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APHA Scientific Session and Event Listing

Shivonne L. Laird, MPH¹, Mary Catherine Beach, MD, MPH², and Lisa A. Cooper, MD, MPH². (1) Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, 443-562-3525, slaird@jhsph.edu, (2) Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, 2024 E. Monument Street, Suite 2-500, Baltimore, MD 21205

Background: Previous studies suggest that international medical graduates (IMGs) face discrimination in the workplace, such as fair consideration for promotions and pay equivalent to their peers; they may also receive fewer referrals from colleagues than USMGs. However, it is unclear whether IMGs perceive this discrimination to be due to race/ethnicity, national origin, and/or location of medical training.

Methods: We used data from The Maryland Study on Physician Experience with Managed Care, a cross-sectional mailed survey of the experience of physicians in Maryland with managed care, to examine the associations between physician IMG status and location of training with self-report of perceived discrimination based on race and country of origin. The survey was conducted between July and November of 2000.

Results: Our sample included 1,192 physicians with data regarding IMG/USMG status; 71% were men, and 36% were IMGs. The racial distribution among IMGs and USMGs differed; the majority of IMG physicians were Asian (61%), while the majority of USMG physicians were either White (47%) or African-American (35%) (p<.001). Eleven percent of IMGs versus 6% of USMGs in this sample report racial discrimination (p=.005), and 11% of IMGs versus 1% of USMGs report discrimination due to their national origin (p<.001). Eighteen percent of physicians trained in Africa and 12% of those trained in Asia perceive racial/ethnic discrimination compared to 8% of those trained in Latin America/Caribbean, 7% of those trained in Europe, and 6% of those trained in the U.S. Additionally, 18% of physicians trained in Africa, 13% of those trained in Asia ,11% of those trained in Europe and 8% of those trained in Latin America and the Caribbean report discrimination due to national origin, compared to 1% of those trained in the U.S.

Conclusion: Perceptions of discrimination due to race or national origin are similarly prevalent among IMGs and less prevalent among USMGs. Physicians who trained in Africa and Asia report higher levels of racial discrimination than those who trained elsewhere, likely because they are ethnic minorities in the U.S. population and in the U.S. physician workforce. It is unclear whether physicians who trained in Latin America, the Caribbean, and/or Europe perceive national origin discrimination because of linguistic or other cultural barriers. Future studies should explore the reasons for these findings and their potential impact on IMG satisfaction and patient outcomes.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Describe the patterns of perceived racial and national origin discrimination among IMGs and USMGs in Maryland
• Identify whether the geographic location of training is associated with perceived racial and national origin discrimination.

Keywords: Managed Care, Physicians

Presenting author's disclosure statement:

Not Answered