International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes.
International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes.
复制标题
DOI：
10.1186/1478-4491-4-17
复制
发表时间：
2006-07-18
影响因子：
4.5
通讯作者：
Mullan, Fitzhugh
中科院分区：
文献类型：
--
作者：
Morris, Amanda L;Phillips, Robert L;Mullan, Fitzhugh
背景：自1997年以来，进入美利坚合众国家庭医学的国际医学毕业生（img）人数稳步增加。以前的研究已经检查了这些IMGs的实践地点及其在向服务不足的人群提供护理方面的作用。据我们所知，目前还没有研究对IMG和美国医学毕业生（USMG）家庭医生的专业概况、资历和态度进行比较。本研究的目的是确定，在IMG大量涌入家庭医学开始的时候，USMG和IMG家庭医生在个人和职业特征和态度方面是否存在差异，这些差异可能会对美国家庭医学中IMG数量增加所导致的医疗保健系统产生影响。方法：这是1996-1997年社区跟踪研究（CTS）医师调查的二次数据分析，比较了2360名美国医学毕业生和366名国际医学毕业生，他们是非联邦对抗疗法或整骨疗法家庭医生，每周至少为患者提供20小时的直接护理。结果：与usmg相比，img年龄较大（p < 0.001），执业规模较小（p = 0.0072），执业年龄较小（p < 0.001）。与农村地区相比，大都市地区的img实践明显更多（p = 0.0454）。更多的IMG实践向所有新的医疗补助（p = 0.018）和医疗保险（p = 0.0451）患者开放，他们的收入中来自这些患者的比例更高（p = 0.0020和p = 0.0310）。获得委员会认证的img较少（p < 0.001）。更多的img对他们的整体职业生涯不满意（p = 0.0190）。img和usmg在向患者提供高质量护理的自评能力方面没有差异（p = 0.4626）。在一些临床小插曲中，img比usmg更有可能安排检查，将患者转介给专家或要求办公室就诊。结论：IMG和USMG家庭医生的专业概况和态度存在显著差异。这些与1997年的差异值得进一步探索和可能的随访，因为美国家庭医生中img的比例有所增加。
BACKGROUND: The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to personal and professional characteristics and attitudes that may have implications for the health care system resulting from the increasing numbers of IMGs in family medicine in the United States.METHODS: This is a secondary data analysis of the 1996-1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week.RESULTS: Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs.CONCLUSION: There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.