The US Distribution of Physicians from Lower Income Countries

Torrey, Ε. Fuller; Torrey, Barbara Boyle

doi:10.1371/journal.pone.0033076

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…As of 2010, there were an estimated 265,851 physicians in the United States (US) who have received their education in other nations, 128,729 of whom came from low income countries [ 3 ]. Home country health systems have suffered from the gap left by emigrated health professionals.…”

Section: Introductionmentioning

confidence: 99%

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems

Nwadiuko¹,

James

Switzer

2016

Global Health

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BackgroundThere is increased interest in the capacity of US immigrants to contribute to their homelands via entrepreneurship and philanthropy. However, there has been little research examining how immigrant physicians may support health systems and what factors facilitate or raise barriers to increased support.MethodsThis study used an observational design with paper questionnaire and interview components. Our sample was drawn from attendees of a 2011 conference for US Based Nigerian physicians; respondents who were not US residents, physicians, and of Nigerian birth or parentage were excluded from further analysis. Respondents were randomly selected to complete a follow-up interview with separate scripts for those having made past financial contributions or medical service trips to support Nigerian healthcare (Group A) and those who had done neither (Group B). Survey results were analyzed using Fischer exact tests and interviews were coded in pairs using thematic content analysis.ResultsSeventy-five of 156 (48 %) individuals who attended the conference met inclusion criteria and completed the survey, and 13 follow-up interviews were completed. In surveys, 65 % percent of respondents indicated a donation to an agency providing healthcare in Nigeria the previous year, 57 % indicated having gone on medical service trips in the prior 10 years and 45 % indicated it was “very likely” or “likely” that they would return to Nigeria to practice medicine. In interviews, respondents tended to favor gifts in kind and financial gifts as modes of contribution, with medical education facilities as the most popular target. Personal connections, often forged in medical school, tended to facilitate contributions. Individuals desiring to return permanently focused on their potential impact and worried about health system under-preparedness; those not desiring permanent return centered on how safety, financial security and health systems issues presented barriers.ConclusionsThis study demonstrates several mechanisms by which health systems may benefit from expatriate engagement. Greater identification of reliable local partners for diaspora, deeper collaboration with those partners and a focus on sustainable interventions might improve the quantity and impact of contributions. Ethnic medical associations have a unique role in organizing and facilitating diaspora response. Public-private partnerships may help diaspora negotiate the challenges of repatriation.

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Section: Introductionmentioning

confidence: 99%

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems

Nwadiuko¹,

James

Switzer

2016

Global Health

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“…3 This shortage is in part due to emigration, as Haiti has one of the top four rates of physician loss to the American workforce globally. 4 In addition to the workforce shortage, there is chronic underfinancing of the health sector: Before the 2010 earthquake, the country spent 9.5% of total government expenditure on health. This under-resourced health system has been further strained with the loss of material and human resources in the earthquake, coupled with an overburdening from excess morbidity and mortality incurred from the earthquake and the introduction of cholera.…”

Section: Introductionmentioning

confidence: 99%

A Needs and Resource Assessment of Continuing Medical Education in Haiti

Nádas

Bedenbaugh²,

Morse

et al. 2015

Annals of Global Health

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“…[29][30][31] International medical graduates from nearly all specialties except OBGYN had lower odds of providing contraceptive services, but the proportion of IMGs among OBGYN physicians is a fraction of that in other specialties. 32 In addition, compared with their colleagues trained in US medical schools, IMGs are more likely to practice in areas that have physician shortages, 33,34 and they generally see a higher proportion of Medicaid beneficiaries. 35 Policy makers should take note of these…”

Section: Jama Health Forum | Original Investigationmentioning

confidence: 99%

Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

et al. 2023

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ImportanceLittle is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for Medicaid beneficiaries’ health.ObjectiveTo describe the primary care physician workforce that provides contraceptive services to Medicaid beneficiaries and explore the factors associated with their Medicaid contraceptive service provision.Design, Setting, and ParticipantsThis cross-sectional study, conducted from August 1 to October 10, 2022, used data from the Transformed Medicaid Statistical Information System from 2016 for primary care physicians from 4 specialties (family medicine, internal medicine, obstetrics and gynecology [OBGYN], and pediatrics).Main Outcomes and MeasuresThe main outcomes were providing intrauterine devices (IUDs) or contraceptive implants to at least 1 Medicaid beneficiary, prescribing hormonal birth control methods (including a pill, patch, or ring) to at least 1 Medicaid beneficiary, the total number of Medicaid beneficiaries provided IUDs or implants, and the total number Medicaid beneficiaries prescribed hormonal birth control methods in 2016. Physician- and community-level factors associated with contraceptive care provision were assessed using multivariate regression methods.ResultsIn the sample of 251 017 physicians (54% male; mean [SD] age, 49.17 [12.58] years), 28% were international medical graduates (IMGs) and 70% practiced in a state that had expanded Medicaid in 2016. Of the total physicians, 48% prescribed hormonal birth control methods while 10% provided IUDs or implants. For OBGYN physicians, compared with physicians younger than 35 years, being aged 35 to 44 years (odds ratio [OR], 3.51; 95% CI, 2.93-4.21), 45 to 54 years (OR, 3.01; 95% CI, 2.43-3.72), or 55 to 64 years (OR, 2.27; 95% CI, 1.82-2.83) was associated with higher odds of providing IUDs and implants. However, among family medicine physicians, age groups associated with lower odds of providing IUDs or implants were 45 to 54 years (OR, 0.66; 95% CI, 0.55-0.80), 55 to 64 years (OR, 0.51; 95% CI, 0.39-0.65), and 65 years or older (OR, 0.29; 95% CI, 0.19-0.44). Except for those specializing in OBGYN, being an IMG was associated with lower odds of providing hormonal contraceptive service (family medicine IMGs: OR, 0.80 [95% CI, 0.73-0.88]; internal medicine IMGs: OR, 0.85 [95% CI, 0.77-0.93]; and pediatric IMGs: OR, 0.85 [95% CI, 0.78-0.93]). Practicing in a state that expanded Medicaid by 2016 was associated with higher odds of prescribing hormonal contraception for family medicine (OR 1.50; 95% CI, 1.06-2.12) and internal medicine (OR, 1.71; 95% CI, 1.18-2.48) physicians but not for physicians from other specialties.Conclusions and RelevanceIn this cross-sectional study of primary care physicians, physician- and community-level factors, such as specialty, age, and the Medicaid expansion status of their state, were significantly associated with how they provided contraceptive services to Medicaid beneficiaries. However, the existence of associations varied across clinical specialties. Ensuring access to contraception among Medicaid beneficiaries may therefore require policy and program approaches tailored for different physician types.

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The US Distribution of Physicians from Lower Income Countries

Cited by 12 publications

References 15 publications

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems

Giving Back: A mixed methods study of the contributions of US-Based Nigerian physicians to home country health systems

A Needs and Resource Assessment of Continuing Medical Education in Haiti

Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

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