Immigrant Physicians Research Articles

Cultural Citizenship and Belonging: Muslim International Medical Graduates in the USA

This paper explores how a predominantly immigrant interview sample of 62 Muslim physicians articulate their cultural citizenship and sense of “belonging” in the USA. Many Muslim physicians who have come as international medical graduates (IMGs) share the challenges, obstacles, and assets of their IMG peers. Yet within the context of rising Islamophobia after the September 11 (9/11) attacks in the USA, immigrant Muslim physicians encounter “racialized” religious discrimination in the workplace and in local communities. This paper examines how this group actively builds a sense of belonging at multiple levels through the family, community, ethnic and religious institutions; and “represents” Islam in the USA and abroad. We also suggest that integration into the American medical profession facilitates cultural citizenship, and perhaps the “disciplining” of Muslim IMGs into broader American society.

Stratification in the Medical profession: Non-Western Physicians in Norway

Previous studies of internal stratification in medicine suggest that non-White foreign-trained physicians fill the bottom level of the specialist hierarchy. However, in this study we use administrative registers for majority and non-Western physicians in Norway and find that non-Western physicians acquire spe-cialisation in the same volume as majority colleagues, are equally likely to enter several of the high prestige specialties and are not delayed in their careers. The equal distribution is discussed as a consequence of strong professional closure, bureaucratisation of hiring procedures and hospital organisation and governmental influence. Identified patterns, however, are not unequivocal. First, immigrant phys-icians have a significantly higher chance of becoming specialists compared to majority physicians. Second, foreign-educated non-Western physicians have a significantly lower likelihood of specialising in surgery fields. The exception from the overall equality may result from exclusionary practices previously identified in surgery, but it could also result from differences in motivation.

Cultural Demands on Skilled Immigrants, A Devaluation of Human Capital: <i>The case of immigrant physicians in Sweden</i>

The Nordic Journal of Migration Research is a double-blind peer-reviewed, open access international journal that is cost free for authors and readers alike. The journal publishes theoretical and empirical analyses of migratory processes, dealing with themes such as nationalism and transnationalism, ethnic relations and racism, border practices and belonging. The journal gives priority to Nordic issues, but publishes articles also from other geographical contexts.Back content now available in our issue archive.

The migration decisions of physicians in Canada: The roles of immigrant status and spousal characteristics

Around 25% of practicing physicians in Canada are graduates of medical schools outside of Canada. These physicians are more likely to be working in rural communities, and in particular account for more than half of new physicians starting practice in rural regions. The extent to which particular health regions and provinces are able to retain their physicians is crucial if shortages in the delivery of physician and surgeon services in both the short and longer terms are to be avoided. In this paper, we use data from the confidential master files of the Canadian Census over the years 1991–2006 to study the geographic mobility of immigrant and non-immigrant physicians who are already resident in Canada. We consider both inter- and intra-provincial migration, with a particular focus on migration to and from rural areas of Canada. We exploit the fact that it is possible to link individuals within families in the Census files in order to investigate the impact on the migration decision of the characteristics of a married physician’s spouse. Our results indicate that the magnitude of outflows is substantial and that the retention of immigrant physicians in rural areas and in some provinces will continue to be difficult. We find strong evidence that migration is a family decision, and spousal characteristics (education, age, years in Canada for immigrants) are important. As well, we find that large Canadian cities (mainly in Ontario) are the likely destination for the types of immigrant physicians typically able to be recruited to other areas, implying recruitment efforts of smaller provinces may have significant implications for the size of health care costs in larger provinces.

Clinical practice patterns among native and immigrant doctors doing out-of-hours work in Norway: a registry-based observational study

ObjectivesTo evaluate whether immigrant and native Norwegian doctors differ in their practice patterns.DesignObservational study.SettingOut-of-hours (OOH) emergency primary healthcare in Norway, 2008.ParticipantsAll primary care physicians doing OOH work, altogether 4165 physicians.Main...

Portrayals of Global Health Worker Migration in Canadian Print News Media: Domestic Concerns vs. Global Awareness

The global migration of physicians and nurses has implications for health human resources in both source and recipient countries. Of particular concern to academics and policy experts is the “brain drain” of health professionals from under-resourced nations to developed countries, which promote immigration of physicians and nurses to solve their own health worker shortages. How does the general public in these destination countries understand and respond to concerns over migration and immigration of health professionals? This understanding is likely to be influenced in large part by how the issues are portrayed in the news media. News media treatment of this issue was explored by surveying news articles; newspaper columns/editorials; and op-ed pieces; and letters to the editor published in four prominent Canadian newspapers between May 2004 and January 2009, a time frame that included two federal elections in which physician immigration was highlighted as a political issue. Despite the prominence among academics of concern over the brain drain of physicians and nurses from developing countries to Canada and other Western nations, this issue received little attention in print news media discussions, which focused on domestic physician shortages and the role of international medical graduates in filling Canadian needs. While recent federal elections brought concerns about immigrant physicians into the political spotlight in Canada, they did so by focusing on Canadians' health care provision needs to the exclusion of promoting a broader, global awareness that the immigration of health professionals to developed nations such as Canada exacerbates global health disparities.

Conceptualizing Professional Diaspora: International Medical Graduates in Canada

This paper applies the concept of diaspora to the analysis of the creation and maintenance of an ethnically diverse community of internationally educated medical graduates residing in Canada. Traditionally, the research on diaspora concerns ethnic communities that preserve their homeland ties while residing in foreign countries. We suggest, however, that ethnic roots are not imperative for the analysis of diasporic communities when other forms of shared values and meanings can become a basis for creation of collective identity. Reconfiguring both the homeland and host country as places of geographical and professional belonging provides opportunity to conceptualize an ethnically diverse group of immigrant physicians residing in Canada as professional diaspora. Probing the interviews with 67 international medical graduates living in Canada, we demonstrate (1) how they create medical diaspora, (2) what myths and sensitivities they share in constructing their professional and/or geographic homelands, and (3) the relationship they develop with their hosting society. We suggest that in spite of the increasing mobility of internationally educated health care providers, the analysis of professional diasporas could become a useful tool for analyzing complex relationships between home countries, hosting countries, and international travelers.

Testing for Statistical Discrimination: The Case of Immigrant Physicians in Israel

Two models have been proposed to explain why two groups of workers who have the same level of productivity can receive different wages: (i) the statistical discrimination model, according to which the discrimination is the result of a rational response to uncertainty about productivity that consists in adopting certain characteristics as proxies for productivity and (ii) the taste-based discrimination model, according to which the discrimination is based on prejudice against a particular group. It is usually difficult to determine empirically whether the gap in earnings is due to statistical or taste-based discrimination. However, the conditions for a natural experiment were created in 1989 when Israel introduced a licensing examination for immigrant physicians arriving from that point onward, thus making it possible to determine which type of discrimination is responsible for the wage gap between immigrant and native physicians. Controlling for other factors, the paper finds that: (1) the earnings of physicians who immigrated to Israel after 1989 are significantly higher than those of physicians who immigrated previously and (2) the earnings of immigrant physicians who have taken the licensing examination converge to those of native physicians after an average of 5.5 years. These results constitute evidence that the difference in earnings between native and immigrant physicians is due to statistical, rather than taste-based, discrimination.

Can Outcome-Based Continuing Medical Education Improve Performance of Immigrant Physicians?

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach.

Immigration, Ethnicity, and the Pandemic

The influenza pandemic of 1918-1919 coincided with a major wave of immigration to the United States. More than 23.5 million newcomers arrived between 1880 and the 1920s, mostly from Southern and Eastern Europe, Asia, Canada, and Mexico. During earlier epidemics, the foreign-born were often stigmatized as disease carriers whose very presence endangered their hosts. Because this influenza struck individuals of all groups and classes throughout the country, no single immigrant group was blamed, although there were many local cases of medicalized prejudice. The foreign-born needed information and assistance in coping with influenza. Among the two largest immigrant groups, Southern Italians and Eastern European Jews, immigrant physicians, community spokespeople, newspapers, and religious and fraternal groups shouldered the burden. They disseminated public health information to their respective communities in culturally sensitive manners and in the languages the newcomers understood, offering crucial services to immigrants and American public health officials.

Disponibilidad de médicos en Chile al año 2004

The number of physicians available in a given country, their efficiency, quality and specialization is of utmost epidemiological importance. To evaluate the availability of physicians in Chile. The information about the number of physicians in Chile up to the year 2004, was obtained from the Ministry of Health, national universities and the register of immigrant physicians since 1950. The total number of physicians licensed to practice was 25,542, of whom 2,700 are immigrants. The physician/inhabitant ratio increased from 1/921 in 1998 to 1/612 in 2004. The greater impact in the increment of available physicians was given by the immigration of professionals and by the increase in the number of physicians graduated from national universities, mainly from the new private universities. Forty two percent of physicians work at public services and 61% of these are certified specialists. The regional distribution of general practitioners and basic specialists is adequate. Along the country, the mean physician/beneficiary ratio is 8.45/10,000, the specialist/beneficiary ratio is 4.9/10,000 and the general practitioner/beneficiary ratio is 2.3/10,000. The national information of available physicians, especially in the private sector, should be improved. Immigration of physicians should be regulated, maintaining validation examinations and a National Medical Test to assess medical proficiency should be instituted.

Quality Assessment in Primary Military Clinics of the Israel Defense Forces Northern Command

To assess the quality of care provided in primary military clinics. A standardized assessment tool was used, with medical record audits and tracers (minimal clinical criteria for proper care of common conditions), peer-review observations of medical encounters, assessments of organization and administration, and patient satisfaction and physicians' occupational stress questionnaires. Forty-three clinics and 113 physicians were assessed. Tracers were high for management of upper respiratory infections and low for low back pains and mental problems. The average encounter time was 9 minutes, and 25% of medical encounters resulted in referrals to specialists. Regular physicians performed better than reservists. Surgeons performed worst as primary health care providers. Female physicians did better than male physicians. The integration of new immigrant physicians was successful, and they expressed less occupational stress. Smaller clinics were better, with longer encounter times and better patient satisfaction scores. Quality assessment of primary health care is feasible in the military system, providing useful information for future improvement.

The Metrics of the Physician Brain Drain

There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration, less developed countries lose important health capabilities as a result of the loss of physicians. Data on the countries of origin, based on countries of medical education, of international medical graduates practicing in the United States, the United Kingdom, Canada, and Australia were obtained from sources in the respective countries and analyzed separately and in aggregate. With the use of World Health Organization data, I computed an emigration factor for the countries of origin of the immigrant physicians to provide a relative measure of the number of physicians lost by emigration. International medical graduates constitute between 23 and 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia, and lower-income countries supply between 40 and 75 percent of these international medical graduates. India, the Philippines, and Pakistan are the leading sources of international medical graduates. The United Kingdom, Canada, and Australia draw a substantial number of physicians from South Africa, and the United States draws very heavily from the Philippines. Nine of the 20 countries with the highest emigration factors are in sub-Saharan Africa or the Caribbean. Reliance on international medical graduates in the United States, the United Kingdom, Canada, and Australia is reducing the supply of physicians in many lower-income countries.

You Never Stop Being a Doctor: The Stories of Russian Immigrant Physicians Who Converted to Physiotherapy

This article is based on 28 in-depth interviews with Russian immigrant physicians (11 men and 17 women, age range 30–53) who decided not to seek Israeli medical license and converted to physiotherapy. This research was theoretically informed by the literature on physicians’ professional commitment. It explored the case of conversion from a perceived higher to lower status health care occupation and the ensuing changes in former doctors’ professional self-image, relations with the patients and colleagues, and adjustment to the new work role. Informants were recruited among the graduates of the retraining courses sponsored in the mid-1990s by the Israeli Ministry of Health in order to provide jobs for immigrant doctors and to fill in existing vacancies in physiotherapy. The stories of former MDs–novice physiotherapists indicate that most are well adjusted to their new role, maintain positive professional self-image, and are satisfied with the terms of their employment. At the same time, most informants admitted that their mode of thinking and relation to patients remained those of physicians rather than paramedics. Some informants gave medical advice to the patients (especially to their co-ethnics) when asked and discussed treatment options with physicians whenever the work context allowed. Ostensibly good readjustment of this group may reflect the interplay of their actual success in the new role, reluctance to disclose problems in the interview, and self-selection of this group (i.e. doctors who were ready to trade their higher status for pragmatic work benefits). We conclude that complete occupational make-over of immigrant physicians is hardly possible; their professional socialization leaves deep imprint on the mindset and conduct, regardless of subsequent career change.

Radically changing the research framework during a health geography study

This paper focuses on the issue of how a research project can shift from a positivist to a nonpositivist framework. Specific attention is given to changes in research methods and philosophical paradigm that emerged while conducting a study on the replacement of immigrant physicians in rural America. In its original conceptualization, the study was expected to yield a simple, right answer. Specifically, one or more types of health professionals (e.g., nurse practitioners, National Health Service Corps physicians) would be identified as expected replacements in the event of a cutback on immigrant physicians. However, as the research progressed, the quest for a simple, right answer became less realistic. The theoretical framework, methods, and research question changed, thereby allowing for greater complexity and ambiguity than anticipated at the outset of the study. What had been a positivist, statistical study was now a nonpositivist, qualitative study, and the research question shifted to include individual perspectives. An overview of such transitions leads to a discussion of the importance of context and ambiguity in research.

Retraining and relicensing immigrant physicians: the Israeli approach.

Retraining and relicensing immigrant physicians: the Israeli approach.

A screening process predicts success rates in residency re-training among new immigrant physicians in Israel.

To evaluate predictors of success in training programs for Israeli international medical graduates (IMGs) from the former USSR. IMGs up to the age of 45 who passed a national licensing examination and a Hebrew knowledge exam were eligible for participation. Each IMG participated in one of three programs that offered similar academic activities. In two programs there was a preliminary selection process and one program had supplementary teaching hours. Resident's self-evaluation of skills compared with evaluation by department heads. The evaluation included eight clinical skills, a general evaluation, and the passing rate for Phase I of the National Certification Exam. A total of 176 IMGs, all graduates from medical schools in USSR who immigrated to Israel from 1990 to 1996, and 20 heads of the participating departments completed the questionnaires. The response rate was 64% among the residents and 71% among the department heads. All residents had a similar level of self-esteem regarding clinical skills and considered themselves equal to or better than Israeli-trained residents. The department heads did not concur with this assessment, particularly for residents who participated in the program with no preliminary selection. Participants in the programs with preliminary selection received better evaluations from department heads than those in the program without and had significantly greater success in the written part of the board certification examination (p < 0.05). Re-training programs for IMGs should include a preliminary process for participant selection. The training program should be implemented in academic departments, in which case supplementary teaching hours are not required.

Número de médicos en Chile: estimaciones, proyecciones y comparación internacional

In the last decades, the number of Universities with medical schools has increased dramatically in our country. To introduce a conceptual model to estimate the number of physicians that are incorporated to the profession in Chile every year as well as the cumulative number of active physicians in specific time frame. To provide information about the number of available physicians in the country and compare it with the international context. This model includes information about the number of students that are admitted in all medical schools of the country, the dropout rate, the number of immigrant physicians from other countries, and the cumulative number of active physicians in the previous period. There is an increased number of new medical students starting in 1994 that will produce, starting in 2001, a significant increased in the number of new physicians graduated from Chilean Universities. Meanwhile the increased number of new physicians in recent years is mainly explained by a significant increase in immigrant physicians. The number of active physicians estimated by the year 2000 is 18,549 and this number will be 25,704 by the year 2007. With these estimated numbers, we introduce a qualitative model that allowed us to compare the current number of active physicians in Chile with other countries, especially those with a comparable degree of development. This model uses first The Human Development Index and later the per capita income of different countries adjusted by purchasing power in USA. According to these calculations, Chile has a lower number of physicians than similar countries, and this difference will persist, even after the significant increase in the new physicians expected for the new future. Chile continues to have a lower number of physicians than countries with similar human development indices (Rev Méd Chile 2000; 128: 1167-76).

The reconstruction of professional identity among immigrant physicians in three societies.

The paper concerns the processes by which migrant physicians seek to re-establish themselves professionally in a new society. The empirical findings are drawn from a study of physicians who emigrated from the former Soviet Union in the early nineties to three different destinations: Canada, Israel, and the United States. The existential quality of the migration experience was explored by means of a set of life-history narratives related by immigrant physicians. Despite major structural differences among the three hosts, there are several important similarities in the processes observed in the three settings. The first concerns the high salience of the professional role for immigrant physicians and their determined efforts to regain their lossed status. These efforts are constrained by structural elements characterizing the three hosts. The second relates to the mediating effects of gender and age in the reconstruction of professional identity: female immigrant physicians are relatively disadvantaged as are older persons in the occupational sphere. Immigrant physicians who decide not to pursue medical licensure often redefine their occupational identity in areas that are close to the health field. Differences noted among the three groups are a function of structural differences among the three host societies.

The professional self-evaluation of immigrant physicians from the former Soviet Union in Israel.

This study tests the hypothesis that the personal construction of a positive professional identity is central to immigrant physicians' psychosocial well-being. Data are derived from responses to structured questionnaires from the first and third stages of a 5-year, three-stage cohort study of physicians who immigrated to Israel from the former Soviet Union in 1990. At the third stage of the study, in 1995, 387 physicians were working as physicians of a total of 519 respondents. Previous analyses of this research population showed that the immigrants who obtained work in their profession had significantly higher scores on a variety of indicators of psychosocial well-being than those who did not. In this paper, which narrows its focus to those who were working as physicians in 1995, significant positive relationships were found among three measures of self-evaluation, and between professional self-esteem, global self-esteem, and work satisfaction, and adaptation to life in Israel. General practitioners and specialists scored higher on professional self-evaluation than residents. Women scored higher than men, and older respondents (age's 36-45) scored higher than younger respondents (ages 25-35). The immigrant physicians viewed themselves as similar to their Israeli-trained colleagues in terms of their professional role behavior and were particularly positive about their diagnostic skills and the quality of their relationships with their patients. These findings are discussed in terms of role theory, which suggests that the work role of professionals is the most salient component of their self-identify.