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J Gen Intern Med. 2012 Feb;27(2):147-52. doi: 10.1007/s11606-011-1832-4. Epub 2011 Aug 25.

Career satisfaction in primary care: a comparison of international and US medical graduates.

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Division of Health Policy and Administration, Yale School of Public Health, 47 College Street, New Haven, CT 06520-8088, USA.



International medical graduates (IMGs) have substantial representation among primary care physicians in the USA and consistently report lower career satisfaction compared with US medical graduates (USMGs). Low career satisfaction has adverse consequences on physician recruitment and retention.


This study aims to identify factors that may account for or explain lower rates of career satisfaction in IMGs compared with USMGs.


Using data from the 2008 Health Tracking Physician Survey, a nationally representative survey, we examined the association between IMG status and career satisfaction among primary care physicians. We used multivariable logistic regression modeling to adjust for a broad range of potential explanatory factors and physician characteristics.


The study participants comprise primary care physicians who reported at least 20 h a week of direct patient care activities (N = 1,890).


The main measures include respondents' overall satisfaction with their careers in medicine.


IMGs were statistically significantly less likely than USMGs to report career satisfaction (75.7% vs. 82.3%; p = 0.005). This difference persisted after adjusting for physician characteristics and variables describing the practice environment (adjusted odds ratio = 0.62; 95% confidence interval, 0.43-0.90). Pediatricians (vs. internists) and those who earned $200,001-250,000 (vs. <$100,000) or >$250,000 were more likely to report career satisfaction, while solo practitioners and those who reported being unable to provide high-quality patient care were less likely to report career satisfaction.


After adjusting for a number of variables previously shown to have an impact on career satisfaction, we were unable to identify additional factors that could account for or explain differences in career satisfaction between IMGs and USMGs. In light of the central role of IMGs in primary care, the potential impact of poorer satisfaction among IMGs may be substantial. Improved understanding of the causes of this differential satisfaction is important to appropriately support the primary care physician workforce.

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