Journal of General Internal Medicine

, Volume 25, Issue 9, pp 947–953

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

  • Peggy Guey-Chi Chen
  • Marcella Nunez-Smith
  • Susannah May Bernheim
  • David Berg
  • Aysegul Gozu
  • Leslie Ann Curry
Original Research



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.


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


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


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.


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.


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.


primary care qualitative research workforce international medical graduates 


  1. 1.
    AMA. IMGs in the United States. In: American Medical Association; 2007.Google Scholar
  2. 2.
    Smart D. Physician Characteristics and Distribution in the US-2006. Chicago: American Medical Association; 2006.Google Scholar
  3. 3.
    NRMP. Advanced Data Tables for 2007 Main Residency Match. In: National Residency Match Program; 2007. p. Table 5.Google Scholar
  4. 4.
    Polsky D, Kletke PR, Wozniak GD, Escarce JJ. Initial practice locations of international medical graduates. Health Serv Res. 2002;37(4):907–28.CrossRefPubMedGoogle Scholar
  5. 5.
    Rao V, Cabbabe E, Adams K, et al. International medical graduates in the U.S. Workforce. Chicago, IL: American Medical Association; 2007.Google Scholar
  6. 6.
    Hing E, Lin S. Role of international medical graduates providing office-based medical care: United States, 2005–2006. NCHS Data Brief. 2009(13):1–8.Google Scholar
  7. 7.
    Cohen JJ. The role and contributions of IMGs: a U.S. perspective. Acad Med. 2006;81(12 Suppl):S17–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Hart LG, Skillman SM, Fordyce M, Thompson M, Hagopian A, Konrad TR. International medical graduate physicians in the United States: changes since 1981. Health Aff (Millwood). 2007;26(4):1159–69.CrossRefGoogle Scholar
  9. 9.
    Boulet JR, Norcini JJ, Whelan GP, Hallock JA, Seeling SS. The international medical graduate pipeline: recent trends in certification and residency training. Health Aff (Millwood). 2006;25(2):469–77.CrossRefGoogle Scholar
  10. 10.
    Akl EA, Mustafa R, Bdair F, Schunemann HJ. The United States physician workforce and international medical graduates: trends and characteristics. J Gen Intern Med. 2007;22(2):264–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Gozu A, Kern DE, Wright SM. Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs. Acad Med. 2009;84(3):385–90.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Stoddard JJ, Hargraves JL, Reed M, Vratil A. Managed care, professional autonomy, and income: effects on physician career satisfaction. J Gen Intern Med. 2001;16(10):675–84.CrossRefPubMedGoogle Scholar
  14. 14.
    Leigh JP, Kravitz RL, Schembri M, Samuels SJ, Mobley S. Physician career satisfaction across specialties. Arch Intern Med. 2002;162(14):1577–84.CrossRefPubMedGoogle Scholar
  15. 15.
    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. 1997;14(2):112–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Malterud K. The art and science of clinical knowledge: evidence beyond measures and numbers. Lancet. 2001;358(9279):397–400.CrossRefPubMedGoogle Scholar
  17. 17.
    Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks: Sage Publications; 2002.Google Scholar
  18. 18.
    Britten N. Qualitative interviews in medical research. BMJ. 1995;311(6999):251–3.PubMedGoogle Scholar
  19. 19.
    WHO. Physician density per 1,000 population. In: World Health Organization; 2007.Google Scholar
  20. 20.
    Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications; 1994.Google Scholar
  21. 21.
    Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119(10):1442–52.CrossRefPubMedGoogle Scholar
  23. 23.
    Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98(9):1441–8.PubMedGoogle Scholar
  24. 24.
    Nunez-Smith M, Curry LA, Bigby J, Berg D, Krumholz HM, Bradley EH. Impact of race on the professional lives of physicians of African descent. Ann Intern Med. 2007;146(1):45–51.PubMedGoogle Scholar
  25. 25.
    Gartland JJ, Hojat M, Christian EB, Callahan CA, Nasca TJ. African American and white physicians: a comparison of satisfaction with medical education, professional careers, and research activities. Teach Learn Med. 2003;15(2):106–12.CrossRefPubMedGoogle Scholar
  26. 26.
    Post DM, Weddington WH. Stress and coping of the African-American physician. J Natl Med Assoc. 2000;92(2):70–5.PubMedGoogle Scholar
  27. 27.
    Fang D, Moy E, Colburn L, Hurley J. Racial and ethnic disparities in faculty promotion in academic medicine. JAMA. 2000;284(9):1085–92.CrossRefPubMedGoogle Scholar
  28. 28.
    Corbie-Smith G, Frank E, Nickens HW, Elon L. Prevalences and correlates of ethnic harassment in the U.S. Women Physicians' Health Study. Acad Med. 1999;74(6):695–701.CrossRefPubMedGoogle Scholar
  29. 29.
    Bickel J. Gender stereotypes and misconceptions: unresolved issues in physicians' professional development. JAMA. 1997;277(17):1405–1407.CrossRefPubMedGoogle Scholar
  30. 30.
    Carr PL, Ash AS, Friedman RH, Szalacha L, Barnett RC, Palepu A, et al. Faculty perceptions of gender discrimination and sexual harassment in academic medicine. Ann Intern Med. 2000;132(11):889–96.PubMedGoogle Scholar
  31. 31.
    Yi M, Jezewski MA. Korean nurses' adjustment to hospitals in the United States of America. J Adv Nurs. 2000;32(3):721–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Magnusdottir H. Overcoming strangeness and communication barriers: a phenomenological study of becoming a foreign nurse. Int Nurs Rev. 2005;52(4):263–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Dicicco-Bloom B. The racial and gendered experiences of immigrant nurses from Kerala, India. J Transcult Nurs. 2004;15(1):26–33.CrossRefPubMedGoogle Scholar
  34. 34.
    Hagey R, Choudhry U, Guruge S, Turrittin J, Collins E, Lee R. Immigrant nurses' experience of racism. J Nurs Scholarsh. 2001;33(4):389–94.CrossRefPubMedGoogle Scholar
  35. 35.
    Torres S, Castillo H. Bridging cultures: Hispanics/Latinos and nursing. In: McCloskey J, Grace H, eds. Current issues in nursing. 5th ed. St. Louis: Mosby; 1997:574–579.Google Scholar
  36. 36.
    Allensworth-Davies D, Leigh J, Pukstas K, Geron SM, Hardt E, Brandeis G, et al. Country of origin and racio-ethnicity: are there differences in perceived organizational cultural competency and job satisfaction among nursing assistants in long-term care? Health Care Manage Rev. 2007;32(4):321–9.PubMedGoogle Scholar
  37. 37.
    Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97(4):467–77.PubMedGoogle Scholar
  38. 38.
    Cole-Kelly K. Cultures engaging cultures: international medical graduates training in the United States. Fam Med. 1994;26(10):618–24.PubMedGoogle Scholar
  39. 39.
    Porter JL, Townley T, Huggett K, Warrier R. An acculturization curriculum: orienting international medical graduates to an internal medicine residency program. Teach Learn Med. 2008;20(1):37–43.PubMedGoogle Scholar
  40. 40.
    Bates J, Andrew R. Untangling the roots of some IMG's poor academic performance. Acad Med. 2001;76(1):43–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Grant J, Jones H, Kilminster S, Macdonald M, Maxted M, Nathanson B, et al. Overseas Doctors' Expectations and Experiences of Training and Practice in the UK. Milton Keynes: Open University; 2004.Google Scholar
  42. 42.
    Han GS, Humphreys JS. Overseas-trained doctors in Australia: community integration and their intention to stay in a rural community. Aust J Rural Health. 2005;13(4):236–41.CrossRefPubMedGoogle Scholar
  43. 43.
    Klein D, Hofmeister M, Lockyear J, Crutcher R, Fidler H. Push, pull, and plant: the personal side of physician immigration to alberta, Canada. Fam Med. 2009;41(3):197–201.PubMedGoogle Scholar
  44. 44.
    Landon BE, Reschovsky JD, Pham HH, Blumenthal D. Leaving medicine: the consequences of physician dissatisfaction. Med Care. 2006;44(3):234–42.CrossRefPubMedGoogle Scholar
  45. 45.
    Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5(11):1431–8.PubMedGoogle Scholar
  46. 46.
    Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15(2):122–8.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Peggy Guey-Chi Chen
    • 1
  • Marcella Nunez-Smith
    • 1
    • 2
  • Susannah May Bernheim
    • 1
    • 3
    • 4
  • David Berg
    • 1
    • 5
  • Aysegul Gozu
    • 6
  • Leslie Ann Curry
    • 1
    • 7
  1. 1.Robert Wood Johnson Foundation Clinical ScholarsYale University School of MedicineNew HavenUSA
  2. 2.Section of General Internal MedicineYale University School of MedicineNew HavenUSA
  3. 3.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  4. 4.Center for Outcomes Research and EvaluationYale-New Haven HospitalNew HavenUSA
  5. 5.Department of PsychiatryYale University School of MedicineNew HavenUSA
  6. 6.Department of Internal Medicine, Franklin Square HospitalJohns Hopkins University School of MedicineBaltimoreUSA
  7. 7.Division of Health Policy and AdministrationYale University School of Public HealthNew HavenUSA

Personalised recommendations