Transition Experiences of International Medical Graduates in the United States

Abstract

International medical graduates (IMGs) constitute nearly 30% of the physicians practicing in the US today (ACGME, 2020). That percentage is much higher in such practice areas as gerontology, internal medicine, and family medicine (AAMC, 2021). It is important to understand how these foreign-trained doctors come to the US and how they transition into practice in the healthcare system serving scores of American patients with unique health needs. Extant literature has attempted to explain this transition among different professions, but no studies have examined the process through which foreign-trained doctors adjust in a foreign, unfamiliar environment from the first-hand experience of the doctors themselves.

Using cross-cultural transition theory and through interviews with a cohort of international medical practitioners in the US, this study found an alignment between the transition stages advanced by Oberg (19960) and Black and Mendenhall (1991) and the first-hand experience of IMGs working in the US. Additionally, this study contributed to new knowledge in three critical transition areas: how IMGs first come to the US to practice; how they experience different stages of their transition relative to extant literature; and why they decide to apply for the Conrad-30 visa waiver so they can immigrate permanently into the US instead of returning home under the terms of their J-1 visa. Based on the phenomenological methodology advanced by Moustakas (1994) and using structured interviews, this research found that IMGs’ interpersonal skills, patience, and empathy served as anchors from which vital relationships with patients, colleagues, and employers developed.

Theoretical and practical implications of this study on IMGs, employers, and policymakers were also investigated, and recommendations were made to expand the Conrad-30 applications to draw more doctors into HPSAs. Specifically, increasing the number of regional commissions and making IMGs aware of that avenue would increase the number of IMG applicants wishing to forgo the two-year home country requirement so they can stay and work in the US. The IMGs recognize the benefits of staying in the US longer than their J-1 visa provides, including increased access to resources to advance their research and more opportunities to change employers or work overtime to increase their incomes. These are benefits IMGs claimed were not available in their home countries; nor were they readily accessible under their J-1 and H-1B visas. This study further recommended guardrails to protect IMGs from discriminatory practices coming from patients, colleagues, and other sources at their practice.