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In the United States, international medical graduates (IMGs) account for one-quarter of the overall physician workforce. Immigrant physicians account for 27% of the country’s residents and fellows, with IMGs from India alone comprising 25% of the total. Between 1975 and 2007, the overall physician population in the United States increased by more than 547,000, with IMGs accounting for nearly 30% of this increase. In that 32-year period, the number of non-IMGs grew by 123%, whereas the number of IMGs increased by 201%. In 1980, IMGs accounted for 20.9% of the total physician count; in 2007, the percentage rose to 25.9% of the total count. Similarly, the percentage of IMGs self-designating internal medicine as their practice specialty (as a percentage of the overall US physician population) climbed from 13% in 1975 to 24.2% in 2007.

Cultural differences between physicians and patients can affect clinical decision making and the quality of health care delivered (5). A patient’s race or ethnicity  and personal health care philosophy can have significant effects on patient care outcomes (6, 7). The provider’s cultural background may also play a role health care system also may have a considerable impact on medical decision making and the resulting patient care outcomes (9).

IMGs are generally highly motivated individuals who want to succeed. Certain differences, however,may exist between IMGs and US medical graduates (USMGs). These differences—often related to the six core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice—can directly affect relationships with peers, colleagues, and ancillary staff and may ultimately impact the quality of patient care. A recent
study of independent characteristics that differentiated IMGs from USMGs found that IMGs more often had a native language other than English and less debt (less than $50,000) upon graduation from medical school, and more often had experience practicing medicine before residency training. IMGs also were found to have less fatigue, higher self-esteem, and greater personal growth scores. Considering these factors helps program directors develop a training structure that supports this diverse cadre of both IMG and USMG

(Excerpted from Yacht AC, Panda M, Bhanot N, Porter JL. Acculturation of IMG Residents.  In: Ficalora RD (Ed). The Toolkit Series:  A Textbook for Internal Medicine Education Programs, 10th Edition.  Washington, DC: Association of Program Directors in Internal Medicine, 2010.)

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