title: Comparing United States versus international medical school graduate physicians who serve African- American and White elderly.
abstract: OBJECTIVE
  To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly.
  
  
  METHODS
  Secondary data analysis of the 1986-1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties.
  
  
  METHODS
  Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and chi2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders.
  
  
  METHODS
  Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews.
  
  
  RESULTS
  Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses.
  
  
  CONCLUSIONS
  IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.
authors.affiliation: The Institute for Health, Social, and Community Research at Shaw University, Raleigh, NC 27601, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Howard
authors.forename: Carol D
authors.initials: CD
authors.lastname: Bunch
authors.forename: Wilberforce O
authors.initials: WO
authors.lastname: Mundia
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Konrad
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: Edwards
authors.forename: M
authors.initials: M
authors.lastname: Ahinee Amamoo
authors.forename: Yhenneko
authors.initials: Y
authors.lastname: Jallah
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005550:Foreign Medical Graduates / Q000706:statistics & numerical data*; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D000078329:Workforce