Introduction:

For my research project I worked as a student researcher under Dr. Kata Chillag on a national study of bioethics that examined the effect of the current immigration climate on international medical school graduates (IMGS) and their experiences studying and working in underserved areas in the United States. The project primarily focused on West Virginia, as the state and its population is uniquely suited for the study of IMGs in the United States. West Virginia has a large rural population, an acute shortage of physicians (especially in the primary care specialty), and a sizable number of IMGs practicing in the state. Additionally, Dr. Kata Chillag had contacts in the state as it was the place she was born and raised. I was with the research project during the initial stages of literature review, the interviewing process, and the qualitative analysis of the interviews. Dr. Chillag left Macalester just before I was able to assist on the coding and analysis of the interview to continue her work at Davidson College in North Carolina.

Background:

The premise and purpose of this study are better understood after learning about the current physician shortage in the US healthcare system. It is estimated that by 2032, the demand for physicians in the United States will surpass the actual supply of physicians by approximately 122,000 doctors. This shortage is most acute in rural areas, with recent reports indicating that U.S. urban areas have 96.2 primary-care physicians for every 100,000 people, compared with rural areas' 55.6 physicians for every 100,000 residents. Currently, IMGs play a vital role in mitigating the physician shortages which often leave rural communities without access to doctors or treatment. IMGs represent 26% of all physicians in practice and 24% of all residents in specialty programs in the U.S. IMGs are particularly important in Geriatric Medicine and Critical Care. In fact, 50.7% of all geriatricians in the US and 43.6% of all critical care physicians in the US are IMGs. The IMGs in the US come from a broad variety of countries, however, the largest number of physicians come from: India, the Philippines, Pakistan, Syria, and Nigeria. IMGs in the US will go on to practice primarily in the Southern and Northeastern parts of the country. However, West Virginia is a state that is particularly affected by the physician shortage and is particularly reliant upon IMGs in order to meet the medical needs of its citizens.

Methodology:

The research project conducted a series of interviews with staff members of national medical organizations, IMGs, and the administration of medical institutions in the state of West Virginia, in order to collect qualitative data on the experiences of IMGs in the U.S. Once the interview phase of the research project was completed, the interviews would be coded and analyzed in order to discern broad themes, similarities, and differences between the narratives of the IMGs. Some of the major themes that were drawn from the initial interviews conducted by the team included: 1) discrimination, 2) obstacles to gaining their license or practicing in the US, 3) systems of support in place for IMGs, and 4) the experience of practicing in rural America. Dr. Chillag left Macalester before I learned of the final results. However, preliminarily I can say that IMGs are playing a vital role, by providing rural residents with critical healthcare in both hostile and friendly environments across the United States.

My Roles:

I had various roles throughout the duration of my involvement in the study that included data collection, data analysis, and administrative oversight. At the beginning of my internship I collected for the study’s official literature review, collecting and processing a wide variety of academic and popular articles over a number of relevant subjects. After preliminary data collection began I was primarily responsible for scheduling and coordinating interviews with Dr. Chillag and her co-investigators. As mentioned, as soon as coding of the interviews was scheduled to begin Dr. Chillag left Macalester to take a position at Davidson College. Overall, I had an amazing experience working under Dr. Chillag and learned a great deal of invaluable first-hand knowledge of the inner-workings and operations of academic research projects.

Citations:

• Association of American Medical Colleges. (2020). Active Physicians Who Are International Medical Graduates (IMGs) by Specialty, 2015. Retrieved from https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-who-are-international-medical-graduates-imgs-specialty-2015

• Appalachian Regional Commission. (n.d.). Rx for the Rural Health-Care Shortage. Retrieved April 28, 2020, from https://www.arc.gov/magazine/articles.asp?ARTICLE_ID=163

• How IMGs have changed the face of American medicine. (2019, October 21). Retrieved from https://www.ama-assn.org/education/international-medical-education/how-imgs-have-changed-face-american-medicine