title: Barriers and facilitating factors in the professional careers of international medical graduates.
abstract: OBJECTIVE
  Social and cultural diversity are increasingly important characteristics of the medical professional workforce. Every year, substantial numbers of international medical graduates (IMGs) seek jobs outside the countries in which they were educated. This article concerns IMGs who enter the Netherlands as refugees or as spouses of Dutch citizens. As their non-European medical qualifications are not considered equivalent to the Dutch qualifications, they are required to undertake additional medical training. Because little is known about their professional careers, we set out to identify the barriers that confront and the facilitating factors that support IMGs before, during and after their supplementary medical training.
  
  
  METHODS
  We invited 58 IMGs who had successfully completed their additional medical training requirements in Maastricht, the Netherlands (1996-2007) to participate in in-depth interviews. They were identified by the university's Institute of Medical Education and from its alumni database.
  
  
  RESULTS
  Thirty-two IMGs participated and reported a range of issues affecting their attempts to practise medicine in the Netherlands. Reported barriers included difficulties in accessing information on complementary medical education and lack of (financial) support. Perseverance was reported to be essential. Financial and social support were also reported as facilitating factors. Lack of command of the Dutch language and age were seen as barriers to securing employment and entrance to specialisation.
  
  
  CONCLUSIONS
  The barriers identified have major implications for IMGs wishing to practise medicine in the Netherlands. Better support to overcome the difficulties inherent in migration and career change will result in better trained and acculturated doctors who will be more motivated to contribute to society.
authors.affiliation: Laboratory of Medical Microbiology and Immunology, 5000 AS Tilburg, the Netherlands. ingehuijskens@hotmail.com
authors.forename: Elisabeth G W
authors.initials: EG
authors.lastname: Huijskens
authors.forename: Afshin
authors.initials: A
authors.lastname: Hooshiaran
authors.forename: Albert
authors.initials: A
authors.lastname: Scherpbier
authors.forename: Frans
authors.initials: F
authors.lastname: van der Horst
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D003144:Communication Barriers; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D004651:Employment; D005260:Female; D005550:Foreign Medical Graduates; D006801:Humans; D007802:Language; D008007:Licensure, Medical; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012036:Refugees; D012067:Religion