Foreign-born Physicians Research Articles

Going back home: Understanding the challenges of international medical graduates (IMGs) in oncology.

9001 Background: With an increasingly diverse patient population in the U.S., the need for a diverse clinician workforce has been exemplified. In 2021, 28% of the practicing physicians in the U.S. were born/trained outside of the continental U.S. Though strides in promoting diversity among oncologists have been made, continuous longitudinal assessments and improvements are important to ensure goals are met. We conducted the first cross-sectional study to understand the challenges and experiences of IMGs and Puerto Rican (PR) medical graduates in oncology in the U.S. Methods: An anonymous online questionnaire via Survey Monkey was developed. Non-U.S. IMGs and PRMGs who trained and/or practicing independently in the U.S. were eligible to participate. The study launched on Twitter with promotional materials, inviting participants to complete the survey. A list of IMGs and PR medical graduates was also compiled and an email invitation with the survey link was sent to. The enrollment period was from Sept-Dec 2023. Data was analyzed using descriptive statistics. Results: 97 participants from oncology-related fields completed the survey. Most were attendings (62.9%), and women (50.5%). 95.9% were IMGs and 5.2% PRMGs. 79.4% participants migrated after medical school and 90.7% were still living In the U.S. The main reasons for migrating were looking for better training (63.9%), seeking professional gains (57.7%), and lack of opportunities in their home country (49.5%). Most had to adapt to new cuisine (51.5%), community (53.6%), traditions (54.6%), and celebrations (58.8%). Participants expressed the need to change their dress code (33%), tone of voice (39.2%), the way they spoke (51.5%), and conducted themselves (49.5%). Participants faced racial/ethnic (54.5%), gender (29.7%), and language (41.9%) discrimination during training in the U.S. Similarly, they experienced racial/ethnic (46.8%), gender (32.8%), and language (24.6%) discrimination during independent practice in U.S. Most participants reported moderate personal (57%), yet extreme professional (57.4%) satisfaction in the U.S. 10.5% of participants had returned to their home country, 27.4% planned to, and 53.7% did not plan to return. The main reasons for going back home were family (67%), quality of life (28.9%), and feelings of isolation/lack of community (22.7%). Conclusions: Our study reveals that the main reasons physicians migrate to the U.S. is for education and professional opportunities. Yet these could come at a high cost, leading foreign-born physicians to compromise their true identities. Despite increasing representation of IMGs and PRMGs in the medical field in the U.S., they remain victims of discrimination at frequent rates. It is imperative to implement changes beyond diversifying the work field and strive for equity to create a more conducive environment for minority physicians.

Development of AGA’s Policy Agenda During the COVID-19 Pandemic

Development of AGA’s Policy Agenda During the COVID-19 Pandemic

The turnover intentions and intentions to leave the country of foreign-born physicians in Finland: a cross-sectional questionnaire study

BackgroundA physician shortage is a worldwide problem and foreign-born physicians fill in the shortage of physicians in many developed countries. One problem that is associated with the physician shortage is increased physician turnover. Also, regarding foreign-born physicians, migration can be costly. The present study aimed to examine the turnover intentions and intentions to leave the country of foreign-born physicians. We examined how demographics, discrimination, language problems, perceived employment barriers, satisfaction with living in Finland, team climate, job satisfaction and patient-related stress were associated with these factors.MethodsThe present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland that were aged between 26 and 65 (65% women). Binary logistic regression analyses were conducted to examine the associations.ResultsHalf of the respondents had turnover intentions and 14.5% had considered leaving the country. High satisfaction with living in Finland was associated with a lower likelihood of both turnover intentions and intentions to leave the country. High levels of discrimination and employment barriers were associated with a high likelihood of turnover intentions whereas good team climate was associated with a low likelihood of turnover intentions. High levels of language problems were associated with a high likelihood of intentions to leave the country.ConclusionsThe present study showed the importance of satisfaction with living in the host country, the prevention of discrimination and employment barriers, language skills and a good team climate for the retention of foreign-born physicians in their current job and in the host country. Thus, to keep their foreign-born physicians, health care organisations should implement measures to tackle these challenges. Organisations could arrange, for example, diversity training, self-assessment, team reflections, leadership coaching and culturally-specific networks. Moreover, internships associated with the qualification process could be utilised better in order to give a thorough introduction to the host country’s health care environment and the possibilities for learning the language.

Foreign-born physicians\u2019 perceptions of discrimination and stress in Finland: a cross-sectional questionnaire study

BackgroundForeign-born physicians fill in the shortage of physicians in many developed countries. Labour market theory and previous studies suggest that foreign-born physicians may be a disadvantaged group with a higher likelihood of discrimination and less prestigious jobs. The present study examines foreign-born physicians’ experiences of discrimination (coming from management, colleagues and patients separately) and patient-related stress and integration-related stress, and it examines how gender, age, employment sector, country of birth, years from getting a practicing license in Finland, language problems, cross-cultural training, cross-cultural empathy, team climate and skill discretion were associated with these factors.MethodsThe present study was a cross-sectional questionnaire study among 371 foreign-born physicians in Finland, aged between 26 and 65 (65% women). Analyses of covariance and logistic regression analyses were conducted to examine the associations.ResultsA good team climate and high cross-cultural empathy were associated with lower likelihoods of discrimination from all sources, patient-related stress and integration-related stress. Skill discretion was associated with lower levels of integration-related stress and discrimination from management and colleagues. Language problems were associated with higher levels of integration-related stress. The biggest sources of discrimination were patients and their relatives.ConclusionsThe present study showed the importance of a good team climate, cross-cultural empathy and patience, skill discretion and language skills in regard to the proper integration of foreign-born health care employees into the workplace. Good job resources, such as a good team climate and the possibility to use one’s skills, may help foreign-born employees, for instance by giving them support when needed and offering flexibility. Health care organizations should invest in continuous language training for foreign-born employees and also offer support when there are language problems. Moreover, it seems that training increasing cross-cultural empathy and patience might be beneficial.

In Rural Towns, Immigrant Doctors Fill A Critical Need.

Immigrant doctors have helped fill physician shortages for years. In the current political climate, are they welcome?

Threats or violence from patients was associated with turnover intention among foreign-born GPs – a comparison of four workplace factors associated with attitudes of wanting to quit one’s job as a GP

Objective: General practitioners (GPs) are crucial in medical healthcare, but there is currently a shortage of GPs in Sweden and elsewhere. Recruitment of GPs from abroad is essential, but foreign-born physicians face difficulties at work that may be related to turnover intention, i.e. wanting to quit one’s job. The study aims to explore the reasons to why foreign-born GPs may intend to quit their job.Design: Survey data were used to compare four work-related factors that can be associated with turnover intentions; patient-related stress, threats or violence from patients, control of work pace, and empowering leadership, among native-born and foreign-born GPs. These work-related factors were subsequently examined in relation to turnover intention among the foreign-born GPs by means of linear hierarchical regression analyses. The questionnaire consisted of items from the QPS Nordic and items constructed by the authors.Setting: A primary care setting in a central area of Sweden.Subjects: Native-born (n = 208) and foreign-born GPs (n = 73).Results: Turnover intention was more common among foreign-born GPs (19.2% compared with 14.9%), as was the experience of threats or violence from patients (22% compared with 3% of the native-born GPs). Threats or violence was also associated with increased turnover intention. Control of work pace and an empowering leadership was associated with reduced turnover intention.Practice implications: The organisations need to recognise that foreign-born GPs may face increased rates of threats and/or violence from patients, which may ultimately cause job turnover and be harmful to the exposed individual.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study.

BackgroundIn 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).MethodsThree 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.ResultsThe 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.ConclusionsPrimary 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.

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care

Although international migration of physicians is increasing, research information on their adjustment to working in a new country is scarce. This study examined the differences in employment, perceptions of psychosocial work environment and well-being between migrant and native physicians in Finland. A cross-sectional survey was sent to a random sample of physicians in Finland (N = 7000) and additionally to all foreign-born physicians licensed to practice in Finland (N = 1292). The final response rates were 56% (n = 3646) among native Finns and 43% (n = 553) among foreign-born physicians. Migrant physicians worked more often in primary care and on-call services and less often in leadership positions than native Finns. They more often experienced lack of professional support and lower work-related well-being compared with native Finns. Those migrant physicians who had lived for a shorter time in Finland perceived less stress related to electronic patient records systems and higher organizational justice compared with native physicians or those foreign physicians who had migrated earlier. Foreign-born physicians are more often employed in the primary care sector, where there are most difficulties in recruiting from the native workforce in Finland. Attention should be paid to enhancing equitable career opportunities and well-being among foreign-born physicians working in Finnish health care. Although migrant physicians are relatively well adjusted to Finnish health care in terms of perceptions of psychosocial work environment, their lower well-being calls for attention.

Psychosocial stress factors and intention to leave job: differences between foreign-born and Finnish-born general practitioners

Physicians' high dropout rate is a significant problem in primary care in many countries. One solution to this issue is to recruit internationally mobile physicians. This study explores the role of psychosocial factors in explaining intention to leave among GPs including potential differences between foreign-born and Finnish GPs. A cross-sectional questionnaire was sent to randomly-selected Finnish physicians (n = 7000) and all foreign-born physicians (n = 1297) living in Finland in the year 2010. The questionnaire was returned by 4333 physicians, of whom 832 were GPs. Of those 176 were foreign-born GPs. Intention to leave was more common among foreign-born GPs (59%) than among Finnish GPs (52%). High job demands were associated with higher intention to leave from primary care both in foreign-born (OR 1.90) and Finnish GPs (OR 2.20). This association remained among foreign-born GPs after adjusted the model for the country of origin or the reason for migration (OR 1.80, 1.82). Lack of job control, patient-related stress, and stresses related to teamwork were associated with higher intention to leave only among Finnish GPs (ORs 0.45, 1.75 and 1.99). There may be cultural differences in the psychosocial factors that enhance or prevent job involvement among physicians. Thus, novel thinking is needed in organizational development of GP work in order to better understand foreign-born physicians' specific needs in a target country. This study also suggests that lightening workload could help to attract more GPs, both foreign-born and Finnish, to primary care.

Conflict and emotional exhaustion in obstetrician-gynaecologists: a national survey

ContextConflicts over treatment decisions have been linked to physicians' emotional states.ObjectiveTo measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the...

Practice under pressure: primary care physicians and their medicine in the twenty-first century

Why a book on primary care? 'Because,' according to Timothy Hoff, 'there is no other part of the health care system that is in greater trouble right now, and no other part that plays such an important role in people's lives. Primary care always receives less attention than sexier specialty counterparts like surgery and emergency medicine'. Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first century - their work, stresses, hopes, expectations, and values. Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicine - larger numbers of younger, female, and foreign-born physicians. Primary care doctors may not deal with acute life-and-death situations on a minute-by-minute or daily basis; their value is in health promotion and prevention - giving patients the best chance to live long lives and avoid serious illness. But, for many Americans, the notion of prevention is out of vogue in a society that gets unhealthier by the year. Hoff even suggests that our increasing use of PCPs as mere gatekeepers to highly specialized services is furthered by a primary care physician community that has adapted to their evolving and politically constrained environment in ways that further their own demise. There is no simple, quick fix to what ails primary care and its practitioners in the United States today. Practice Under Pressure champions medical education reform and a rebranding of primary care careers, a new business model for delivering primary care services, and individualized attention to and support for groups that will soon dominate the ranks of generalist medicine, such as women and foreign-born physicians. In this first-of-its-kind sociological analysis of the primary care system in the United States, Hoff helps inform the current policy debate around national health reform and the key role of preventive care in producing greater access and quality within the U.S. health system.

Public Health and the Conrad Visa Waiver Program: How the Placement of Foreign-Born Doctors in Health Professional Shortage Areas is Helping to Mitigate the Effects of America's Growing Physician Shortfall

I estimate the effect, on age-adjusted and unadjusted death rates, of the placement of foreign-born physicians in Health Professional Shortage Areas through the Conrad State 30 program. Existing annual, county-level data on deaths, income, and the placement of Conrad physicians is collected for the years 1990- 2004 in Washington and Pennsylvania states. Ordinary least squares, difference-in-difference, robust regression, and fixed effects models are used to estimate the correlation between physician placement and county death rate. In Pennsylvania, Conrad physician placement in county x at time t is positively correlated with the death rate in county x at time t; in Washington, Conrad physician placement in county x at time t is negatively correlated with the death rate in county x at time t. The divergence of results is speculated to be due, among other factors, to differences in Conrad physician placement strategies and differences in the unobserved, state-specific methods of addressing counties' public health needs.

New Rules Limit Eligibility For J-1 Visa Waivers

Back to table of contents Previous article Next article Professional NewsFull AccessNew Rules Limit Eligibility For J-1 Visa WaiversEve BenderEve BenderSearch for more papers by this authorPublished Online:5 Mar 2004https://doi.org/10.1176/pn.39.5.0022Only physicians working in the neediest areas of the United States will qualify for waivers of foreign residency from the Department of Health and Human Services (HHS) under new application requirements issued in December 2003.Under the new guidelines, which became effective in January, HHS will process J-1 visa-waiver applications only for physicians working in regions the government designates as Health Professional Shortage Areas and who score at least 14 on a 25-point scale that assesses several criteria about the area in which the physician would be practicing.When HHS began accepting these waiver applications in June 2003, there were no score requirements. HHS suspended the program in October 2003 so it could review its policies and then reopened the program in January under the new guidelines.Personnel from the Shortage Designations Branch within HHS’s Health Resources and Services Administration assign the scores based on a number of variables including the population-to-health-care-provider ratio, the extent of poverty in the area, and the average travel distance to reach a health care facility in the area.In mental health shortage areas, the proportion of children and elderly people and the rates of alcohol and substance abuse are also taken into consideration.Furthermore, HHS will accept waiver applications only from health care professionals working in certain health care centers in a particular region. Qualifying facilities are public health centers as defined by the Public Health Service Act, a rural health clinic as defined by the Social Security Act, and a Native American/Alaskan Native tribal medical facility as defined by the Indian Self-Determination and Education Assistance Act.The U.S. Immigration and Naturalization Service requires foreign-born physicians who receive residency training in the United States to return to their countries of origin for at least two years following training before they can renew their visas. In inner cities or rural areas, however, certain agencies can request a waiver that would allow these physicians to stay in the country following residency training if they agree to practice in the underserved areas for at least three years.According to Joyce Jones, an official with the HHS Exchange Visitor Program, the new guidelines will “target the populations and communities in greatest need.”Jones said she doesn’t expect that the new guidelines will severely restrict the number of physicians applying for waivers. She noted, for example, that HHS had processed only 37 waiver applications since it began acting as an “interested government agency.”But psychiatrist Godehard Oepen, M.D., chair of APA’s Committee on International Medical Graduates, disagreed.He noted that before December 2003, there was no score requirement. As a result, the new rules “narrow down the options for international medical graduates [IMGs], who are known to provide care where American graduates don’t want to go—to rural settings, professional-shortage areas, and state hospitals,” he said.Oepen also said that IMGs “fulfill another essential role in providing care for patients who are of racial and ethnic minorities and enrich our profession with a diversity of cultural, ethical/spiritual, and linguistic perspectives. . . .They are one of the main sources of the richness and superiority of American medicine.”More information on U.S. Health Professional Shortage Areas, including criteria used to determine such areas and a searchable database of Health Professional Shortage Areas, is posted online at bhpr.hrsa.gov/shortage/. ▪ ISSUES NewArchived

New Law Makes It Easier For IMGs to Practice in U.S.

Back to table of contents Previous article Next article Government NewsFull AccessNew Law Makes It Easier For IMGs to Practice in U.S.Eve BenderEve BenderSearch for more papers by this authorPublished Online:20 Dec 2002https://doi.org/10.1176/pn.37.24.0009President George W. Bush signed legislation in November allowing hundreds of additional foreign-born physicians to practice in underserved areas after completing residency training in the United States.The provision is part of a Department of Justice Appropriations Authorization Act (HR 2215), which both the House and Senate passed by wide margins earlier this year.Under the new law, state health departments can increase from 20 to 30 the number of J-1 visa waiver recommendations for foreign-born physicians who wish to practice in underserved areas of the United States.Under the Conrad State 20 program, medical facilities in participating states have been able to request 20 waivers a year for physicians practicing in rural areas or inner-city neighborhoods, where there are far too few physicians to meet treatment needs.Sen. Kent Conrad (D-N.D.) launched the Conrad State 20 program in 1994 as a pilot project that extended waivers for foreign-born doctors who obtained their J-1 visa status by last June 1. The new legislation has extended that date to June 1, 2004. Forty-nine states now participate in the program, with Oklahoma being the exception.Regulations upheld by the Immigration and Naturalization Service (INS) require foreign-born physicians to return to their countries of origin for up to two years after completing a residency in the United States. After that two-year period, the physicians may attempt to return to the United States after applying for another form of immigrant visa.In inner cities or rural areas, however, certain government agencies can request a waiver that would allow the physician to stay in this country if he or she agrees to practice in the underserved area for at least three years.The U.S. Department of Agriculture (USDA) played a role as an “interested government agency” by providing recommendation letters on behalf of foreign doctors and their prospective employers to the Department of State, which reviewed the applications to ensure that they met federal standards. The INS then granted the J-1 visa waiver to the physician.However, in late September 2001, the USDA ended its participation in the waiver program due to security concerns stemming from the terrorist attacks on New York and Washington, D.C., causing concern among many in the medical community (Psychiatric News, May 17).That’s precisely why the move to increase the number of waivers for foreign-born physicians in each state is embraced by psychiatrists such as Godehard Oepen, M.D., chair of APA’s Committee on International Medical Graduates. “This new legislation is a wonderful change,” he said. ▪ ISSUES NewArchived

Panel 3: Speaker 2

Panel 3: Speaker 2

Action research in mental health: acute care teams

Action research applies knowledge and research findings to practical problems in order to strengthen the capability of the work unit, to contribute to the personal growth and satisfaction of organization members, and to improve theory. An action research project studying acute care teams at a state residential psychiatric facility found that foreign-born physicians chair high-performing teams. This unexpected result strengthens theories of diversity, status inconsistency, and project team effectiveness.