Document Detail

The impact of international medical graduate status on primary care physicians' choice of specialist.
MedLine Citation:
PMID:  15258476     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Approximately one fourth of practicing physicians in the United States graduated from medical schools in other countries. It is unknown how the role of international medical graduate status affects physician decision-making. OBJECTIVE: The objective of this study was to determine whether a primary care physicians' knowledge of a specialist's international medical graduate status affects his or her decision to refer patients to that specialist. RESEARCH DESIGN AND SUBJECTS: We studied a national, cross-sectional study of primary care physicians who see adult patients. The sample was drawn from the American Medical Association Physician's Professional Data. Each physician received 2 clinical case vignettes describing a patient for whom referral to a specialist was considered necessary. Each vignette was followed by 5 vignette specialist descriptions with medical school graduate status varied randomly alongside other physician characteristics. MEASURE: We measured the decision to refer to an international versus U.S. medical graduate specialist. RESULTS: Of 1054 eligible physicians, 623 (59.1%) responded. Respondents were significantly more likely to refer to a U.S. medical graduate (USMG) compared with an international medical graduate (IMG) (63% vs. 54%, P <0.05). After adjustment for age, race, sex, and referral characteristics of the vignette specialists, a positive referral decision was noted in a higher proportion of vignettes in which the vignette specialist was described as a USMG versus an IMG (63% vs. 51%, P <0.05). CONCLUSION: With other factors being equal, vignette specialists described as IMGs versus USMGs were significantly less likely to be associated with a positive referral decision. Although specialist IMG status, relative to other factors, might not have a major effect on referral decisions, it is possible that negative views of international medical graduates could lead to suboptimal choices in referral decisions. Potentially, a patient could be referred to an USMG who happens to have inferior clinical skills than an IMG with superior clinical skills.
Kraig S Kinchen; Lisa A Cooper; Nae-Yuh Wang; David Levine; Neil R Powe
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Medical care     Volume:  42     ISSN:  0025-7079     ISO Abbreviation:  Med Care     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-19     Completed Date:  2004-08-19     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  747-55     Citation Subset:  IM    
Robert Wood Johnson Clinical Scholars Program, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
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MeSH Terms
Attitude of Health Personnel*
Choice Behavior
Cross-Sectional Studies
Databases, Factual
Foreign Medical Graduates / utilization*
Health Care Surveys
Health Manpower
Interprofessional Relations
Medicine / statistics & numerical data*
Middle Aged
Physicians, Family / psychology*
Referral and Consultation*
Regression Analysis
United States
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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