Article Text
Abstract
Objectives Physician migration from low-income to high-income nations is a global concern. Despite the centrality of understanding the perspectives of international medical graduates (IMGs) who have experienced migration to understanding the causes and consequences of this phenomenon, empirical literature is limited. The authors sought to characterise the experiences of IMGs from limited resource nations currently practicing primary care in the USA, with a focus on their perspectives on physician migration.
Design The authors conducted a qualitative study utilising in-depth, in-person interviews and a standardised interview guide. The sample comprised a diverse, purposeful sample of IMGs (n=25) from limited resource nations (defined as having ≤2 physicians per 1000 population).
Results Analyses revealed four recurrent and unifying themes reflecting the perspectives of IMGs in the USA on physician migration: (1) decisions to migrate were pragmatic decisions made in the context of individual circumstance; (2) the act of migration ultimately affected participants' ability to return home in multiple, unpredictable ways; (3) the ongoing process of acclimation was coupled with inherent conflicts surrounding the decision to remain in the USA; and (4) the effects of policies in both the home country and in the USA occurred at multiple levels.
Conclusion The perspectives of IMGs who have migrated to the USA are an important addition to the ongoing discussion surrounding the global health workforce. Our findings highlight the effects of workforce policies which are often developed and discussed in abstraction, but have real, measurable impacts on the lives of individuals. Future efforts to address physician migration will need to acknowledge the immediate needs of the health workforce as well as the long-term needs of individuals within health systems.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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Footnotes
Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).
To cite: Chen PG, Nunez-Smith M, Berg D, et al. International medical graduates in the USA: a qualitative study on perceptions of physician migration. BMJ Open 2011;1:e000138. doi:10.1136/bmjopen-2011-000138
Funding This study was funded by the Robert Wood Johnson Clinical Scholars Program, the Robert Wood Johnson Foundation and the Agency for Healthcare Research and Quality (T32 HS 017589-02T32) and the Yale Global Health Leadership Institute. The research team was independent from the funders, who had no role in the collection, analysis and interpretation of data; in the writing of the report; or the decision to submit the article for publication.
Competing interests None.
Ethics approval Ethics approval was provided by Yale University Human Investigations Committee.
Contributors PC, MNS and LC conceived of and designed the study. PC, MNS, DB, AG, SR and LC contributed to the analysis and interpretation of data. PC, MNS and LC drafted the article. PC, MNS, DB, AG, SR and LC revised the article critically for important intellectual content. PC, MNS, DB, AG, SR and LC provided final approval of the version to be published. All authors, external and internal, had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The study protocol, interview guide and code structure are available from the corresponding author at peggy.chen{at}yale.edu. No additional data are available. The authors were required by the Yale Human Investigations Committee to destroy all data following final analysis in order to protect the identities of the participants.