International medical graduates in family medicine in the United States of America: an exploration of professional characteristics and attitudes

This is a secondary data analysis of the 1996–1997 Community Tracking Study (CTS) Physician Survey comparing 2360 United States medical graduates and 366 international medical graduates who were nonfederal allopathic or osteopathic family physicians providing direct patient care for at least 20 hours per week.Compared to USMGs, IMGs were older (p < 0.001) and practised in smaller (p = 0.0072) and younger practices (p < 0.001). Significantly more IMGs practised in metropolitan areas versus rural areas (p = 0.0454). More IMG practices were open to all new Medicaid (p = 0.018) and Medicare (p = 0.0451) patients, and a greater percentage of their revenue was derived from these patients (p = 0.0020 and p = 0.0310). Fewer IMGs were board-certified (p < 0.001). More IMGs were dissatisfied with their overall careers (p = 0.0190). IMGs and USMGs did not differ in terms of self-rated ability to deliver high-quality care to their patients (p = 0.4626). For several of the clinical vignettes, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs.There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.International Medical Graduates (IMGs) comprised 20.8% of the family physician workforce in 1995 [1]. In 2003, this number increased to 22.1% and is expected to continue to rise, given the large increase of IMGs entering family medicine residency programmes [1].Historically, family medicine has a smaller proportion of IMGs entering residency training than other primary-care specialties. This relationship is changing as IMGs increasingly filled family medicine residency positions not selected by United States Medical Graduates (USMGs), particularly those vacant after the annual Match [2].In the 2005 Match, 36.5% of PGY-