Original Research

Journal of General Internal Medicine

, Volume 25, Issue 9, pp 947-953

First online:

Professional Experiences of International Medical Graduates Practicing Primary Care in the United States

  • Peggy Guey-Chi ChenAffiliated withRobert Wood Johnson Foundation Clinical Scholars, Yale University School of Medicine Email author 
  • , Marcella Nunez-SmithAffiliated withRobert Wood Johnson Foundation Clinical Scholars, Yale University School of MedicineSection of General Internal Medicine, Yale University School of Medicine
  • , Susannah May BernheimAffiliated withRobert Wood Johnson Foundation Clinical Scholars, Yale University School of MedicineDepartment of Internal Medicine, Yale University School of MedicineCenter for Outcomes Research and Evaluation, Yale-New Haven Hospital
  • , David BergAffiliated withRobert Wood Johnson Foundation Clinical Scholars, Yale University School of MedicineDepartment of Psychiatry, Yale University School of Medicine
  • , Aysegul GozuAffiliated withDepartment of Internal Medicine, Franklin Square Hospital, Johns Hopkins University School of Medicine
  • , Leslie Ann CurryAffiliated withRobert Wood Johnson Foundation Clinical Scholars, Yale University School of MedicineDivision of Health Policy and Administration, Yale University School of Public Health

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Abstract

Background

International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited.

Objective

To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US.

Design

Qualitative study based on in-depth in-person interviews.

Participants

Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut.

Approach

A standardized interview guide was used to explore professional experiences of IMGs.

Key Results

Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of “the deal”; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace.

Conclusions

Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs’ experiences may also improve the experiences of an increasingly diverse healthcare workforce.

KEY WORDS

primary care qualitative research workforce international medical graduates