of this pilot project was to assess IMG perceptions in three major policy areas: (a) IMG impact on the United States (US) healthcare, (b) IMG impact on countries of origin, (c) bias/discrimination faced by IMGs. Methods: A survey was conducted of IMGs in an internal medicine residency program based at a Queens, New York Hospital. Results: Surveyed population (n = 27) was 41% PGY1, 30% PGY2, 22% PGY3, 7% PGY4. 55% were men, 78% were between 25 and 35 years old, and 70% had emigrated to the US within the last 10 years. Impact on US healthcare: 54% supported US policies favoring immigration of IMGs willing to practice in underserved areas. 70% believed that IMGs would provide care in these areas for a longer period than the US graduates, due to satisfaction in serving that patient population (57%) and lack of better opportunities (22%). Justifiable reasons to reduce IMG immigration were to avoid a physician surplus (58%), to reduce harms to countries of origin (21%), and to avoid overcrowding residency programs (13%). Impact on countries of origin: Eighty percent of the surveyed IMGs do not plan to return to their country of origin. Fifty-six percent reported that physician emigration is a detriment to their countries of origin; 84% felt no personal obligation to help reduce the negative effects. Two-thirds received loans or subsidies for education from countries of origin. Thirty-one percent supported policies for required subsidies repayment, 27% for required service after medical school graduation, 25% for more restrictive emigration policies, 19% for required return to the country of origin after residency training, and 12% for monetary compensation beyond subsidies repayment. Bias or Discrimination: Over one-third of respondents felt bias or discrimination in their work environment. Eighty-five percent felt that medical professional organizations do not adequately address issues specific to IMGs, and 77% reported a desire for greater involvement in such organizations. Conclusions: There is a growing debate in public policy over the status of IMG migration to the US. This pilot study was designed to explore IMG attitudes toward three major policy areas. A larger, multi-institutional study should be considered. The following core competencies are addressed in this article: Interpersonal skills and communication, Professionalism, Systems based practice. Republished with permission from: Agrawal S. International medical graduate perceptions of health policy: A pilot study. OPUS 12 Scientist 2008;2(1):9-12.