title: Professional experiences of international medical graduates practicing primary care in the United States.
abstract: BACKGROUND
  International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited.
  
  
  OBJECTIVE
  To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US.
  
  
  METHODS
  Qualitative study based on in-depth in-person interviews.
  
  
  METHODS
  Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut.
  
  
  METHODS
  A standardized interview guide was used to explore professional experiences of IMGs.
  
  
  RESULTS
  Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace.
  
  
  CONCLUSIONS
  Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars, Yale University School of Medicine, 333 Cedar Street; IE-61 SHM, PO Box 208088, New Haven, CT 06520-8088, USA. peggy.chen@yale.edu
authors.forename: Peggy Guey-Chi
authors.initials: PG
authors.lastname: Chen
authors.forename: Marcella
authors.initials: M
authors.lastname: Nunez-Smith
authors.forename: Susannah May
authors.initials: SM
authors.lastname: Bernheim
authors.forename: David
authors.initials: D
authors.lastname: Berg
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: Leslie Ann
authors.initials: LA
authors.lastname: Curry
mesh_terms: D000069:Acculturation; D000328:Adult; D000368:Aged; D003237:Connecticut; D005260:Female; D005550:Foreign Medical Graduates; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D011287:Prejudice; D014481:United States; D017132:Workplace