Foreign Physicians Research Articles

Migration policy and the supply of foreign physicians: Evidence from the Conrad 30 waiver program

In the United States, rural and low-income communities have difficulty attracting and retaining physicians, potentially adversely impacting health outcomes. With a limited supply of physicians completing medical school at US universities, foreign-born and educated physicians provide a potential source of supply in underserved areas. Although nearly a quarter of medical residents in US hospitals received their medical degrees abroad, the terms of the commonly used J-1 visa require a return to the home country for two years, which may limit the capacity of international medical graduates (IMGs) to pursue employment in the US market. Our analysis examines the extent to which reducing visa barriers impacts the supply of physicians at state and local levels, particularly in areas designated as medically underserved. The Conrad 30 Visa Waiver program gives states the opportunity to attract foreign IMGs to practice in underserved areas by waiving the two-year home residency requirement for those with J-1 visas and providing a path to obtaining US citizenship. Changes in the federal limit on the number of waivers per state, combined with variations in the state-level restrictions on eligible specialties and geographies in which physicians can work, provide evidence of the role of visa restrictions in limiting the supply of doctors. We find that the expansion of the cap on visa waivers increased the supply of IMGs in states impacted by the cap lift. There is little evidence of reductions in US-trained doctors in states where IMGs increases were the largest, suggesting little evidence for crowding out. Health Professional Shortage Areas (HPSAs) in states with fewer restrictions on the program had relatively more IMGs but no fewer US-trained doctors. Importantly, HPSAs in states with less restriction to the program also had relatively lower early mortality rates and lower COVID-19 death rates.

Forty-Eight Years in Ottoman Service: General Inspector of Quarantines Dr Bartoletti Efendi and His Activities [1840-1888

Foreign specialists were employed in the Ottoman Empire's health services, particularly during the 18th century onwards. The Ottomans required international cooperation to implement reforms to combat epidemics during the global epidemics of the 19th century. As a result, many foreign physicians joined the Ottoman medicine service. Therefore, numerous foreign physicians began serving with the central health organization in Istanbul and the quarantine units established in the provinces. Some physicians made significant contributions to the Ottoman sanitary administration through their positions, time in Ottoman service, and activities. Dr Bartoletti, who was born in Istanbul in 1808, was one of these specialists. After medical education in Italy, he started his Ottoman service as a quarantine doctor and became a member of the Sanitary Council. He also represented the Ottoman Empire at the international medical conferences held in Paris, Istanbul and Vienna and performed important duties in Ottoman sanitary affairs during his forty-four years of service. By examining Dr Bartoletti's activities between 1840 and 1888, this study aims to contribute to the existing literature on this field.

Turnover intention of foreign trained physicians in German rehabilitation facilities—a quantitative study

BackgroundGermany’s medical specialist shortage is an acute challenge, especially in the rehabilitation segment. One countermeasure is to recruit foreign trained physicians (FTP), but the high turnover of FTP is a burden on the departments that train them and integrate them professionally. Preliminary research showed that currently one in three physician positions in German Pension Insurance (DRV) contract facilities is filled by FTP.This paper examines factors related to turnover intention of FTP in German rehabilitative departments.MethodologyIn spring 2022, we surveyed FTP across all inpatient and outpatient rehabilitation departments under the German Pension Insurance, using a two-stage cross-sectional approach. We conducted an online survey of FTP and developed a specialized questionnaire that captured sociodemographic, occupation related and professional biographical data, turnover intention, satisfaction, difficulties with professional integration and departmental structural characteristics. To analyze retention within the rehabilitation field, we used a measure of turnover intention, taking into account the direction of potential turnover, residency requirements and considerations of returning to the rehabilitation field. The data was evaluated in a subgroup analysis comparing FTP with and without turnover intention using Fisher’s exact tests.ResultsThe sample includes n = 145 FTP, 119 stating no turnover intention and 27 with turnover intention. More than half of FTP with turnover intention wished to move to an acute care hospital. FTP with turnover intention are comparatively younger and came to Germany and were employed in the rehabilitation departments more recently, indicating an earlier career stage. Besides, career-related and regional factors show the strongest relation to turnover intention.Discussion and conclusionThe results reveal a group of “established FTP” whose professional integration has been successfully completed. FTP with turnover intention are comparatively younger, career-oriented physicians for whom work in a rehabilitative facility is a career springboard to gain a foothold in acute care clinics. A limitation is that FTP with turnover intention are difficult to reach and may be underrepresented in our sample.

Reviewing the pages of the first issues of «Perm medical journal»: 100th anniversary of this authoritative russian scientific edition

In 2023, we celebrate a historical date – the 100th anniversary of publishing the first issue of “Perm Medical Journal”. The first editor-in-chief was an outstanding doctor, the founder of the first surgical school, Professor V.N. Parin. The content of the first eight volumes of the journal issued from 1923 to 1930 is analyzed in the article. The first paper of the first issue of a journal was devoted to epidemic typhus and relapsing fever. The papers of great scientists, professors such as A.V. Pshenichnov, P.I. Pichugin, A.S. Lebedev, P.I. Chistyakov, V.P. Pervushin and others impress by profundity of thought. Great attention in the journal was paid to the questions of surgery and urology; these papers constituted 52% of the content of the first eight volumes. Analysis of the works belonging to V.N. Parin, D.P. Kuznetsky, V.P. Shipitsyn, B.Ya. Strelkov, A.A. Vechtomov and other authors, which were devoted to diagnostics, treatment and prevention of gastric ulcer, ventral hernias, tumors of different organs, inflammatory surgical diseases, vascular, urinary, urethral and genital injuries, rhinoplasty, show that these publications aroused interest among Russian and foreign scientists and physicians and significantly influenced a progress of medical science and practical health care.

Intercultural characterization of the empathetic physician: Experiences of chronic patients of the chilean public health system

Empathy is a fundamental element of the physician-patient relationship for treatment and therapeutic adherence that has had to face significant changes due to the migrations of the health system in Chile. Characterize the empathetic physicians according to the perceptions of chronic patients during the encounter with national and foreign doctors in the public health system in the Maule Region. Qualitative study of exploratory-descriptive type. Twenty chronic patients from public health services in the Maule region were interviewed remotely using the free listing technique. A thematic processual qualitative analysis of the content and a descriptive quantitative analysis were carried out where the frequency and salience of the Smith index assisted by the Anthropac 4.98 software were obtained. Seven categories of empathetic care were identified in the physicians-patient relationship: Affectivity (37%), Communication (19%), Attention (13%), Respect (12%), Research (9%), Knowledge (5%) and Efficiency (5%). The affective and psychoemotional aspects were more valued than the cognitive aspects of empathetic care. No differences were observed in assessing the empathetic care of patients seen by Chilean physicians and those treated by foreign physicians.

Ślady ajurwedy w dziewiętnastowiecznej medycynie polskiej: kazus szpitali cholerycznych w Warszawie i Poznaniu w latach 1831 i 1866

Elements of Ayurveda in nineteenthcentury Polish medicine: the case of cholera hospitals in Warsaw and Poznań in 1831 and 1866 The article contributed to the history of translational medicine and presents the transfer of elements of the Ayurvedic treatment of cholera to the medical practice in Poland in the 19th century, carried out through Western European doctors. Special attention is paid to the role played in this process by foreign physicians and surgeons working in Warsaw hospitals during the November Uprising. Their education, medical experience and competence as regards cholera treatment were described, as well as the scientific research they carried out in Warsaw and their preferences for cholera treatment. It was demonstrated that the Hindu treatment regimen was accepted by colonial doctors and after some modifications disseminated in Europe. To assess the persistence of the treatment in Poland, the medications used in 1831 in Warsaw hospitals were compared with those administered to patients in the Poznan lazarette in 1866. The article is based on foreign doctors reports on the fight against cholera in 1831 in the Kingdom of Poland, as well as a unique report on the treatment of cholera at the Sisters of Charity Hospital in Poznan in 1866.

Migration Policy and the Supply of Foreign Physicians: Evidence from the Conrad 30 Waiver Program

Migration Policy and the Supply of Foreign Physicians: Evidence from the Conrad 30 Waiver Program

Turnover intention of foreign trained physicians in German rehabilitation facilities

Abstract Germany's medical specialist shortage is an acute challenge, especially in the rehabilitation segment. One countermeasure is to recruit foreign trained physicians (FTP), but high turnover of FTP is a burden on the departments that train them and integrate them professionally. Preliminary research showed that currently one in three physician positions in German Pension Insurance (DRV) contract facilities is filled by FTP. This paper examines the turnover intention of FTP in German rehabilitative departments. In spring 2022, we conducted an online survey of FTP that captured sociodemographic and professional biographical data, turnover intention, satisfaction, difficulties with professional integration and structural characteristics. The data was evaluated in a subgroup analysis using chi-square tests. The sample includes n = 145 FTP, 119 stating no turnover intention and 27 with turnover intention. More than half of FTP with turnover intention wished to move to an acute care hospital. They are significantly (p < 0.05) younger, have worked in Germany and in the institutions for a shorter time, and have studied in more countries than FTP without turnover intention. The latter are proportionally more likely to have a German specialist title and management responsibilities. FTP with turnover intention are far less satisfied, particularly with career prospects and institution location. Structurally, FTP with turnover intention are proportionately more likely to be based in peripheral regions than conurbations, which are where all FTP without turnover intention are based. FTP with turnover intention have reported a much higher rate of discrimination by non-physician colleagues. Key messages • The results reveal a group of ‘established FTP’ whose professional integration has been successfully completed. • FTP with turnover intention are comparatively younger, career-oriented physicians for whom work in the rehabilitation facility is a career springboard to gain a foothold in acute care clinics.

Healthcare Interpreting in Emergency Departments: Importance of Healthcare Interpreters in the Communicational Process of Foreign Patients and Physicians

This study aims to investigate the role of healthcare interpreters in overcoming language barriers in Emergency Departments from the perspective of emergency physicians in Türkiye. Although there is a limited number of studies focusing on healthcare interpreting in EDs, they do not evaluate the opinions of ED physicians. Therefore, this study will be a pioneer research analyzing the importance of healthcare interpreting from the perspective of ED physicians in Türkiye. For this purpose, a questionnaire comprising 14 questions was prepared through the survey method to collect the opinions of emergency physicians about communication problems with foreign patients. The convenience sampling method was used to determine the study group consisting of 102 emergency physicians. The data was analyzed with descriptive analysis techniques by calculating the arithmetic mean and frequencies. After the data analysis process, it was found that communication problems in EDs lead to prolonged duration of taking anamnesis, delays in diagnosis, treatment, and discharge, extensive medical examinations, and unnecessary use of medical resources.

Medical empathy in the physician-patient relationship: A review from a cultural perspective.

Medical empathy is a fundamental pillar in the social construction of the physician-patient relationship. In this light, patients' beliefs and perceptions of medical empathy, and physicians' empathic attitudes towards their patients are guided by their socio-cultural understandings and expectations, which naturally vary from culture to culture. Such considerations are particularly relevant to the field of social psychology and to public healthcare systems where a growing number of foreign physicians characterise their highly diverse socio-demographic makeup. However, there is no clear research agenda concerning the way in which medical empathy should be investigated from a cultural point of view in years to come. To this end, the paper presents a systematic review of studies that examines medical empathy in healthcare contexts from a cultural perspective to synthesize their findings, evaluate their limitations and propose future lines of research. The review considers articles published from January 2010 to June 2022 in the PubMed, Scopus and Web of Science databases and follows the PRISMA methodology. Three studies, of the 314 articles analysed, met the criteria established for this investigation. The analysis shows that research on medical empathy has analysed the cultural diversity of physicians of a limited range of cultural backgrounds, exclusively from a cross-cultural perspective, employing quantitative research designs and exclusively using the Jefferson Medical Empathy Scale. We suggest that future studies adopt an intercultural perspective of medical empathy as a psychocultural construct rather than as merely a sociocultural one.

Impact and Sustainability of Foreign Medical Aid: A Qualitative Study with Honduran Healthcare Providers.

There is growing concern about the sustainability and long-term impact of short-term medical missions (STMMs)-an increasingly common form of foreign medical aid-given that brief engagements do little to address the underlying poverty and fragmented healthcare system that plagues many low- and middle-income countries (LMICs). In the absence of formal evaluations, unintended but serious consequences for patients and local communities may arise, including a lack of continuity of patient care, poor alignment with community needs, and cultural and language barriers. We conducted semi-structured interviews with Honduran healthcare providers (n = 88) in 2015 to explore local providers' perceptions of the impact and sustainability of foreign medical aid on patient needs, community health, and the country's healthcare system. Respondents represented a random sample of Honduran healthcare providers (physicians, dentists, nurses) who worked for either a government-run rural clinic or non-governmental organization (NGO) in Honduras. Honduran healthcare providers largely framed foreign medical teams as being assets that help to advance community health through the provision of medical personnel and supplies. Nonetheless, most respondents identified strategies to improve implementation of STMMs and reduce negative impacts. Many respondents emphasized a need for culturally- and linguistically-tailored medical care and health education interventions. Participants also recommended strengthening local partnerships to mitigate the risk of dependence, including on-going training and support of community health workers to promote sustainable change. Guidelines informed by local Honduran expertise are needed to increase accountability for more robust training of foreign physicians in the provision of context-appropriate care. These findings provide valuable local perspectives from Honduran healthcare providers to improve the development and implementation of STMMs, informing strategies that can complement and strengthen healthcare systems in LMICs.

Documenting Difference: Standardizing Foreign Physicians

This essay traces the transformation and standardization of the first cohort of Asian physicians trained outside the United States into Foreign Medical Graduates (FMGs) within the United States through documentary regimes. Congress solicited foreign physicians under the Hart-Celler Immigration and Nationality Act of 1965 to address doctor shortages in inner-city and rural communities throughout the country—a trend that continues today. Central to their migratory journey was an archive of expertise, a compilation of documents intended to verify identity, skill, and competence. Through the analysis of a physician's case file, new relations to documentation emerge that reveal how claims of underdocumentation, incorrect documentation, and overdocumentation regulate immigrant possibilities. In adopting this approach, this case study moves away from the unskilled / model minority dichotomy to show how documentary proceduralism operates as a racializing, disciplinary strategy across categories of immigrant labor.

Sassanids and Their Attitude to Medical Knowledge

The Sassanid Empire ruled in Iran between 224 AD and 651 AD. The founder of this dynasty, Ardashir I (241-224 AD), a Zoroastrian cleric, took two very important steps in the beginning; One was the creation of a central government and the other was the formalization of the religion of Zoroaster. The homogeneity and alignment of government and religion in the Sassanid administration had very important effects on the growth and development of science and knowledge, especially medical science, which began in the Achaemenid Empire (330 559 AD). The under-consideration question in this research is that despite the class system and the monopoly of learning science and knowledge in the privileged classes of society, what was the status of medical science in the Sassanid period? This study showed that medical science had the highest position in the teachings of Zoroastrian religion; Because with that, they took care of their health and performed their religious duties well, and with it, they overcame the devil. In Zoroastrian religious texts, the duties and characteristics of the physician, the types of diseases and how to treat and the rules related to ‘Tebabat’(medicine) are discussed. In addition to this, the encouragement policy of kings and Sassanid government, including; Expanding cultural and scientific relations with India, Greece and Rome, translating the works of foreign physicians into Pahlavi and archiving them along with the formation of a large library, inviting foreign physicians to work at ‘GondiShapur’ University and sending Iranian physicians abroad in order to acquire more medical knowledge and experience, they were very influential in the growth and development of medical science. The current study has been conducted in a historical method with reference to library sources and archaeological sources as well as new researches have been used to complete the topics. It seems that due to the spread of Iranian civilization in the Sassanid era and paying attention to science and knowledge as well as the creation of a medical city in the Sassanid period, medical knowledge had a great importance in this period and this knowledge was researching professionally.

All the love: transnational youth and disability in El Salvador’s civil war

ABSTRACT During El Salvador’s civil war, the Farabundo Martí National Liberation Front (FMLN) developed infrastructure and expertise to improve medical attention for combatants and rural and poor Salvadorans alike. This expansive popular health system included Salvadoran nurses, foreign physicians and community health promotors. However, hundreds of wounded combatants required more intensive rehabilitation. This article discusses the FMLN’s approach to youth and disability through a trio of documentary films that examine the popular health system, the 26 July rehabilitation camp outside of Havana and the work of German physician Christa Baatz. These films fused youth, disability and transnational solidarity to appeal to a spirit of revolutionary love. They not only spoke of transnational solidarity but were also transnational texts that circulated in order to build support for the FMLN. Most importantly, they conveyed the voices of young disabled combatants whose understandings of loss, sacrifice and revolution are otherwise forgotten. The films suggest the formation of an identity as lisiados de guerra grounded in the mutualist principles of the popular health system. However, the signing of the Peace Accords in 1992 ensured that human rights would become the dominant framework for disability politics, sidelining the solidarity that guided popular health.

Foreign Physicians: Discriminatory Patient Preferences and Doctor Availability

Foreign Physicians: Discriminatory Patient Preferences and Doctor Availability

Abstract 13866: Interventional Heart Failure: Current State of the Field

Introduction: The expanding intersection between interventional cardiology (IC) and advanced heart failure (AHF) has raised interest in an Interventional Heart Failure (IHF) specialty. Methods: We conducted a survey among cardiologists trained in AHF and IC to investigate the state of this new field. This was distributed by the Society of Cardiovascular Angiography and Interventions (SCAI) via their newsletter and publicized via Twitter. Results: Data from 55 respondents in 47 medical centers (22% outside the United States) was acquired. In the US, these centers are concentrated in the South (43%) and Northeast (23%), and commonly host advanced therapies programs: 89% ECMO, 69% durable LVAD and 56% heart transplant. Respondents were 94% men; 47% were 35-45 y. and 41% were &gt45y. old. Foreign physicians accounted for 13%. In the US, 56% of respondents were international medical graduates (IMGs) and 31% were American medical graduates (AMGs). Most completed training after 2013 (69%). IC fellowship was completed first by 47% of AMGs, 50% of IMGs (Figure). Only 23% trained beyond AHF and IC. Area of clinical focus is coronary artery disease (CAD) 42%, cardiogenic shock (CS) 40%, structural procedures 13%. Respondents regularly implant IABP (95%), Impella (83%) and VA-ECMO (69%). Time devoted to IC is 50-80% in 49% (Figure). Most take STEMI call (84%) and do CCU rounds (95%) while only 21% take donor call. Only 32% feel their training was excessive and 82% would repeat it. Most (84%) support the creation of integrated 2-year AHF and IC fellowships. Conclusions: We report the first survey assessing the IHF specialty. We observed a growing workforce focused on CAD, mechanical circulatory support and CS. Development of integrated training pathways is viewed favorably by the IHF community.

Virtual Communication Across Differences: Development of a Workshop on Managing Patient Bias.

Despite the prevalence and detrimental effects of racial discrimination in American society and its health care systems, few medical schools have designed and implemented curricula to prepare medical students to respond to patient bias and racism. During the summer of 2020, a virtual communication class was designed that focused on training medical students in how to respond to patient bias and racism. Following brief didactics at the start of the session, students practiced scenarios with actors in small groups and received direct feedback from faculty. For each scenario, students were instructed to briefly gather a patient's history and schedule an appointment with the attending whose name triggered the patient to request an "American" provider. In one scenario, the patient's request was motivated by untreated hearing loss and difficulty understanding accents. In another, it was motivated by racist views toward foreign physicians. Students were to use motivational interviewing (MI) to uncover the reasoning behind the request and respond appropriately. Students assessed their presession and postsession confidence on 5 learning objectives that reflect successful communication modeled after MI techniques. Following the session, student skills confidence increased in exploring intentions and beliefs ( P = .026), navigating a conversation with a patient exhibiting bias ( P = .019) and using nonverbal skills to demonstrate empathy ( P = .031). Several students noted that this was their first exposure to the topic in a medical school course and first opportunity to practice these skills under supervision. The experience designing and implementing this module preparing students in responding to patient bias and racism suggests that such an effort is feasible, affordable, and effective. With the clear need for such a program and positive impact on student confidence navigating these discussions, including such training in medical school programs appears feasible and is strongly encouraged.

Physicians imprisoned in Franco Spain’s Miranda de Ebro “Campo de Concentración”

AbstractMiranda de Ebro was created in 1937 to imprison Republicans and foreigners who fought with the International Brigades in Spanish Civil War. From 1940, the camp was used only to concentrate detained foreign refugees with no proper documents. More than 15 000 people, most of them from France and Poland, were kept there until the camp was closed in January 1947. Playing both sides of the international divide, fascist Spain at various points in time allowed passage and was a country of refuge both for those escaping Nazism and for Nazis and collaborators who, at the end of World War II (WWII), sought to escape justice. Treatment of each of these groups passing through Miranda was very different: real repression was meted out to the members of the International Brigades (IB), tolerance shown towards those escaping Nazism, and protection and active cooperation given to former Nazis and their collaborators. For the first time, data about foreign physicians imprisoned in Miranda de Ebro were consulted in the Guadalajara Military Archive (Spain). From 1937 to 1947, 151 doctors were imprisoned, most of them in 1942 and 1943, which represents around 1% of the prisoners. Fifty-two of the doctors were released thanks to diplomatic efforts, thirty-two by the Red Cross, and ten were sent to other prisons, directly released or managed to escape. All of them survived. After consulting private and public archives, it was possible to reconstruct some biographies and fill the previous existing gap in the history of migration and exile of doctors during the Second World War.

Canadian fellowship experience: the different challenges and emotions faced by an International Medical Graduate and mitigation strategies

Acknowledging the mental remodeling that a foreign physician goes through and attempting to mitigate the difficulties of this process is crucial to achieving better outcomes in education and patient care. Canada's Healthcare System offers Clinical Fellowship Programs that allow physicians specialists to obtain advanced expertise in a chosen subspecialty. In a Clinical Fellowship, Canadian Medical Graduates (CMGs) practice alongside International Medical Graduates (IMGs); however, there is evidence that they undergo different challenges in the learning experience. IMGs usually have a higher cognitive load during the adaptation period, which can be due to multiple factors, such as the transition to practice in a foreign country, language, level of supervision, teaching methods applied, feeling disconnected from home, and other competing needs fellows face outside of the clinical context. We propose strategies that may help mitigate the transition to practice process that IMGs undergo when starting a Canadian fellowship, such as Self-Efficacy Encouraging Approach, Thinking Framework Across Cultures, and Social Engagement and Wellbeing.

The Lived Nile: Environment, Disease, and Material Colonial Economy in Egypt by Jennifer L. Derr

<i>The Lived Nile: Environment, Disease, and Material Colonial Economy in Egypt</i> by Jennifer L. Derr