Foreign Physicians Research Articles

Celebrate a new start for Journal of Echocardiography as an indexed journal in MEDLINE

At the end of June, we received a pleasant reply from the National Library of Medicine, National Institutes of Health, USA. After the foundation of Journal of Echocardiography in 2003 as the official journal of the Japanese Society of Echocardiography (JSE), Dr. Kiyoshi Yoshida as the editor-in-chief and Dr. Shintaro Beppu as the president of JSE faced many challenges to raise the journal. The largest challenge was the small number of submissions. From 2003 to 2008, Journal of Echocardiography has published 114 articles and 21 from Dr. Yoshida’s department and 8 from Dr. Beppu’s. They have maintained the journal with their pioneering dedication. Dr. Yoshida passed the baton to me with a new electronic submission and editorial system and I became the second editorin-chief in 2009. The electronic system was driven by Springer. Springer also offered us strategies to improve the journal. However, even with the electronic system, we continued to have the same challenge. The number of submissions was low relative to our expectations. With the increase in the number of medical journals, competition between journals was getting more severe year by year. We have done multiple trials to increase the number of submissions, including more invitations for review articles from mainly foreign physicians, new invitations for highly acclaimed presentations in the annual scientific meeting of the JSE, and recent invitations for review articles from younger domestically active investigators. With these, the number of published article gradually increased and 38 articles were published in 2014 (21.7 articles per year up to 2008). Springer suggested that we apply to have the journal included in MEDLINE. There were new challenges again for this submission. It took more than 1 year from the suggestion to actual submission. I am very happy to announce that Journal of Echocardiography was finally accepted to be indexed in MEDLINE and PubMed. I appreciate the many contributions by members of the JSE, especially authors of articles, Drs. Yoshida and Beppu, previous and current associate editors, honorary and consulting editors, staff of the JSE office, and staff of Springer for offering us critical suggestions and support. I expect that acceptance from MEDLINE will prompt more people to submit articles to Journal of Echocardiography. We will have a new challenge again, especially to increase the impact factor for our journal further. At the end of this message I wish to repeat my declaration made in 2009 when I was inaugurated as the second editor-in-chief. I would like to celebrate this new challenge for Journal of Echocardiography with all of the physicians, sonographers, investigators, and others working on or with echocardiography to bring benefits for patients.

Global Surgery Fellowship: A model for surgical care and education in resource-poor countries

Background/PurposeSurgical diseases have recently been shown to be a major cause of global morbidity and mortality. Effective methods to decrease the burden of surgical disease and provide care in resource-poor settings are unknown. An opportunity to meet this need exists through collaborative efforts to train local surgeons in specialty care, such as pediatric general surgery. MethodsWe present a novel model for the provision of surgical care and education in a resource-poor setting via a collaborative Global Surgery Fellowship program. Through Partners in Health in Haiti, this program placed a fully trained pediatric surgeon at an established rural hospital, both to temporarily serve that community and to teach local surgeons pediatric surgical care. ResultsThe Global Surgery Fellow performed the cases presented here during his term, between July 2009 and June 2010. A total of 147 operative procedures were performed on 131 patients over the course of 12weeks in Haiti. A total of 134 of the 147 total cases performed (91.2%) were educational cases, in which the Fellow operated with and trained one or more of the following: American medical students, American residents, Haitian residents, or Haitian staff surgeons. ConclusionThe Global Surgery Fellowship model overcomes many of the traditional challenges to providing adequate surgical care in resource-poor countries. Specifically, it meets the challenge of providing a broad educational experience for many levels of local and foreign physicians, while working within an established locally run health care system. We believe that this model is generalizable to many resource-poor hospitals with permanent local staff that are open to collaboration.

Impact of policies regulating foreign physician migration to Switzerland: a modelling case study in anaesthesia.

BackgroundSeveral countries have developed policies that restrict or limit duration of stay, clinical privileges or the number of residency permits allocated to migrating physicians. Switzerland is currently preparing a new law limiting overall foreign immigration. The impact of such restrictive policies is currently unknown. In a case study of anaesthesia care in Switzerland we modelled, trends in the size of physicians’ workforce until 2024, following the implementation of a strict quota policy for foreign medical trainees.MethodsWe developed a computer-based Markov model with Monte-Carlo simulations to project, in the context of a strict quota policy for foreign trainees, supply and demand for anaesthesia positions until 2024. We used data from a cross-sectional study performed in the French- and Italian-speaking cantons of Switzerland and the Health dataset from the OECD.ResultsWith 8 to 12 (95 % CI 4–20) anaesthetists retiring per year, the implementation of strict quotas of foreign graduates would result in a 38 % decrease in the number of anaesthetists in intermediary (senior registrars) positions by 2024. This decrease would be particularly important in district hospitals where nearly half (49 %) of the non-Swiss anaesthetists are practising. Swiss graduates are unlikely to balance the shortage. Despite efforts by Swiss universities to increase the number of medical graduates, their number has dropped from 10.5 to 9.7/100 000 inhabitants between 2000 and 2012, due to the growth of the population.ConclusionsThis case study in Latin Switzerland shows that a restrictive policy limiting foreign immigration of trainees would result in a major deficit in the number of anaesthetists available to meet population needs. These aspects should be carefully considered when countries develop restrictions and limitations of foreign immigration.

In the Name of Human Capital

The international migration of physicians is considered an effective response to ageing societies. However, the international recruitment of physicians may be challenged by the protectionist rationale of the medical profession in many countries. How is the potential contradiction between open recruitment policies and exclusive professional regulations managed in Europe? What is the role played by foreign credential recognition or language knowledge in the recruitment process? Are there differences among countries? These questions are analysed by comparing Germany and Spain, which possess not only two divergent migration regimes but also two completely different health care systems. The main goal of the article is to explore how the capacity of national health care sectors to attract and integrate foreign physicians may affect Europe’s quest for highly skilled health professionals in the long term.

More Than A Recruitment Task In German Hospitals: Effects Around Cultural Diversity Of Physicians Impatriation

Hospitals in industrialized countries increasingly recruit foreign physicians and thus have to work with a diverse workforce that exerts challenges. On the basis of social identity theory and the job-resources-demands model, the authors discuss effects on job performance, the intention to leave, and develop a set of propositions.

Numerus clausus et démographie médicale en France

In France, the number of students admitted to the second year of medical studies is limited (numerus clausus) by law. In 1971 this limit was first based according to hospital training capacity and subsequently 1979 it has been based on demographic trends. An objective of 250 physicians per 100 000 inhabitants seemed reasonable and required 6 000 students to be trained each year. In 1979, it was decided to restrict the number of students temporarily because of a likely demographic slump after the year 2000. These steps were introduced progressively, in order not to unfairly treat a particular student class. The numerus clausus is also modulated geographically to take into account differences in medical density, as most students set up in the region where they did their medical studies. It is logical to practice preselection for admission to medical school, yet in France every baccalaureat holder can enrol any medical school, and students are totally opposed to preselection. This is why selection takes place at the end of the first year. In the late 1980s, the numerus clausus should have been increased by the health and education ministries, but this was in fact done only ten years later. Estimates of medical demography are complicated by three factors. First, many physicians from European Union member states (mainly Belgium and Romania) practice in France. Second, some students not admitted to the second year of medical studies go to learn medicine in aforeign country before returning to sit the French national examination at the end of the sixth year. Third, public hospitals hire foreign physicians from outside the EU (mainly Algeria and Morocco), who then stay in France permanently. Thus, EU-level decisions are needed to harmonize the medical numerus clausus across member states. The hiring of physicians from non EU countries by French hospitals should be more tightly controlled.

Factors Identified with Higher Levels of Career Satisfaction of Physicians in Andalusia, Spain.

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

A comparative study of reciprocity in international physician licensing

Purpose – The purpose of this paper is to examine the international mobility of physicians by comparing the regulations governing the practice of foreign physicians in the USA and eight other countries. Design/methodology/approach – This is a comparative study of the regulations governing the practice of foreign physicians in eight countries: China, India, the Philippines, the UK, Germany, Denmark, Israel and Australia. Their requirements are then contrasted with the USA’s requirements for foreign physician licensure to evaluate the extent of reciprocity among these countries. We conclude the paper by outlining some recommendations to increase the international mobility of physicians in the future. Findings – The results indicate that licensure for US physicians to practice in the nations above ranges from impossible (India), to difficult (China), to moderately difficult (the UK, Germany and Denmark), to easy and completely reciprocal (Australia, Israel and the Philippines). Originality/value – The results and recommendations in this study are a valuable starting point for further research and policy changes that will ensure a more reciprocal relationship between the USA and other countries, in terms of opportunities for international medical practice.

Combating Prejudice and Protectionism in American Medicine: The Physicians Committee's Fight for Refugees from Nazism, 1939-1945

No lobby reacted with more hostility to Jewish refugees from Nazi-dominated Europe than did the medical profession, yet refugee physicians ultimately fared better than any other occupational group. The counter-campaign waged by a group of American doctors partly resolves this paradox. The National Committee for the Resettlement of Foreign Physicians helped immigrants pass licensing exams in the rapidly shrinking number of states that allowed them to take the tests, and to procure exemptions in the growing number of states that did not. It thus helped physicians to become the only refugees collectively to retain their professional status in their new country.

Responsible global health engagement: a road map to equity for academic partnerships.

Responsible global health engagement: a road map to equity for academic partnerships.

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.

Der Boykott gegen die deutschen Wissenschaftler und die deutsche Sprache nach dem Ersten Weltkrieg

After the First World War, the Allied academies of sciences staged a boycott against German scientists and the German language. The objective of the boycott was to prevent the re-establishment of the prewar dominance of German scientists, the German language and German publications in the area of international scientific cooperation. Therefore the Allies excluded German scientists and the German language from international associations, congresses and publications, while they created new international scientific organizations under their leadership. Medical associations and congresses were also affected, e. g. congresses on surgery, ophthalmology and tuberculosis. Allied physicians replaced the "International Anti-Tuberculosis Association" founded in Berlin in 1902 with the "Union Internationale contre la Tuberculose"/"International Union against Tuberculosis", founded in Paris in 1920. Only French and English were used as the official languages of the new scientific organizations, just as in the League of Nations. The boycott was based on the fact that the German scientists had denied German war guilt and war crimes and glorified German militarism in a manifesto "To The Civilized World!" in 1914. The boycott first started in 1919 and had to be abolished in 1926, when Germany became a member of the League of Nations. Many German and foreign physicians as well as other scientists protested against the boycott. Some German scientists and institutions even staged a counter-boycott impeding the resumption of international collaboration. The boycott entailed an enduring decline of German as an international scientific language. After the Second World War scientists of the victorious Western Powers implemented a complete reorganization of the international scientific arena, based on the same organizational structures and language restrictions they had built up in 1919/1920. At the same time scientists from the U.S.A. staged an active language and publication policy, in order to establish the dominance of English in the international scientific arena.

Brazil’s Health in Black and White

Brazil’s Health in Black and White

Medical missionaries to China: the antecedents

Notwithstanding the traditional belief that disciples of Jesus Christ introduced Christianity into China, conclusive evidence showed that it was the Nestorian missionaries who entered China in AD 635. Alongside commercial contacts between the West and China during the prosperous T'ang dynasty (618-906), trepanation, bloodletting and the universal antidote theriac were introduced from the Byzantium Empire. Nestorian Christians built churches throughout China and offered some form of medical services. During the Yuan (Mongol) dynasty (1260-1368), foreign physicians were present in the Royal Court; the most famous was the astronomer, linguist and physician Ai-hsieh (Isaiah), Head of the Imperial Medical Bureau. With the fall of this dynasty, Christianity, being primarily the faith of a foreign community, naturally fell into oblivion. It was not until the sixteenth-century's Age of Discovery when a safe sea route to China was found that a new phase of Christian missionaries began.

American Physician in Japan: Teaching Out of Context

American Physician in Japan: Teaching Out of Context

11 Years of experience in vitreoretinal surgery training in Nairobi, Kenya, from 2000 to 2010

ObjectiveWe aim to demonstrate that vitreoretinal surgery can be established in Nairobi, Kenya, by intermittent short visits of experienced surgeons combined with clinical/surgical observerships over a longer period of cooperation. This strategy might be a model for other developing countries. DesignTime series over 11 years. Participants685 operations were performed over 11 years. MethodsAfter the 1998 al-Qaeda bomb assault on the U.S. embassy in Nairobi, Kenya, the Ludwig-Maximilians-University München (Germany) provided materials for surgery of 42 victims with eye injuries. From the year 2000 onward, this equipment has been used to establish a training unit at the Kenyatta Hospital in Nairobi. In 1 annual “project week,” 1 author (C-L.S.) performed vitreoretinal surgery at the University of Nairobi in cooperation with the Kenyatta National Hospital and supervised resident eye surgeons. After 7 years of training in Nairobi, clinical/surgical observerships of vitreoretinal surgeons and operating theatre staff were commenced in Munich by 4- to 12-week visits. The project week in Nairobi was carried on. Number, indications, operating surgeons, kind, difficulty, duration of operations, and preparation were recorded and evaluated. ResultsThe percentage of operations by resident surgeons increased from 29% (in 2000) via 80% (in 2009) to 73% (in 2010) with a partial failure of the laser device. The learning curve of local surgeons is also reflected by an increase of the operations’ difficulty with only a moderate increase in operation time and marked decrease of preparation time. ConclusionsA vitreoretinal unit has been established in Nairobi using our training model. This unit has the potential to train colleagues from other sub-Saharan countries. This strategy has advantages over long-term aid deployment of foreign physicians such as avoiding financial burden for the surgeons to be trained and improving the home facility, but it requires commitment for long-term cooperation.

Too Many Doctors? Foreign Medical Graduates and the Debate over Health Care Accessibility in Canada, c.1976-1991.

Although the last decade has been dominated by commentators lamenting the national shortage of medical practitioners, only a generation ago policy makers concluded that most Canadian provinces had too many doctors. As a consequence, provincial ministers of health placed new restrictions on the licensing of foreign-trained health professionals. Assisted by the 1976 Immigration Act, Canada suddenly witnessed a precipitous drop in the number of newly licensed, foreign-trained doctors, a dramatic reversal of the previous decade which had seen over 10,000 physicians immigrate and take up practice in this country. The 1980s was notable for a variety of health care initiatives aimed at relocating the diminishing number of foreign physicians to underserviced areas, some of which were struck down as contravening the new Charter of Rights and Freedoms. This paper will examine the period of 1976-91, when, after two decades of relatively liberal immigration and licencing policies, Canadian provinces introduced new measures to restrict the scope of practice of incoming foreign-trained doctors and to divert them to underserviced areas. The paper will explore these health policy debates in order to understand better the context of the landmark Barer-Stoddart Report (1991), which concluded that a new interprofessional mix of health care practitioners was needed to reform, and make more accessible, the Canadian health care system.

Disasters and Women's Health: Reflections from the 2010 Earthquake in Haiti

Increasing attention is being focused on the needs of vulnerable populations during humanitarian emergency response. Vulnerable populations are those groups with increased susceptibility to poor health outcomes rendering them disproportionately affected by the event. This discussion focuses on women's health needs during the disaster relief effort after the 2010 earthquake in Haiti. The Emergency Department (ED) of the temporary mobile encampment in L'Hôpital de l'Université d'Etat d'Haïti (HUEH) was the site of the team's disaster relief mission. In February 2010, most of the hospital was staffed by foreign physicians and nurses, with a high turnover rate. Although integration with local Haitian staff was encouraged, implementation of this practice was variable. Common presentations in the ED included infectious diseases, traumatic injuries, chronic disease exacerbations, and follow-up care of post-earthquake injuries and infections. Women-specific complaints included vaginal infections, breast pain or masses, and pregnancy-related concerns or complications. Women were also targets of gender-based violence. Recent disasters in Haiti, Pakistan, and elsewhere have challenged the international health community to provide gender-balanced health care in suboptimal environments. Much room for improvement remains. Although the assessment team was gender-balanced, improved incorporation of Haitian personnel may have enhanced patient trust, and improved cultural sensitivity and communication. Camp geography should foster both patient privacy and security during sensitive examinations. This could have been improved upon by geographically separating men's and women's treatment areas and using a barrier screen to generate a more private examination environment. Women's health supplies must include an appropriate exam table, emergency obstetrical and midwifery supplies, urine dipsticks, and sanitary and reproductive health supplies. A referral system must be established for patients requiring a higher level of care. Lastly, improved inter-organization communication and promotion of resource pooling may improve treatment access and quality for select gender-based interventions. Simple, inexpensive modifications to disaster relief health care settings can dramatically reduce barriers to care for vulnerable populations.

Demographic Situation in Operative Medicine in Switzerland - Time to React?

Objective: The decreasing proportion of physicians of Swiss origin and the increasing number of part-time jobs in operative medicine might lead to a shortage of physicians in operative disciplines in Switzerland. The objective of the present study was to analyze the current demographic situation in operative medicine in Switzerland. Methods: During the summer of 2011, a 19-item anonymous electronic questionnaire was mailed to all directors of departments in operative medicine in Switzerland. The questionnaire was designed to gather data about the characteristics of the participating departments, the demographics (including the appointment (consultant, attending or resident), the proportion of female and foreign physicians, the latter’s origin, and the number of part-time jobs with a working time between 20 and 90%), and the proportion of vacant posts. Results: Of 775 questionnaires mailed to all directors of departments in operative medicine in Switzerland, 183 (24%) were returned. Overall, 40% were female, and 42% foreign physicians. The proportion of part-time jobs amounted to 17%. Vacant posts were found in 2%. Conclusions: An expansion of study places at the medical universities and of the incentives for the incumbents in operative medicine is necessary to avert a shortage of physicians in Switzerland.

What influences national and foreign physicians' geographic distribution? An analysis of medical doctors' residence location in Portugal.

BackgroundThe debate over physicians’ geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it.MethodsA cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) doctors’ characteristics that could increase the odds of residing outside the country’s metropolitan areas.ResultsThere were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians’ location. For foreign physicians, the MDI was not statistically significant, while municipalities’ foreign population applying for residence appeared to be an additional positive factor in their location decisions. In general, being foreigner and male resulted to be the physician characteristics increasing the odds of residing outside the metropolitan areas. However, among the internationals, older doctors were more likely to reside outside metropolitan areas. Being Spanish or Brazilian (but not of African origin) was found to increase the odds of being based outside the Lisbon and Oporto metropolitan areas.ConclusionsThe present study showed the relevance of studying one country’s physician population to understand the factors driving national and international doctors’ location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the imbalance of medical services across geographical areas.