“Reverse” cultural competency training: A model workforce orientation program for international medical graduates serving in rural states

The United States is currently experiencing a significant shortage of physicians and nurses, particularly in rural states like Iowa where 70% of its counties are at least partially designated by the federal government as medically underserved and/or provider shortage areas. In order to address this shortage, many hospitals in the state are legally recruiting large numbers of physicians from foreign countries to work in hospitals and clinics throughout the region. In fact, approximately 30% of Iowa's physician workforce is comprised of foreign-born doctors, in a state that is 93% white. Health organizations in Iowa have traditionally had a difficult time retaining these foreign-born providers, in part because these newcomers have had little previous exposure to, or understanding of, the local health care system, the mentality of Iowan patients, and the culture of rural America. This case study discusses a unique orientation program that was developed through a long-time partnership between the University of Northern Iowa and Mercy Hospital System in North Iowa, as a result of the difficulty in recruiting and retaining foreign-born physicians. A comprehensive assessment of cultural and language barriers affecting staff members was implemented, and then a unique “reverse” cultural competency training program for these physicians was created at the request of these new foreign-born employees. Faculty experts in multicultural health with the University of Northern Iowa then implemented this comprehensive orientation program for the doctors to improve their understanding of critical structural and cultural issues affecting Iowa's hospitals and patients. This project is a model program that could be replicated by other rural hospitals struggling with workforce development issues among their international medical graduates.