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Velagala S, Gupta S, Bruno CJ, Johnston LC. Facilitating integration of international medical graduates into neonatal-perinatal medicine: a critical strategy to meet workforce demands. J Perinatol 2024; 44:1390-1393. [PMID: 38773217 DOI: 10.1038/s41372-024-02002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Suganthinie Velagala
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Shruti Gupta
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
| | - Christie J Bruno
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Lindsay C Johnston
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
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Silvestre J, Fernandez CA, Oni JK, Sabesan VJ, Nelson CL, Slone HS. International medical graduates in orthopaedic surgery: An opportunity to improve diversity and inclusion? J Clin Orthop Trauma 2024; 56:102522. [PMID: 39286006 PMCID: PMC11402300 DOI: 10.1016/j.jcot.2024.102522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 06/08/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Background/aims Racial and ethnic minorities are under-represented in orthopaedic surgery despite efforts to promote diversity and inclusion in the specialty. The purpose of this study was to determine the proportion of international medical graduates (IMGs) in the surgical workforce and future residency pipeline. We further analyze IMG applicant qualifications relative to their US-based counterparts to assess the viability of recruiting IMG candidates as one strategy to advance diversity and inclusion in orthopaedic surgery. Methods Physician workforce data from the American Medical Association and residency match data from the National Resident Match Program were analyzed for Orthopaedic Surgery. Trends in the proportion of IMG applicants were compared with those from other specialties. Qualifications of applicants were compared including board exam scores, number of abstracts/publications, and additional graduate degrees. Results In 2020, orthopaedic surgery had the lowest percentage of IMGs relative to otolaryngology (5.8 %, p < 0.001), neurosurgery (12.1 %, p < 0.001), obstetrics & gynecology (14.0 %, p < 0.001), and general surgery (19.1 %, p < 0.001). From 1986 to 2021, IMG Graduates who matched into orthopaedic surgery increased from 1 (0.3 %) to 8 (0.9 %). Compared to other surgical specialties, orthopaedic surgery had among the lowest annual rates of incoming IMG residents. In 2021, most respondents to the orthopaedic surgery residency program directors survey reported never selecting IMG applicants for interview (74 % for non-US IMG applicants and 53 % for US IMG applicants). From 2020 to 2021, non-US IMG applicants (17 %) and US IMG applicants (26 %) had lower match rates than DO Senior (74 %) and MD Senior (80 %) applicants (p < 0.001). In 2020, matched non-US IMGs had similar board scores as matched US MD Senior applicants, but more abstracts/publications. Conclusion The recruitment of IMGs into orthopaedic surgery residency remains limited and lower than other surgical specialties. IMGs have similar board scores and more abstracts/publications, thus representing a potential pipeline for workforce diversity. More research is needed to understand the special needs of IMGs in the orthopaedic surgery match.
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Affiliation(s)
| | | | - Julius K Oni
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Charles L Nelson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Harris S Slone
- Medical University of South Carolina, Charleston, SC, USA
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Coutinho AJ, Levin Z, Petterson S, Phillips RL, Peterson LE. Residency Program Characteristics and Individual Physician Practice Characteristics Associated With Family Physician Scope of Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1561-1566. [PMID: 31192802 DOI: 10.1097/acm.0000000000002838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE A family physician's ability to provide continuous, comprehensive care begins in residency. Previous studies show that patterns developed during residency may be imprinted upon physicians, guiding future practice. The objective was to determine family medicine residency characteristics associated with graduates' scope of practice (SCoP). METHOD The authors used (1) residency program data from the 2012 Accreditation Council for Graduate Medicine Education Accreditation Data System and (2) self-reported data supplied by family physicians when they registered for the first recertification examination with the American Board of Family Medicine (2013-2016)-7 to 10 years after completing residency. The authors used linear regression analyses to examine the relationship between individual physician SCoP (measured by the SCoP for primary care [SP4PC] score [scale of 0-30; low = small scope]) and individual, practice, and residency program characteristics. RESULTS The authors sampled 8,261 physicians from 423 residencies. The average SP4PC score was 15.4 (standard deviation, 3.2). Models showed that SCoP broadened with increasing rurality. Physicians from unopposed (single) programs had higher SCoP (0.26 increase in SP4PC); those from major teaching hospitals had lower SCoP (0.18 decrease in SP4PC). CONCLUSIONS Residency program characteristics may influence family physicians' SCoP, although less than individual characteristics do. Broad SCoP may imply more comprehensive care, which is the foundation of a strong primary care system to increase quality, decrease cost, and reduce physician burnout. Some residency program characteristics can be altered so that programs graduate physicians with broader SCoP, thereby meeting patient needs and improving the health system.
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Affiliation(s)
- Anastasia J Coutinho
- A.J. Coutinho was, when this research occurred, a third-year family medicine resident, Santa Rosa Family Medicine Residency Program, Santa Rosa, California. Z. Levin was, when this research occurred, research assistant, Robert Graham Center, Washington, DC. S. Petterson is research director, Robert Graham Center, Washington, DC. R.L. Phillips Jr is executive director, Center for Professionalism and Value in Health Care, Washington, DC. L.E. Peterson is vice president of research, American Board of Family Medicine, Lexington, Kentucky
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Najeeb U, Wong B, Hollenberg E, Stroud L, Edwards S, Kuper A. Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:103-123. [PMID: 30259266 DOI: 10.1007/s10459-018-9852-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/19/2018] [Indexed: 05/16/2023]
Abstract
Many international medical graduates (IMGs) enter North American residency programs every year. The Canadian IMG physician pool increasingly includes Canadian-born IMGs (C-IMGs) along with Immigrant-IMGs (I-IMGs). Similar trends exist in the United States. Our objective was to understand the similarities and differences in the challenges faced by both I-IMGs and C-IMGs during residency to identify actionable recommendations to support them during this critical time. We performed a multiple case study of IMGs' experiences at a large Canadian university. Within our two descriptive cases (I-IMGs, C-IMGs) we iteratively conducted twenty-two semi-structured interviews; we thematically analyzed our data within, between, and across both cases to understand challenges to IMGs' integration and opportunities for curricular innovations to facilitate their adaptation process. Research team members with different perspectives contributed reflexively to the thematic analysis. Participants identified key differences between medical culture and knowledge expected in Canada and the health systems and curricula in which they originally trained. I-IMG and C-IMG participants perceived two major challenges: discrimination because of negative labelling as IMGs and difficulties navigating their initial residency months. C-IMGs described a third challenge: frustration around the focus on the needs of I-IMGs. Participants from both groups identified two major opportunities: their desire to help other IMGs and a need for mentorship. I-IMGs and C-IMGs face diverse challenges during their training, including disorientation and discrimination. We identified specific objectives to inform the design of curriculum and support services that residency programs can offer trainees as well as important targets for resident education and faculty development.
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Affiliation(s)
- Umberin Najeeb
- Wilson Centre for Research in Education, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada.
- Faculty Lead R4 Internal Medicine Program, University of Toronto, Toronto, ON, Canada.
- Faculty Lead IMG/IFT Mentorship Program, University of Toronto, Toronto, ON, Canada.
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Brian Wong
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre of Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada
| | | | - Lynfa Stroud
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Core Internal Medicine Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Susan Edwards
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Urban Family Health Team, St. Joseph Health Centre, Toronto, ON, Canada
- Resident Wellness, Postgraduate Medical Education Office, University of Toronto, Toronto, ON, Canada
| | - Ayelet Kuper
- Wilson Centre for Research in Education, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Massey College, Toronto, ON, Canada
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Katakam SK, Frintner MP, Pelaez-Velez C, Chakraborty R. Work Experiences and Satisfaction of International Medical School Graduates. Pediatrics 2019; 143:peds.2018-1953. [PMID: 30563877 DOI: 10.1542/peds.2018-1953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared demographics and work, financial, and satisfaction experiences of early-career and midcareer pediatricians categorized by their childhood and medical school locations. METHODS Data from the Pediatrician Life and Career Experience Study were used to examine the characteristics and experiences of 3 groups, which were categorized as (1) international childhood and medical school graduate (international-IMG), (2) United States childhood and international medical school graduate (US-IMG), and (3) United States or international childhood and United States medical school graduate (USMG). With multivariable logistic regression, we examined the experiences of the groups, controlling for participant characteristics. RESULTS Data from 1467 of 1804 participants were analyzed; 13% were categorized as international-IMGs, 6% were categorized as US-IMGs, and 81% were categorized as USMGs. International-IMGs and US-IMGs were less likely than USMGs to report their race and ethnicity as white and non-Hispanic (26%, 32%, and 71%, respectively; P < .05) and more likely to report caring for patients with public insurance (adjusted odds ratio [aOR] 1.80 [95% confidence interval (CI) 1.27-2.56] and aOR 2.12 [95% CI 1.31-3.42], respectively). International-IMGs were less likely than USMGs to agree that physician colleagues value their work (aOR 0.35; 95% CI 0.21-0.56). Overall, 8 in 10 reported that their work was personally rewarding; international-IMGs were less likely than USMGs to report such satisfaction (P < .05). CONCLUSIONS Among a national sample of pediatricians, international-IMGs and US-IMGs play important roles in workforce diversity. They also report unique challenges. Most are satisfied with their work, but international-IMGs are the least satisfied.
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Affiliation(s)
| | | | | | - Rana Chakraborty
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Goodfellow A, Ulloa JG, Dowling PT, Talamantes E, Chheda S, Bone C, Moreno G. Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1313-21. [PMID: 27119328 PMCID: PMC5007145 DOI: 10.1097/acm.0000000000001203] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PURPOSE The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States. METHOD In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles. RESULTS Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas. CONCLUSIONS Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.
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Affiliation(s)
- Amelia Goodfellow
- A. Goodfellow is a medical student, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California. J.G. Ulloa is a VA/Robert Wood Johnson Foundation Clinical Scholar, UCLA, Los Angeles, California and Surgery Resident, Department of Surgery, University of California, San Francisco, San Francisco, California. P.T. Dowling is professor and chair, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. E. Talamantes at the time of this research was primary care research fellow, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and is now assistant professor, Division of General Internal Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California. S. Chheda is research assistant, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. C. Bone at the time of this research was a third-year resident physician, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. G. Moreno is assistant professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
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Verma V, Shah C, Lautenschlaeger T, Lin C, Beriwal S, Zhen W, Mehta MP, Zietman AL. International Medical Graduates in Radiation Oncology: Historical Trends and Comparison With Other Medical Specialties. Int J Radiat Oncol Biol Phys 2016; 95:1102-6. [DOI: 10.1016/j.ijrobp.2016.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/20/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Opoku ST, Apenteng BA, Lin G, Chen LW, Palm D, Rauner T. A Comparison of the J-1 Visa Waiver and Loan Repayment Programs in the Recruitment and Retention of Physicians in Rural Nebraska. J Rural Health 2015; 31:300-9. [DOI: 10.1111/jrh.12108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Samuel T. Opoku
- Department of Health Policy Management, Jiann-Ping Hsu College of Public Health; Georgia Southern University; Statesboro Georgia
| | - Bettye A. Apenteng
- Department of Health Policy Management, Jiann-Ping Hsu College of Public Health; Georgia Southern University; Statesboro Georgia
| | - Ge Lin
- Department of Health Services & Administration; College of Public Health; University of Nebraska Medical Center (UNMC); Omaha Nebraska
| | - Li-Wu Chen
- Department of Health Services & Administration; College of Public Health; University of Nebraska Medical Center (UNMC); Omaha Nebraska
| | - David Palm
- Department of Health Services & Administration; College of Public Health; University of Nebraska Medical Center (UNMC); Omaha Nebraska
| | - Thomas Rauner
- Office of Rural Health; Nebraska Department of Health and Human Services; Omaha Nebraska
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Boonyasai RT, Lin YL, Brotman DJ, Kuo YF, Goodwin JS. Characteristics of primary care providers who adopted the hospitalist model from 2001 to 2009. J Hosp Med 2015; 10:75-82. [PMID: 25627347 PMCID: PMC4311567 DOI: 10.1002/jhm.2269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/07/2014] [Accepted: 09/13/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND The characteristics of primary care providers (PCPs) who use hospitalists are unknown. METHODS Retrospective study using 100% Texas Medicare claims from 2001 through 2009. Descriptive statistics characterized proportion of PCPs using hospitalists over time. Trajectory analysis and multilevel models of 1172 PCPs with ≥20 inpatients in every study year characterized how PCPs adopted the hospitalist model and PCP factors associated with this transition. RESULTS Hospitalist use increased between 2001 and 2009. PCPs who adopted the hospitalist model transitioned rapidly. In multilevel models, hospitalist use was associated with US training (odds ratio [OR] 1.46, 95% confidence interval [CI]: 1.23-1.73 in 2007-2009), family medicine specialty (OR: 1.46, 95% CI: 1.25-1.70 in 2007-2009), and having high outpatient volumes (OR: 1.32, 95% CI: 1.20-1.44 in 2007-2009). Over time, relative hospitalist use decreased among female PCPs (OR: 1.91, 95% CI: 1.46-2.50 in 2001-2003; OR: 1.50, 95% CI: 1.15-1.95 in 2007-2009), those in urban locations (OR: 3.34, 95% CI: 2.72-4.09 in 2001-2003; OR: 2.22, 95% CI: 1.82-2.71 in 2007-2009), and those with higher inpatient volumes (OR: 1.05, 95% CI: 0.95-1.18 in 2001-2003; OR: 0.55, 95% CI: 0.51-0.60 in 2007-2009). Longest-practicing PCPs were more likely to transition in the early 2000s, but this effect disappeared by the end of the study period (OR: 1.35, 95% CI: 1.06-1.72 in 2001-2003; OR: 0.92, 95% CI: 0.73-1.17 in 2007-2009). PCPs with practice panels dominated by patients who were white, male, or had comorbidities are more likely to use hospitalists. CONCLUSIONS PCP characteristics are associated with hospitalist use. The association between PCP characteristics and hospitalist use has evolved over time.
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Affiliation(s)
- Romsai T. Boonyasai
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore Maryland
| | - Yu-Li Lin
- Sealy Center on Aging, Departments of Internal Medicine and Preventive Medicine and Community Health University of Texas Medical Branch, Galveston, TX
| | - Daniel J. Brotman
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore Maryland
| | - Yong-Fang Kuo
- Sealy Center on Aging, Departments of Internal Medicine and Preventive Medicine and Community Health University of Texas Medical Branch, Galveston, TX
| | - James S. Goodwin
- Sealy Center on Aging, Departments of Internal Medicine and Preventive Medicine and Community Health University of Texas Medical Branch, Galveston, TX
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A comparative study of reciprocity in international physician licensing. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2014. [DOI: 10.1108/ijphm-06-2014-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to examine the international mobility of physicians by comparing the regulations governing the practice of foreign physicians in the USA and eight other countries.
Design/methodology/approach
– This is a comparative study of the regulations governing the practice of foreign physicians in eight countries: China, India, the Philippines, the UK, Germany, Denmark, Israel and Australia. Their requirements are then contrasted with the USA’s requirements for foreign physician licensure to evaluate the extent of reciprocity among these countries. We conclude the paper by outlining some recommendations to increase the international mobility of physicians in the future.
Findings
– The results indicate that licensure for US physicians to practice in the nations above ranges from impossible (India), to difficult (China), to moderately difficult (the UK, Germany and Denmark), to easy and completely reciprocal (Australia, Israel and the Philippines).
Originality/value
– The results and recommendations in this study are a valuable starting point for further research and policy changes that will ensure a more reciprocal relationship between the USA and other countries, in terms of opportunities for international medical practice.
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Ricketts TC. The migration of physicians and the local supply of practitioners: a five-year comparison. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:1913-1918. [PMID: 24128618 DOI: 10.1097/acm.0000000000000012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE The overall distribution of physicians in the United States is uneven, with concentrations in urban areas while some rural places have proportionately very few. This report examines the movement of physicians who have completed their training and choose to move from one location to another. METHOD The analysis linked the locations of practice of physicians practicing in the 50 U.S. states in 2006 and 2011 using data from the American Medical Association Physician Masterfile. Age, gender, location practice, activity status, and specialty were included in the data. Physicians who changed address in the five-year period were identified and were compared with nonmovers using descriptive statistics. A summary logistic regression of movers compared with nonmovers was performed to assess the most important correlates of migration. RESULTS The overall rate of county-to-county relocation for physicians was 19.8% for the five-year period 2006-2011. Analyses indicated that older, male, and urban physicians were less likely to move; that physicians with osteopathic training were more likely to move; and that surgeons and primary care physicians were less likely to move compared with other specialists. CONCLUSIONS The physician workforce in the United States migrates from place to place, and this movement determines the local supply of practitioners at any given time. Programs that intend to influence the local supply of doctors should account for this background tendency to relocate practice in order to achieve goals of more equal geographic distribution.
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Affiliation(s)
- Thomas C Ricketts
- Dr. Ricketts is professor of health policy and management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Greig A, Dawes D, Murphy S, Parker G, Loveridge B. Program evaluation of a model to integrate internationally educated health professionals into clinical practice. BMC MEDICAL EDUCATION 2013; 13:140. [PMID: 24119470 PMCID: PMC3852753 DOI: 10.1186/1472-6920-13-140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 10/08/2013] [Indexed: 05/15/2023]
Abstract
BACKGROUND The demand for health professionals continues to increase, partially due to the aging population and the high proportion of practitioners nearing retirement. The University of British Columbia (UBC) has developed a program to address this demand, by providing support for internationally trained Physiotherapists in their preparation for taking the National Physiotherapy competency examinations.The aim was to create a program comprised of the educational tools and infrastructure to support internationally educated physiotherapists (IEPs) in their preparation for entry to practice in Canada and, to improve their pass rate on the national competency examination. METHODS The program was developed using a logic model and evaluated using program evaluation methodology. Program tools and resources included educational modules and curricular packages which were developed and refined based on feedback from clinical experts, IEPs and clinical physical therapy mentors. An examination bank was created and used to include test-enhanced education. Clinical mentors were recruited and trained to provide clinical and cultural support for participants. RESULTS The IEP program has recruited 124 IEPs, with 69 now integrated into the Canadian physiotherapy workforce, and more IEPs continuing to apply to the program. International graduates who participated in the program had an improved pass rate on the national Physiotherapy Competency Examination (PCE); participation in the program resulted in them having a 28% (95% CI, 2% to 59%) greater possibility of passing the written section than their counterparts who did not take the program. In 2010, 81% of all IEP candidates who completed the UBC program passed the written component, and 82% passed the clinical component. CONCLUSION The program has proven to be successful and sustainable. This program model could be replicated to support the successful integration of other international health professionals into the workforce.
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Affiliation(s)
- Alison Greig
- Department of Physical Therapy, Wesbrook Mall, The University of British Columbia, Vancouver, BC, Canada
| | - Diana Dawes
- Department of Physical Therapy, Wesbrook Mall, The University of British Columbia, Vancouver, BC, Canada
| | - Susan Murphy
- Department of Physical Therapy, Wesbrook Mall, The University of British Columbia, Vancouver, BC, Canada
| | - Gillian Parker
- Department of Physical Therapy, Wesbrook Mall, The University of British Columbia, Vancouver, BC, Canada
| | - Brenda Loveridge
- Department of Physical Therapy, Wesbrook Mall, The University of British Columbia, Vancouver, BC, Canada
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Abstract
PURPOSE Health information technology (HIT) holds promise for improving the quality of health care and reducing health care system inefficiencies. Numerous studies have examined HIT availability, specifically electronic health records (EHRs), and utilization among physicians in individual countries. However, no one has examined EHR use among physicians who train in one country and move to practice in another country. In the United States, physicians who complete medical school outside the country but practice within the United States are commonly referred to as International Medical Graduates (IMGs). IMGs have a growing presence in the United States, yet little is known about the availability and use of HIT among these physicians. The purpose of this study is to explore the availability and use of HIT among IMGs practicing in United States. DESIGN/METHODOLOGY/APPROACH The Health Tracking Physician Survey (2008) was used to examine the relationship between availability and use of HIT and IMG status controlling for several physician and practice characteristics. Our analysis included responses from 4,720 physicians, 20.7% of whom were IMGs. FINDINGS Using logistic regression, controlling for physician gender, specialty, years in practice, practice type, ownership status and geographical location, we found IMGs were significantly less likely to have a comprehensive EHR in their practices (OR = 0.84; p = 0.005). In addition, findings indicate that IMGs are more likely to have and use several so-called first generation HIT capabilities, such as reminders for clinicians about preventive services (OR = 1.31; p = 0.001) and other needed patient follow-up (OR = 1.26; p = 0.007). ORIGINALITY/VALUE This study draws attention to the need for further research regarding barriers to HIT adoption and use among IMGs.
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Dywili S, Bonner A, Anderson J, O' Brien L. Experience of overseas-trained health professionals in rural and remote areas of destination countries: A literature review. Aust J Rural Health 2012; 20:175-84. [DOI: 10.1111/j.1440-1584.2012.01281.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Durant RW, Parmar G, Shuaib F, Le A, Brown TM, Roth DL, Hovater M, Halanych JH, Shikany JM, Prineas RJ, Samdarshi TJ, Safford MM. Awareness and management of chronic disease, insurance status, and health professional shortage areas in the REasons for Geographic And Racial Differences in Stroke (REGARDS): a cross-sectional study. BMC Health Serv Res 2012; 12:208. [PMID: 22818296 PMCID: PMC3571909 DOI: 10.1186/1472-6963-12-208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 07/04/2012] [Indexed: 01/01/2023] Open
Abstract
Background Limited financial and geographic access to primary care can adversely influence chronic disease outcomes. We examined variation in awareness, treatment, and control of hypertension, diabetes, and hyperlipidemia according to both geographic and financial access to care. Methods We analyzed data on 17,458 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with either hypertension, hyperlipidemia, or diabetes and living in either complete Health Professional Shortage Area (HPSA) counties or non-HPSA counties in the U.S. All analyses were stratified by insurance status and adjusted for sociodemographics and health behaviors. Results 2,261 residents lived in HPSA counties and 15,197 in non-HPSA counties. Among the uninsured, HPSA residents had higher awareness of both hypertension (adjusted OR 2.30, 95% CI 1.08, 4.89) and hyperlipidemia (adjusted OR 1.50, 95% CI 1.01, 2.22) compared to non-HPSA residents. Also among the uninsured, HPSA residents with hypertension had lower blood pressure control (adjusted OR 0.45, 95% CI 0.29, 0.71) compared with non-HPSA residents. Similar differences in awareness and control according to HPSA residence were absent among the insured. Conclusions Despite similar or higher awareness of some chronic diseases, uninsured HPSA residents may achieve control of hypertension at lower rates compared to uninsured non-HPSA residents. Federal allocations in HPSAs should target improved quality of care as well as increasing the number of available physicians.
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Affiliation(s)
- Raegan W Durant
- University of Alabama at Birmingham School of Medicine, 1717 11th Avenue South, Birmingham, AL 35294, USA.
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Russo G, Ferrinho P, de Sousa B, Conceição C. What influences national and foreign physicians' geographic distribution? An analysis of medical doctors' residence location in Portugal. HUMAN RESOURCES FOR HEALTH 2012; 10:12. [PMID: 22748122 PMCID: PMC3549747 DOI: 10.1186/1478-4491-10-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 07/02/2012] [Indexed: 05/04/2023]
Abstract
UNLABELLED BACKGROUND The debate over physicians' geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians' location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policy-makers to identify policies to influence it. METHODS A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians' residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities' population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians' geographical distribution, and; (b) doctors' characteristics that could increase the odds of residing outside the country's metropolitan areas. RESULTS There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population's Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians' location. For foreign physicians, the MDI was not statistically significant, while municipalities' foreign population applying for residence appeared to be an additional positive factor in their location decisions. In general, being foreigner and male resulted to be the physician characteristics increasing the odds of residing outside the metropolitan areas. However, among the internationals, older doctors were more likely to reside outside metropolitan areas. Being Spanish or Brazilian (but not of African origin) was found to increase the odds of being based outside the Lisbon and Oporto metropolitan areas. CONCLUSIONS The present study showed the relevance of studying one country's physician population to understand the factors driving national and international doctors' location decisions. A more nuanced understanding of national and foreign doctors' location appears to be needed to design more effective policies to reduce the imbalance of medical services across geographical areas.
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Affiliation(s)
- Giuliano Russo
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal
| | - Paulo Ferrinho
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal
| | - Bruno de Sousa
- International Public Health and Biostatistics Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa and Centre for Malaria and Tropical Diseases, Associated Laboratory, Lisbon, Portugal
| | - Cláudia Conceição
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B’s - PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Rabinowitz HK, Petterson S, Boulger JG, Hunsaker ML, Diamond JJ, Markham FW, Bazemore A, Phillips RL. Medical school rural programs: a comparison with international medical graduates in addressing state-level rural family physician and primary care supply. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:488-92. [PMID: 22361802 DOI: 10.1097/acm.0b013e3182488b19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Comprehensive medical school rural programs (RPs) have made demonstrable contributions to the rural physician workforce, but their relative impact is uncertain. This study compares rural primary care practice outcomes for RP graduates within relevant states with those of international medical graduates (IMGs), also seen as ameliorating rural physician shortages. METHOD Using data from the 2010 American Medical Association Physician Masterfile, the authors identified all 1,757 graduates from three RPs (Jefferson Medical College's Physician Shortage Area Program; University of Minnesota Medical School Duluth; University of Illinois College of Medicine at Rockford's Rural Medical Education Program) practicing in their respective states, and all 6,474 IMGs practicing in the same states and graduating the same years. The relative likelihoods of RP graduates versus IMGs practicing rural family medicine and rural primary care were compared. RESULTS RP graduates were 10 times more likely to practice rural family medicine than IMGs (relative risk [RR] = 10.0, confidence interval [CI] 8.7-11.6, P < .001) and almost 4 times as likely to practice any rural primary care specialty (RR 3.8, CI 3.5-4.2, P < .001). Overall, RPs produced more rural family physicians than the IMG cohort (376 versus 254). CONCLUSIONS Despite their relatively small size, RPs had a significant impact on rural family physician and primary care supply compared with the much larger cohort of IMGs. Wider adoption of the RP model would substantially increase access to care in rural areas compared with increasing reliance on IMGs or unfocused expansion of traditional medical schools.
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Affiliation(s)
- Howard K Rabinowitz
- Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Baker HH, Pathman DE, Nemitz JW, Boisvert CS, Schwartz RJ, Ridpath LC. Which U.S. medical schools are providing the most physicians for the Appalachian region of the United States? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:498-505. [PMID: 22361793 DOI: 10.1097/acm.0b013e318248f3be] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To identify the U.S. medical schools with the most graduates practicing in rural, urban, and economically distressed areas of Appalachia. METHOD Using June 2009 American Medical Association Physician Masterfile data, the authors identified physicians who graduated from medical school during 1991-2005 and were practicing in the 420 counties of the United States' Appalachian region. They then determined the U.S. medical schools with the most 2001-2005 graduates practicing in primary care (PC) or non-PC specialties in urban or rural areas and the most 1991-2005 graduates practicing in economically distressed/at-risk counties. RESULTS Ten U.S. medical schools, led by the West Virginia School of Osteopathic Medicine, produced 50.5% (197/390) of 2001-2005 graduates practicing PC in rural areas of Appalachia; 10 schools, led by the University of Alabama School of Medicine, produced 44.1% (366/829) of graduates practicing PC in urban areas. During 2001-2005, 10 schools, led by the West Virginia University School of Medicine, graduated 42.1% (128/304) of non-PC physicians practicing in rural counties; 11 schools, led by the University of Alabama School of Medicine, graduated 38.5% (323/840) of non-PC physicians practicing in urban areas. All schools on the top 10 lists are located within states with Appalachian counties. University of Kentucky College of Medicine had the most 1991-2005 graduates practicing in economically distressed or at-risk counties. CONCLUSIONS Physicians practicing in Appalachia are largely graduates of medical schools in or near the region. New schools being developed in the region may help reduce its continuing physician shortages.
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Affiliation(s)
- Helen H Baker
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia 24901, USA.
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Wong A, Lohfeld L. Recertifying as a doctor in Canada: international medical graduates and the journey from entry to adaptation. MEDICAL EDUCATION 2008; 42:53-60. [PMID: 18086199 DOI: 10.1111/j.1365-2923.2007.02903.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Globalisation and severe doctor shortages in many countries have resulted in increased numbers of international medical graduates (IMGs) in medical training programmes in major recipient countries such as Canada. Much of the literature on IMGs is written from the perspective of the doctor workforce. Less is known about the recertification training experiences of IMGs in recipient countries. This study aims to describe the recertification training experiences of IMGs in Canada in order to help medical training programmes understand how to facilitate the integration of IMGs into recipient medical communities. METHODS A phenomenological (qualitative) research approach was undertaken for this study. International medical graduates undergoing recertification training in order to practise in Canada were individually interviewed about their experiences. Data collection and analysis followed the procedures of interpretive phenomenology. RESULTS Twelve IMGs participated. Analysis of the interviews revealed 4 themes that typified IMG recertification training experiences: training entry barriers; and a 3-phase process of loss, disorientation and adaptation. International medical graduates must complete this 3-phase process in order to feel fully integrated into their professional environments. CONCLUSIONS This study provided a description of IMGs' training experiences during certification for practice in Canada and revealed that these experiences were characterised by a 3-phase process of adjustment. Using this framework, a series of recommendations were proposed for medical training programmes to help IMGs with this process.
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Affiliation(s)
- Anne Wong
- Department of Anaesthesia, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada.
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Abstract
PURPOSE We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States. METHODS We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States. RESULTS Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce. CONCLUSION The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply.
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Akl EA, Mustafa R, Bdair F, Schünemann HJ. The United States physician workforce and international medical graduates: trends and characteristics. J Gen Intern Med 2007; 22:264-8. [PMID: 17356997 PMCID: PMC1824721 DOI: 10.1007/s11606-006-0022-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. OBJECTIVE To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States. DESIGN Longitudinal analysis of the American Medical Association Physicians' Professional Data (AMA-PPD) database using the 1978-2004 files and a comparative analysis of the characteristics of a random sample of 1,000 IMGs and a random sample of 1,000 USMGs using the 2004 file. MEASUREMENTS Historical trends and characteristics of IMGs in the United States. RESULTS Over the last 26 years, the number of IMGs in the United States grew by 4,873 per year reaching a total of 215,576 in 2004, about 2.4 times its size in 1978. The proportion of IMGs increased 0.12% per year, from 22.2% in 1978 to 25.6% in 2004. In 2004, compared with USMGs, IMGs were older, less likely to be board certified [Odds ratio (OR), 0.68; 95% CI, 0.53 to 0.86], less likely to work in group practice (OR, 0.60; 95% CI, 0.37 to 0.98), more likely to have Internal Medicine as practice specialty (OR, 2.10; 95% CI, 1.62 to 2.71) and more likely to be residents (OR, 1.52; 95% CI, 1.07 to 2.16). CONCLUSIONS Over the last quarter century, the IMGs provided a significant and steady supply for the United States physician workforce that continues to grow. Policymakers should consider the consequences for both the United States and source countries.
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Affiliation(s)
- Elie A Akl
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14215, USA.
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Phillips RL, Bazemore AW, Dodoo MS, Shipman SA, Green LA. Family physicians in the child health care workforce: opportunities for collaboration in improving the health of children. Pediatrics 2006; 118:1200-6. [PMID: 16951016 DOI: 10.1542/peds.2006-0051] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric workforce studies suggest that there may be a sufficient number of pediatricians for the current and projected US child population. These analyses do not fully consider the role of family medicine in the care of children. Family physicians provide 16% to 26% of visits for children, providing a medical home for one third of the child population, but face shrinking panels of children. Family medicine's role in children's health care is more stable in rural communities, for adolescents, and for underserved populations. For these populations, in particular, family medicine's role remains important. The erosion of the proportion of visits to family medicine is likely caused by the rapid rise in the number of pediatricians relative to a declining birth rate. Between 1981 and 2004, the general pediatrician population grew at 7 times the rate of the US population, and the family physician workforce grew at nearly 5 times the rate. The number of clinicians caring for children meets or exceeds most estimates of sufficiency; however, the workforce distribution is skewed, leaving certain populations and settings underserved. More than 5 million children and adolescents live in counties with no pediatrician. Unmet need, addressing health in the context of families and communities, and tackling "millennial morbidities" represent common ground for both specialties that could lead to specific, collaborative training, research, intervention, and advocacy.
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Affiliation(s)
- Robert L Phillips
- American Academy of Family Physicians, Robert Graham Cente4 for Policy Studies in Family Medicine and Primary Care, Washington, DC 20036, USA.
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Freed GL, Nahra TA, Wheeler JRC. Counting physicians: inconsistencies in a commonly used source for workforce analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:847-52. [PMID: 16936499 DOI: 10.1097/00001888-200609000-00017] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To assess the accuracy of the AMA Masterfile. METHOD In 2002, the authors compared the listing in the Masterfile for pediatric cardiologists with a roster of all such physicians documented by the American Board of Pediatrics (ABP) to have completed pediatric cardiology training. Physicians listed on the Masterfile but without ABP records of training completion received a mail survey. For main outcome measures, the differences in state-level distribution of pediatric cardiologists were used, depending on whether data were from the ABP or the AMA Masterfile. Survey items included nature and duration of medical training, the amount of time caring for pediatric or adult cardiology patients, and whether the respondent conducted echocardiograms and/or cardiac catheterizations on children and/or adults. RESULTS Of the 2,675 unique, individual physicians obtained from the queries of both lists, 58% (1,558) were listed by both the Masterfile and the ABP. Another 28% (738) were listed by the AMA Masterfile only, and 4% (108) were listed by the ABP only.Of those listed by the Masterfile only, 40% reported they provide no pediatric cardiology care. The amount of pediatric cardiology training was highly variable among the remainder of the respondents. CONCLUSIONS There are large differences in the number and distribution of physicians identified as pediatric cardiologists between these two datasets. Also, many are potentially providing care for which they have little or no training. Use of such data has the potential to lead to policy options at odds with the actual needs of our nation as a whole or of specific geographic areas.
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Affiliation(s)
- Gary L Freed
- Division of General Pediatrics, University of Michigan, 300 N. Ingalls Building 6E08, Ann Arbor, MI 48109-0456, USA.
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Morris AL, Phillips RL, Fryer GE, Green LA, Mullan F. International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes. HUMAN RESOURCES FOR HEALTH 2006; 4:17. [PMID: 16848909 PMCID: PMC1543651 DOI: 10.1186/1478-4491-4-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 07/18/2006] [Indexed: 05/10/2023]
Abstract
BACKGROUND The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to personal and professional characteristics and attitudes that may have implications for the health care system resulting from the increasing numbers of IMGs in family medicine in the United States. METHODS This is a secondary data analysis of the 1996-1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week. RESULTS Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs. CONCLUSION There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.
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Affiliation(s)
| | - Robert L Phillips
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, DC, USA
| | - George E Fryer
- Department of Pediatrics, New York University, New York City, USA
| | - Larry A Green
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington, DC, USA
| | - Fitzhugh Mullan
- Department of Health Policy, George Washington University School of Public Health and Health Services, Washington, DC, USA
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Laditka SB, Laditka JN, Probst JC. Racial and ethnic disparities in potentially avoidable delivery complications among pregnant Medicaid beneficiaries in South Carolina. Matern Child Health J 2006; 10:339-50. [PMID: 16496219 DOI: 10.1007/s10995-006-0071-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 01/04/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To examine race and ethnicity differences in accessibility and effectiveness of health care during pregnancy. METHODS Data were 26,866 year 2000 Medicaid-insured deliveries from the South Carolina Office of Research and Statistics, and Area Resource File. The access indicator was Potentially Avoidable Maternity Complications (PAMCs). PAMC risks can be reduced through prenatal care, such as infection screening and treatment, and healthy behaviors it promotes. We compared PAMC risks of Blacks, Hispanics, and Whites. Analyses included PAMC rates, Chi-square, t-tests, multilevel logistic regression. Risks were estimated for ages 10-17, and 18+. RESULTS At ages 10-17 (n=2,691), Blacks and Hispanics had notably higher unadjusted and adjusted PAMC risks (adjusted odds ratios, ORs, 2.26, p < .001; 3.29, p < .05, respectively). At ages 18+, adjusted odds for Hispanics were about half those of Whites (p < .05). Adjusted odds for adult Blacks and Whites did not differ. This may be due to controlling for many risk factors that are more prevalent among Blacks: Single, disabled, poverty, diabetes, hypertension, rurality; however, unadjusted PAMC prevalence also did not differ greatly (3.9 for Blacks, 3.4 for Whites, p < .1). Adjusted risks were high for adults with diabetes (OR 2.40, p < .001) and all rural women (teen OR 4.02, p < .05; adult OR 1.83, p < .001). CONCLUSIONS Young Blacks and Hispanics have notably higher risks of delivery outcomes indicating less access to prenatal care of reasonable quality. Policies to reduce PAMCs in Medicaid should address needs of young Blacks and Hispanics; enhance diabetes treatment for adult women; and address rural access barriers for all women.
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Affiliation(s)
- Sarah B Laditka
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, 29208, USA.
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Abstract
This statement discusses the importance of pediatrician-workforce issues and their relevance to the provision of pediatric health care. It reviews previous work in the health policy arena on physician and pediatrician workforce. Key pediatrician-workforce trends are described, including the growth in the number of pediatricians in relation to the child population, the increase in the number of female pediatricians, the role of international medical graduates, the diversity of the pediatrician workforce, the contributions of internal medicine-pediatrics physicians, the increasing number of nonpediatrician providers of pediatric care, geographic distribution of physicians, and the future of pediatric subspecialists. Methods of influencing the pediatrician workforce are also considered. In the concluding series of recommendations, the statement identifies both overarching policy goals for the pediatrician workforce and implementation strategies designed to ensure that all of America's infants, children, adolescents, and young adults have access to appropriate pediatric health care.
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Kostis JB, Ahmad B. International medical graduates and the cardiology workforce. J Am Coll Cardiol 2004; 44:1172-4. [PMID: 15364315 DOI: 10.1016/j.jacc.2004.05.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 12/22/2003] [Accepted: 05/25/2004] [Indexed: 11/20/2022]
Abstract
Recent publications have expressed the view that there is a shortage of cardiologists and it is growing worse. Both an increasing demand and a diminishing supply of cardiologists have been projected. An increase in the number of international medical graduates (IMGs) who enter cardiology practice has been proposed as a remedy for a projected shortage. The IMGs have to overcome challenges including clinical practice, language proficiency, and cultural differences before they are incorporated into the fabric of U.S. cardiology. With hard work, perseverance, excellence,compassionate care and support and mentoring, many have contributed to scientific and clinical cardiology in the U.S. Whether in the absence of a present crisis the projected shortage of cardiologists necessitates change in U.S. immigration policy is an open question.
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Affiliation(s)
- John B Kostis
- UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA.
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Hagopian A, Thompson MJ, Kaltenbach E, Hart LG. The Role of International Medical Graduates in America's Small Rural Critical Access Hospitals. J Rural Health 2004; 20:52-8. [PMID: 14974436 DOI: 10.1111/j.1748-0361.2004.tb00007.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. PURPOSE This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. METHODS Chief executive officers (CEOs) of CAH facilities answered a telephone survey on their use of IMGs and the characteristics of those IMGs in winter 2002 (388 responded, for a 96% response rate). This descriptive report presents roles and characteristics of IMGs in CAH facilities and the opinions of the CEOs about these practitioners. FINDINGS Overall, 1 (24%) in 4 admitting physicians in CAHs are graduates of non-US medical schools (compared with 23% of physicians nationally), although the rates are higher for CAHs in persistent poverty counties, CAHs that report recruitment problems, and CAHs with smaller medical staffs. Hospitals east of the Mississippi River are more heavily reliant on IMGs than hospitals in the west. Most IMGs are internists (59%) and most (61%) come from India, the Philippines, or Pakistan. Hospital administrators rate the clinical skills of their IMGs highly and their interpersonal skills only slightly lower. Almost half of CAH administrators said their communities recruited their first IMGs during or after 1994, the year of pro-IMG legislative changes. CONCLUSION IMG physicians play a significant and possibly growing role in staffing CAHs.
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Affiliation(s)
- Amy Hagopian
- Department of Family Medicine, University of Washington's WWAMI, Rural Health Research Center, University of Washington School of Public Health and Community Medicine, Seattle, Wash., USA.
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