Working with International Medical Grads (IMGs)

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Since 25% of the physicians in the US now are graduates of foreign medical schools, virtually all of you have worked with international medical graduates (IMGs). Almost everyone who goes into health care wants to help people keep or regain good health, and most IMGs are well intended health care practitioners, but not all of them are easy to work with.

1) Have your work experiences with foreign doctors been largely positive, negative, or mixed?

2) Do you have a story which exemplifies your working relationship with foreign-born doctors?

3) If you had to give advice to an IMG who is about to begin working in the US, what would you tell him/her?

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Are you an IMG? I have to ask. And if you are, you need to say so here.

Foreign doctors and nurses are coming into our country. My concern is that their initial training is not as good as here in the US. Patients also have concerns about someone with whom they are expressing their greatest needs/emotions while dealing with language and cultural barriers. I am not all that happy about the US physican and nursing shortage, resulting in foreign imports. I am concerned about ultimate quality care in this country...and I have been in it 26 years. Welcome to the new US Healthcare System. I am torn about this. I want it to be good, but am just not so sure it will be....

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Specializes in Pediatric Psychiatry, Home Health VNA.

No, I don't find foreign trained physicians are up to caliber with U.S. trained physicians. I find that it is much more difficult to communicate, and I find that they are less confident in practice and have had less hands-on training. I will also say that after one year of internship most IMG physicians are 100% better than they were at the beginning. I think they can be brought up to par and excel, but not all will. It can be very frustrating to try and balance the playing field when their training has been dramatically different from how physicians in the states are trained.

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Specializes in LTC, wound care.

I have seen that many, many patients rely upon nursing staff to explain over again what the doc said primarily because they cannot understand english spoken with a thick accent. Therefore, it costs the nurses a lot of time re-explaining.

There are also examples of foreign doctors behaving in ways that would lead one to believe that they are either ignorant or careless of american culture. Just take a gander at:

https://allnurses.com/forums/f8/i-slapped-doctor-312376.html

Now, perhaps an american-born doctor might try this, but I'd bet money they'd wouldn't try this because they understand that our predominant culture will not put up with this type of behavior.

But you might understand that nurses working in rural, "underserved" areas, might wonder if their new foreign doc is going to be one of these "nurse-slappers", even if only verbally.

My advice to IMG? 1. Learn and use English. If you are fluent, then you can think in english and it's not exhausting. (btw, Alan, all kids in India learn english as part of their education, so it's not exhausting for them).

2. Learn and abide by american culture. It's just like the "when in Rome" quote. This is America, not Europe, which is a collection of a bunch of small countries. We might come from lots of other countries, my ancestors spoke english, as well as other languages, but they learned and used english to become americans. IMG's need to be able to keep from offending people they work with. Remember: most americans think it is rude for foreigners to speak a foreign language, when it is known that they can speak english.

If they want to live here, have a career here, and make lots and lots of money here, then they need to RESPECT the people who are HERE, if they don't, it will be apparent to the other professionals as well as the patients that they don't. If not, then they should jump a plane and head home because they certainly don't consider this country to be their home.

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My experience with some foreign MD"s is that they find it difficult to take a suggestion from a female and are quick to argue with you about it, which in turn leads to delaying treatment to the patient. They would rather argue with you and walk away, leaving the patient in limbo, than say, ok I didn't know that.

I always get several argumentative explanations meant to demean me, as to why he doesn't think it's a good idea, then writes an order for it anyway, and takes credit for it. Those docs I am always less than helpful to when the behavior is continued.

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Specializes in LTC, wound care.

Alan, you stated:

"Since 25% of the physicians in the US now are graduates of foreign medical schools"

cite, please. Thanks.

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Specializes in OB.

My advice to foreign trained medical graduates would concur with the above, particularly in regards to treating your female coworkers (whether MD, nurse or other hospital personnel) in a respectful manner, no matter what the mores of your own culture dictate. Be aware of the effect of your attitude on others - it may be reticence rather than arrogance, but if others perceive it this way, you will miss out on a lot of assistance they could give you.

This should definitely extend to your patients as well - particularly the senior citizens. They need to be treated in a respectful manner and their concerns addressed, being sure that they can comprehend your speech - especially since age related hearing loss can make understanding a thick accent even more difficult. Pain management seems to be an issue I have seen to be a problem with many IMG's. Cultural expectations of pain differ and American born patients should not be expected to "put up with" treatable pain simply because other cultures may be more stoic. This is a problem I have seen frequently with seniors who are being treated by IMG's through their HMO's and may not want to "make waves" to try to change their assigned provider (and few US trained providers are available through many of these HMO's).

Most people at work will welcome you if you are open to suggestion, admit when something is unfamiliar, and most of all - do not criticize the US and our culture and politics until you have been here enough years to be a citizen.

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Are you an IMG? I have to ask. And if you are, you need to say so here.....

I am an American who works with foreign-born professionals in lots of workplaces, including hospitals, helping them become more proficient in their communication with Americans. My job is to make sure everyone is heard and everyone does his/her job to the maximum potential.

See allnurses posting from earlier: https://allnurses.com/forums/f8/what-brings-non-nurses-allnurses-321291-4.html#post3030734

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Alan, you stated:

"Since 25% of the physicians in the US now are graduates of foreign medical schools,"

Cite, please. Thanks.

Jane,

It's a 2006 statistic from the AMA website: http://www.ama-assn.org/ama/pub/category/211.html. Thanks for asking. BTW, my state of Michigan is one of a half-dozen states with over 30% IMGs.

Also, thanks in advance to everyone willing to share his/her stories. This is an important step in getting more understanding of how the other members of the health care team are perceived and perceiving. I appreciate both the candor and the suggestions.

Alan

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Specializes in Cardiac.

Like others have posted, there seems to be a problem with International Drs accepting any kind of suggestion from women. Even when it's blatently correct what I am saying. (Dr's do know that we document these conversations, right?)

Also, like another poster mentioned, they seem to be far below the par of American trained Drs. I'm really, really, really, really sick and tired of them having to look something up on their PDA when it's something they should know by now.

Or saying "I'll have to ask my attending" when it's something painfully simple (Like a renewal of tylenol, for instance)

Jees. Just figure it out and get it done. Pt's lives are at stake while you google the proper dose of Dopamine (or tylenol).

I'm not a fan.

And, this is just a reflection of the International Dr that I've personally dealt with, so please, no flames.

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i am more patient w/their lack of knowledge...

but i am not patient with their cultural biases towards women.

and i do not hold back.

i will not hesitate to look them in the eye and remind them,

"this is america, buddy. and you don't treat women with the same disdain you may get away with treating them at home".

and, the staring contest persists until they realize they don't really want to deal with 'this' crazy, american woman with an attitude.

leslie

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There are also examples of foreign doctors behaving in ways that would lead one to believe that they are either ignorant or careless of american culture. Just take a gander at:

https://allnurses.com/forums/f8/i-slapped-doctor-312376.html

Now, perhaps an american-born doctor might try this, but I'd bet money they'd wouldn't try this because they understand that our predominant culture will not put up with this type of behavior.

Jane,

I have just gone through all 29 pages of discussion from the incident where the male MD slapped the nurse (and he eventually got fired). Unless I missed it, there was no mention of the MD's being foreign-born. Can you help me here?

Alan

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