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Firouzabadi FD, Hesami M, Sheikhy A, Radmard M, Dabiri M, Ramezanpour S, Yousem DM. Representation of International Medical Graduates Among Diagnostic Radiology Chairs, Neuroradiology Chiefs, and Program Directors. Acad Radiol 2024; 31:3844-3850. [PMID: 38871553 DOI: 10.1016/j.acra.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
RATIONALE AND OBJECTIVES The number of international medical graduates (IMGs) entering radiology residencies and neuroradiology fellowships averaged 9.7% and 20.9% from 2021 to 2023, respectively. We aimed to determine whether IMG graduates are populating leadership roles at a proportionate rate in diagnostic radiology (DR) and neuroradiology. MATERIALS AND METHODS We surveyed 191 DR program directors, 94 neuroradiology program directors (PDs), 192 chairs of radiology, and 91 directors of neuroradiology inquiring about their original citizenship and medical school (American Medical Graduates [AMG] vs IMG). We reviewed institutional websites to obtain missing data and recorded H indices for each person using Scopus. RESULTS We confirmed the original citizenship and medical school location in 61-75% and 93-98% of each leadership group. We found that 16.2% of DR program directors, 43.7% of neuroradiology PDs, 28.5% of Chairs, and 40.6% of neuroradiology directors were not originally US citizens. The IMG rate was 18/188 (9.6%), 20/90 (22.2%), 26/186 (14.0%), and 19/85 (22.4%) for the same groups respectively. The most common country of origin and medical school cited was India for all leadership groups. IMGs had a median H index of 14 while AMG 10, significantly different (p = 0.021) CONCLUSION: Compared to the rate of diagnostic and neuroradiology trainees entering from 2021 to 2023, IMGs are proportionately represented at the leadership positions studied. The H index of the IMGs was higher than AMG. We conclude that IMGs have made substantial and proportionate inroads in radiology and neuroradiology leadership.
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Affiliation(s)
| | - Mina Hesami
- Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ali Sheikhy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahla Radmard
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mona Dabiri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | | | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Jun H, Grabowski DC. Nursing Home Staffing: Share Of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010-21. Health Aff (Millwood) 2024; 43:108-117. [PMID: 38190591 PMCID: PMC10824124 DOI: 10.1377/hlthaff.2023.00881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Nursing homes have long faced a shortage of direct care workers, a problem that was magnified during the COVID-19 pandemic. Using nationally representative data from three sources, we found that much of the certified nursing assistant (CNA) workforce in US nursing homes is filled by immigrant labor. The number of native-born CNAs has been declining rapidly since the mid-2010s, whereas the number of foreign-born CNAs has remained relatively constant. During the first two years of the COVID-19 pandemic, the share of immigrant CNAs employed by nursing homes surged, which can be explained by a simultaneous drop in the share of native-born staff. Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce. However, the share of foreign-born CNAs varied considerably across states, from less than 1 percent in West Virginia to more than 70 percent in Hawaii. In an analysis of prepandemic data, we found that nursing homes in regions with a higher share of immigrant CNAs were associated with more direct care staff hours per resident day and better nursing home quality performance. With the growing demand for long-term care, creating pathways for job-seeking immigrants to fill the gaps in direct care will be crucial to meeting future staffing needs.
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Affiliation(s)
- Hankyung Jun
- Hankyung Jun , Harvard University, Boston, Massachusetts
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Al Achkar M, Dahal A, Frogner BK, Skillman SM, Patterson DG. Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions. J Immigr Minor Health 2023; 25:1270-1278. [PMID: 37084020 PMCID: PMC10119818 DOI: 10.1007/s10903-023-01472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA.
| | - Arati Dahal
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
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Uppal N, Chin ET, Lee CH, Erfani P, Peeler KR. International Medical Graduates and practice rates in underserved communities in Florida. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2022; 10:100628. [PMID: 35588579 DOI: 10.1016/j.hjdsi.2022.100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 04/13/2022] [Accepted: 05/04/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Nishant Uppal
- Harvard Medical School, Boston, MA, USA; Harvard Business School, Boston, MA, USA.
| | - Elizabeth T Chin
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | | | - Parsa Erfani
- Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Katherine R Peeler
- Harvard Medical School, Boston, MA, USA; Division of Medical Critical Care, Boston Children's Hospital, Boston, MA, USA
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Shahid I, Khan MS, Khan SU, Fudim M, Sharma G, Mehta L, Nasir K. Status of International Medical Graduates in Cardiology and Its Subspecialties in the United States. Circ Cardiovasc Qual Outcomes 2021; 14:e008196. [PMID: 34784230 DOI: 10.1161/circoutcomes.121.008196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan (I.S.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, NC (M.S.K., M.F.)
| | - Safi U Khan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist Debakey Heart and Vascular Institute, TX (S.U.K., K.N.)
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, NC (M.S.K., M.F.).,Duke Clinical Research Institute, Durham, NC (M.F.)
| | - Garima Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (G.S.)
| | - Laxmi Mehta
- Division of Cardiology, Ohio State University Hospital, Columbus (L.M.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist Debakey Heart and Vascular Institute, TX (S.U.K., K.N.)
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David YN, Issaka RB. Advancing diversity: the role of international medical graduates. Lancet Gastroenterol Hepatol 2021; 6:980-981. [PMID: 34774151 DOI: 10.1016/s2468-1253(21)00376-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Yakira N David
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel B Issaka
- Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA, USA.
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Escarce JJ, Wozniak GD, Tsipas S, Pane JD, Brotherton SE, Yu H. Effects of the Affordable Care Act Medicaid Expansion on the Distribution of New General Internists Across States. Med Care 2021; 59:653-660. [PMID: 33956413 PMCID: PMC8191468 DOI: 10.1097/mlr.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Some states expanded Medicaid under the Affordable Care Act, boosting their low-income residents' demand for health care, while other states opted not to expand. OBJECTIVE The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices. RESEARCH DESIGN Using 2009-2019 data from the American Medical Association Physician Masterfile and information on states' Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following implementation of the expansion to where they located during the 5 years preceding implementation. SUBJECTS The sample consisted of 160,842 physicians in 8 specialty groups. RESULTS Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Compared with preexpansion patterns, we found that physicians in one specialty group-general internal medicine-were increasingly likely to locate in expansion states with time after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine; women and United States medical graduates did not alter their preexpansion location patterns. Simulations estimated that, between 2014 and 2019, nonexpansion states lost 310 general internists (95% confidence interval, 156-464) to expansion states. CONCLUSIONS The Medicaid expansion influenced the practice location choices of new general internists. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all their residents irrespective of insurance coverage.
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Affiliation(s)
- José J. Escarce
- Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA
- Department of Health Policy and Management, Fielding School of Public Health, Los Angeles, CA
| | | | | | | | | | - Hao Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Agrawal V, Plantinga L, Abdel-Kader K, Pivert K, Provenzano A, Soman S, Choi MJ, Jaar BG. Burnout and Emotional Well-Being among Nephrology Fellows: A National Online Survey. J Am Soc Nephrol 2020; 31:675-685. [PMID: 32123052 DOI: 10.1681/asn.2019070715] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Physician burnout and emotional distress are associated with work dissatisfaction and provision of suboptimal patient care. Little is known about burnout among nephrology fellows. METHODS Validated items on burnout, depressive symptoms, and well being were included in the American Society of Nephrology annual survey emailed to US nephrology fellows in May to June 2018. Burnout was defined as an affirmative response to two single-item questions of experiencing emotional exhaustion or depersonalization. RESULTS Responses from 347 of 808 eligible first- and second-year adult nephrology fellows were examined (response rate=42.9%). Most fellows were aged 30-34 years (56.8%), male (62.0%), married or partnered (72.6%), international medical graduates (62.5%), and pursuing a clinical nephrology fellowship (87.0%). Emotional exhaustion and depersonalization were reported by 28.0% and 14.4% of the fellows, respectively, with an overall burnout prevalence of 30.0%. Most fellows indicated having strong program leadership (75.2%), positive work-life balance (69.2%), presence of social support (89.3%), and career satisfaction (73.2%); 44.7% reported a disruptive work environment and 35.4% reported depressive symptoms. Multivariable logistic regression revealed a statistically significant association between female gender (odds ratio [OR], 1.90; 95% confidence interval [95% CI], 1.09 to 3.32), poor work-life balance (OR, 3.97; 95% CI, 2.22 to 7.07), or a disruptive work environment (OR, 2.63; 95% CI, 1.48 to 4.66) and burnout. CONCLUSIONS About one third of US nephrology fellows surveyed reported experiencing burnout and depressive symptoms. Further exploration of burnout-especially that reported by female physicians, as well as burnout associated with poor work-life balance or a disruptive work environment-is warranted to develop targeted efforts that may enhance the educational experience and emotional well being of nephrology fellows.
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Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, Vermont;
| | | | - Khaled Abdel-Kader
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kurtis Pivert
- Workforce, Training, and Career Advancement Department, American Society of Nephrology, Washington, DC
| | | | - Sandeep Soman
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, Michigan
| | - Michael J Choi
- Division of Nephrology and Hypertension, Medstar Georgetown University Hospital, Washington, DC
| | - Bernard G Jaar
- Department of Medicine, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland; and.,Nephrology Center of Maryland, Baltimore, Maryland
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Ganesh GS. On "A grounded theory study of the narrative behind Indian physiotherapists global migration" Grafton K., Gordon F. Int J Health Plann Manage. 2019 Jan 18. https://doi.org/10.1002/hpm.2725. [Epub ahead of print]. Int J Health Plann Manage 2019; 35:658-660. [PMID: 31736120 DOI: 10.1002/hpm.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 09/12/2019] [Indexed: 11/05/2022] Open
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Tackett S. Examining the Educational Commission for Foreign Medical Graduates Announcement Requiring Medical School Accreditation Beginning in 2023. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:943-949. [PMID: 30844935 DOI: 10.1097/acm.0000000000002675] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG, Philadelphia, Pennsylvania) announced that, beginning in 2023, graduation from a formally accredited medical school would be necessary for an international medical graduate (IMG) to be eligible for ECFMG certification. The announcement is notable because ECFMG certification is required for graduate medical training and practice in the United States. Graduating from a school accredited by an agency formally recognized by the World Federation for Medical Education (WFME), which has been formally evaluating and recognizing accrediting agencies since 2012, would fulfill the new ECFMG requirement. In 2015, ECFMG applicants came from 1,141 medical schools located in 139 countries or territories. As of December 2018, the WFME had formally recognized 14 accrediting agencies, which would cover only approximately a third of these recent ECFMG-certified IMGs. In this Perspective, the author compares the context of the ECFMG announcement to the beginning of accreditation in the United States so as to provide insight into the challenges the WFME faces as it seeks to evaluate and recognize what could ultimately be over 100 more accrediting authorities. The author then explores the possible effects of the requirement-specifically, its potential to restrict the ECFMG applicant pool-on the quantity and quality of the U.S. physician workforce. The author ends the Perspective by considering the implications of three broad policy options that the ECFMG could consider starting in 2023: implementation as announced, maintenance of the status quo, or a policy modified from the original announcement.
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Affiliation(s)
- Sean Tackett
- S. Tackett is assistant professor of medicine and director, International Medical Education, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland; ORCID: https://orcid.org/0000-0001-5369-7225
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Ahmed AA, Hwang WT, Thomas CR, Deville C. International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends. J Grad Med Educ 2018; 10:214-218. [PMID: 29686763 PMCID: PMC5901803 DOI: 10.4300/jgme-d-17-00580.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/19/2017] [Accepted: 12/04/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. OBJECTIVE We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. METHODS We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990-2015, the slope was estimated using simple linear regression. RESULTS IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. CONCLUSIONS IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.
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Abstract
International medical graduates (IMGs) play a vital role in the US health care system. These graduates represent 26% of physicians in practice and 24% of residents in specialty programs. All IMGs go through US medical licensing examination and credentialing verification to receive certification from the Educational Commission for Foreign Medical Graduates to become eligible to enter the US graduate medical education process. Compared with US graduates, IMGs tend to practice in primary care specialties and in underserved and rural areas. The author summarizes available data regarding IMGs in training and in practice to convey the role IMGs play in the US health care system.
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Samson FL. Support for immigration reduction and physician distrust in the United States. SAGE Open Med 2016; 4:2050312116652567. [PMID: 27621801 PMCID: PMC5006807 DOI: 10.1177/2050312116652567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/04/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives: Health research indicates that physician trust in the United States has declined over the last 50 years. Paralleling this trend is a decline in social capital, with researchers finding a negative relationship between immigration-based diversity and social capital. This article examines whether physician distrust is also tied to immigration-based diversity and declining social capital. Methods: Data come from the 2012 General Social Survey, one of the gold standards of US public opinion surveys, using a national probability sample of 1080 adult US respondents. Key measures included support for reducing levels of immigration to the United States and multiple measures of physician trust. Results: The results of ordinary least squares regressions, using survey weights, indicate that support for reducing immigration is positively linked to physician distrust, bringing physician distrust into the orbit of research on diversity and declining social capital. Models controlled for age, education, income, gender, race, nativity, conservatism, unemployed status, lack of health insurance, and self-rated health. Furthermore, analyses of a subset of respondents reveal that measures of general trust and some forms of institutional trust do not explain away the association between support for immigration reduction and physician distrust, though confidence in science as an institution appears relevant. Conclusion: Consistent with diversity and social capital research, this article finds that an immigration attitude predicts physician distrust. Physician distrust may not be linked just to physician–patient interactions, the structure of the health care system, or health policies, but could also be tied to declining social trust in general.
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Characteristics of US-Licensed Foreign-Educated Physical Therapists. Phys Ther 2016; 96:293-304. [PMID: 26294682 DOI: 10.2522/ptj.20140569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Foreign-educated physical therapists are often viewed as one possible solution to the current shortage of physical therapists, yet there is very little research regarding these individuals. OBJECTIVE The purpose of this study was to describe those physical therapists who are licensed in the United States but who were educated in another country. This description includes their country of education, their employment patterns, and the reasons they decided to emigrate and work as a physical therapist in the United States. DESIGN A cross-sectional survey was conducted. METHODS An electronic survey was sent to all physical therapists currently licensed in the United States who had been educated in another country. Those who had been licensed within the last 5 years are reported. RESULTS The results of the survey indicated that the typical foreign-educated physical therapist is female, aged 32.2 years, and was born and trained in either the Philippines or India. A majority of foreign-educated physical therapists obtained their first license in New York, Michigan, Illinois, Texas, or Florida. The most common reasons cited as to why a particular jurisdiction was chosen for initial employment were "recruiter recommendation," "family, spouse, partner, or friends," "ease of the licensure process," and "ability to secure a visa sponsor." A majority of foreign-educated physical therapists in this study initially worked in a skilled nursing facility, a long-term care or extended care facility, or a home health setting. LIMITATIONS Only those foreign-educated physical therapists licensed within the last 5 years are reported. CONCLUSIONS This study is the first to report on foreign-educated physical therapists in the United States. The findings of this study will provide important and useful information to others dealing with physical therapy professional and workforce issues.
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Brugha R, Crowe S. Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel--Ethical and Systems Perspectives. Int J Health Policy Manag 2015; 4:333-6. [PMID: 26029891 DOI: 10.15171/ijhpm.2015.103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/19/2015] [Indexed: 11/09/2022] Open
Abstract
The relevance and effectiveness of the World Health Organization's (WHO's) Global Code of Practice on the International Recruitment of Health Personnel is being reviewed in 2015. The Code, which is a set of ethical norms and principles adopted by the World Health Assembly (WHA) in 2010, urges members states to train and retain the health personnel they need, thereby limiting demand for international migration, especially from the under-staffed health systems in low- and middle-income countries. Most countries failed to submit a first report in 2012 on implementation of the Code, including those source countries whose health systems are most under threat from the recruitment of their doctors and nurses, often to work in 4 major destination countries: the United States, United Kingdom, Canada and Australia. Political commitment by source country Ministers of Health needs to have been achieved at the May 2015 WHA to ensure better reporting by these countries on Code implementation for it to be effective. This paper uses ethics and health systems perspectives to analyse some of the drivers of international recruitment. The balance of competing ethics principles, which are contained in the Code's articles, reflects a tension that was evident during the drafting of the Code between 2007 and 2010. In 2007-2008, the right of health personnel to migrate was seen as a preeminent principle by US representatives on the Global Council which co-drafted the Code. Consensus on how to balance competing ethical principles--giving due recognition on the one hand to the obligations of health workers to the countries that trained them and the need for distributive justice given the global inequities of health workforce distribution in relation to need, and the right to migrate on the other hand--was only possible after President Obama took office in January 2009. It is in the interests of all countries to implement the Global Code and not just those that are losing their health personnel through international recruitment, given that it calls on all member states "to educate, retain and sustain a health workforce that is appropriate for their (need) ..." (Article 5.4), to ensure health systems' sustainability. However, in some wealthy destination countries, this means tackling national inequities and poorly designed health workforce strategies that result in foreign-trained doctors being recruited to work among disadvantaged populations and in primary care settings, allowing domestically trained doctors work in more attractive hospital settings.
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Affiliation(s)
- Ruairí Brugha
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sophie Crowe
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Duarte T, Baumann SL. Nursing in Switzerland: struggling to maintain quality and ideals. Nurs Sci Q 2014; 28:74-9. [PMID: 25520468 DOI: 10.1177/0894318414558610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
After an edited transcript of an interview with a nurse leader, Teodora Duarte, RN; MA, on nursing in Switzerland, the author further discusses the challenges and opportunities facing nursing in that country from a global perspective. Also discussed are some of the advantages and problems of international nursing, in particular nurses who migrate to work in other countries or commute across national borders.
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