Career Satisfaction in Primary Care: A Comparison of International and US Medical Graduates
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
International medical graduates (IMGs) have substantial representation among primary care physicians in the USA and consistently report lower career satisfaction compared with US medical graduates (USMGs). Low career satisfaction has adverse consequences on physician recruitment and retention.
This study aims to identify factors that may account for or explain lower rates of career satisfaction in IMGs compared with USMGs.
Using data from the 2008 Health Tracking Physician Survey, a nationally representative survey, we examined the association between IMG status and career satisfaction among primary care physicians. We used multivariable logistic regression modeling to adjust for a broad range of potential explanatory factors and physician characteristics.
The study participants comprise primary care physicians who reported at least 20 h a week of direct patient care activities (N = 1,890).
The main measures include respondents’ overall satisfaction with their careers in medicine.
IMGs were statistically significantly less likely than USMGs to report career satisfaction (75.7% vs. 82.3%; p = 0.005). This difference persisted after adjusting for physician characteristics and variables describing the practice environment (adjusted odds ratio = 0.62; 95% confidence interval, 0.43–0.90). Pediatricians (vs. internists) and those who earned $200,001–250,000 (vs. <$100,000) or >$250,000 were more likely to report career satisfaction, while solo practitioners and those who reported being unable to provide high-quality patient care were less likely to report career satisfaction.
After adjusting for a number of variables previously shown to have an impact on career satisfaction, we were unable to identify additional factors that could account for or explain differences in career satisfaction between IMGs and USMGs. In light of the central role of IMGs in primary care, the potential impact of poorer satisfaction among IMGs may be substantial. Improved understanding of the causes of this differential satisfaction is important to appropriately support the primary care physician workforce.
- US Department of Health and Human Services. Healthy people, 2010: understanding and improving health, 2nd Ed. Washington, DC: US Government Printing Office; November 2000.
- Starfield B. Primary care in the United States. Int J Health Serv. 1986;16(2):179–198. CrossRef
- Institute of Medicine. Primary care: America’s health in a new era. Washington, DC: Institute of Medicine; 1996.
- American Medical Association IMG Section. International medical graduates: contemporary challenges and opportunities. Chicago, IL: American Medical Association; 2010.
- Hing E, Lin S. Role of international medical graduates providing office-based medical care: United States, 2005–2006. NCHS Data Brief. Feb 2009(13):1–8.
- Morris AL, Phillips RL, Fryer GE, Jr., Green LA, Mullan F. International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes. Hum Resour Health. 2006;4:17. CrossRef
- Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. Oct 2001;16(10):675–684. CrossRef
- Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician career satisfaction across specialties. Arch Intern Med. Jul 22 2002;162(14):1577–1584. CrossRef
- Pagan JA, Balasubramanian L, Pauly MV. Physicians’ career satisfaction, quality of care and patients’ trust: the role of community uninsurance. Health Econ Policy Law. Oct 2007;2(Pt 4):347–362.
- Leigh JP, Tancredi DJ, Kravitz RL. Physician career satisfaction within specialties. BMC Health Serv Res. 2009;9:166. CrossRef
- Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997–2001. Jama. Jan 22–29 2003;289(4):442–449. CrossRef
- Landon BE, Aseltine R, Jr., Shaul JA, Miller Y, Auerbach BA, Cleary PD. Evolving dissatisfaction among primary care physicians. Am J Manag Care. Oct 2002;8(10):890–901.
- Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. Mar 2006;44(3):234–242. CrossRef
- Buchbinder SB, Wilson M, Melick CF, Powe NR. Primary care physician job satisfaction and turnover. Am J Manag Care. Jul 2001;7(7):701–713.
- Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. Nov 1999;5(11):1431–1438.
- Association of American Medical Colleges. Physician shortages to worsen without increases in residency training. Chicago, IL: AAMC; 2010.
- Chen P, Nunez-Smith M, Bernheim S, Berg D, Gozu A, Curry LA. Professional experiences of international medical graduates in primary care. J Gen Intern Med. 2010;25(9):947–953. CrossRef
- Center for Studying Health System Change. 2008 health tracking physician survey restricted use file: user’s guide. Washington, DC: Center for Studying Health System Change; January 2010 2009.
- American Medical Association. International Medical Graduates in American Medicine. American Medical Association; 2010.
- American Association of Physicians of Indian Origin. AAPI Clinical Observership Program. http://aapiusa.org/education/observership.aspx. Accessed July 2011.
- Baldwin DC, Jr., Daugherty SR, Rowley BD. Racial and ethnic discrimination during residency: results of a national survey. Acad Med. Oct 1994;69(10 Suppl):S19-21. CrossRef
- Fiscella K, Roman-Diaz M, Lue BH, Botelho R, Frankel R. ‘Being a foreigner, I may be punished if I make a small mistake’: assessing transcultural experiences in caring for patients. Fam Pract. Apr 1997;14(2):112–116. CrossRef
- Reed VA, Jernstedt GC, McCormick TR. A longitudinal study of determinants of career satisfaction in medical students. Med Educ Online; 2004;9:11. Available from http://www.med-ed-online.org. Accessed July 2011
- Konrad TR, Williams ES, Linzer M, McMurray J, Pathman DE, Gerrity M, Schwartz MD, Scheckler WE, Van Kirk J, Rhodes E and Douglas J, for the Society of General Internal Medicine Career Satisfaction Study Group. Measuring Physician Job Satisfaction in a Changing Workplace and a Challenging Environment. Med Care, 1999; 37(11): 1174–1182. CrossRef
- Forrest CB et al. Managed care, primary care, and the patient-practitioner relationship. J Gen Intern Med, 2002. 17(4): p. 270–7. CrossRef
- Williams ES, Konrad TR, Linzer M, McMurray J, Pathman DE, Gerrity M, Schwartz MD, Scheckler WE, Van Kirk J, Rhodes E, and Douglas J for the SGIM Career Satisfaction Study Group. Refining the measurement of physician job satisfaction: results from the Physician Worklife Survey. Med Care 1999;37:1140–1154. CrossRef
- Linzer M, Konrad TR, Douglas J, McMurray JE, Pathman D, Williams ES, Schwartz MD, Gerrity M, Scheckler W, Bigby JA, and Elnora Rhodes for the Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG). Managed care, time pressure and physician job satisfaction: results from the Physician Worklife Study. J Gen Intern Med 2000;15:441–450. CrossRef
- Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by gradutes of international medical schools. Health Affairs. 2010;29(8):1461–1468. CrossRef
- Career Satisfaction in Primary Care: A Comparison of International and US Medical Graduates
Journal of General Internal Medicine
Volume 27, Issue 2 , pp 147-152
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- primary care
- physician satisfaction
- Industry Sectors
- Author Affiliations
- 1. Division of Health Policy and Administration, Yale School of Public Health, Room 104, 47 College Street, New Haven, CT, 06520-8088, USA
- 2. Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA
- 5. Global Health Leadership Institute, Yale University, 55 Whitney Avenue, Suite 400, New Haven, CT, 06510, USA
- 3. Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- 4. Division of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA