Elderly/Long-term Care

Elderly people find international medical school graduates to lack in cultural competency and communication skills

Each year in the United States, there are at least 5,000 more openings for first-year residency trainees than there are graduates of U.S. medical schools. As a result, many of these training slots are filled by international medical school graduates (IMGs). Their requirement to return to their home country for at least 2 years upon completion of their medical education can be waived, if they agree to practice in designated rural or inner city physician shortage areas. IMGs provide necessary and needed access to medical care for underserved black and rural elderly populations. However, according to a new study, their lack of communication skills and cultural competency may undermine their contribution to the care of these poor and underserved populations.

Daniel L. Howard, Ph.D., of Shaw University, and colleagues analyzed survey data from 1986 to 1998 from urban and rural elderly persons in five North Carolina counties to determine the impact of medical school graduate status on the care of elderly people in these counties. The group studied included 341 physicians and 3,250 people age 65 and older in 1986, and 211 physicians and 1,222 elderly people by 1998. Nine percent of the elderly people surveyed were treated by IMGs in 1986, and 11 percent were treated by IMGs in 1998. The majority of IMGs were trained in medical schools in developing countries.

Over time, IMGs treated more black elderly people and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas than graduates of U.S. medical schools (USMGs). However, white elderly people with IMG physicians were more likely to delay getting needed care and were less satisfied with care than those with USMGs. Both black and white elderly people seemed to perceive IMGs as difficult to communicate with, lacking in cultural competency, and reluctant to use expensive treatments, such as surgery. They mentioned that the IMGs did not explain things well, leading them to worry, or made "patients my age" feel foolish. For blacks, perception of IMGs was directly related to issues of cultural competency, communication, and ageism. The study indicated no difference in access to care or consistency of care among elders with USMG versus IMG physicians. The study was supported in part by the Agency for Healthcare Research and Quality (HS13353).

See "Comparing United States verus international medical school graduate physicians who serve African-American and white elderly," by Dr. Howard, Carol D. Bunch, Ph.D., Wilberforce O. Mundia, Th.D., and others in the December 2006 HSR: Health Services Research 41(6), pp. 2155-2181.

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