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Refugee Physicians in the United States: Barriers, Resources and Pathways to Practice

Project: 2
Name: Susan Bell, PhD | seb376@drexel.edu
Department: Sociology

Description

The purpose of this sociological study is to explore the experiences of refugee physicians in the US; to describe the pathways they take after arriving and the legal, educational and licensing environment within which they live; and to understand how they navigate the US system of medical licensure and practice.

In the US, 25% of physicians are International Medical Graduates (IMG). 'Refugee physicians' are people trained in medicine outside the US who have entered the US as refugees and are a subset of IMGs. The study asks: Why do so few refugee physicians practice medicine in the US? What role does legal status place in refugee physicians' career pathways? If they do not practice medicine, what do they do, and why? What structural, cultural, economic and personal factors contribute to their pathways into or away from medicine?

The study's primary goal is to reach a theoretically-informed analysis of the experiences of refugee physicians in the US (whether they work in health fields or not). The secondary goal is to provide best practices for support programs and proposals for ways to adjust training and credentialing processes to encourage refugee physicians to pursue clinical careers, and to help remediate the physician shortage, increase diversity in the medical profession and address issues of equity and quality of care - particularly the primary care shortage and needs of underserved areas in the US.

The analysis is based on qualitative, in-depth interviews: 30 interviews with refugee physicians and 20 interviews with staff at organizations providing support and training programs for refugee physicians and international medical graduates (IMG). The study was approved by the Drexel University IRB in January 2019. Outreach began in February, and interviews began in March. Interviews last approximately 90 minutes and are audio-recorded. The initial interviews have yielded rich and complex narratives about choosing a career in medicine, leaving a homeland, arriving in the US, and preparing for and taking the required 3-step exam (to qualify in the competition for a residency in the US).

Interviews will be transcribed, and transcripts will be coded using both hand coding and NVivo. Memos are written throughout the project to develop theories and concepts, and to reflect on research processes. Analysis employs qualitative and narrative methodologies that sociologists often use and looks for connections between individual experiences and social structural conditions. Open coding is used to identify patterns and themes, leading to focused coding of themes and sub-themes, and the development of a fully conceptualized analytic interpretation and description. This in turn supports the identification of narrative portions in which people construct stories, making events meaningful in relationship to other events and social structural circumstances, especially when there has been a breach or interruption. Narrative analysis examines how images, pictures, and explanations are interwoven in a story and convey meaning, as well as the position of the narrator in relation to story events and audiences. The PI is Susan E. Bell, PhD. The co-PI is Lillian Walkover, PhD, Postdoctoral Fellow in Global Health, Department of Sociology.

Gained Experience

  • Proficiency in the use of qualitative social science research methods (including transcription, thematic and narrative coding, memo-writing and NVivo software)
  • Proficiency in research ethics (CITI training, use of SafeGuard)
  • Sociological understanding of medical licensure and challenges, barriers and supports for refugee physicians
  • Development and presentation of social science research in poster and paper formats at professional associations

Outcome

The expected outcome of this project is a series of articles to be published in academic journals. Results will also be presented at professional conferences. There are two core audiences for this work: sociologists interested in immigration, health and illness, and global health; and educators and advocates working to support refugee physicians.

Initial findings from a census of programs completed to frame this project were presented during the Eastern Sociology Society Annual Meeting, March 2019. A manuscript based on that work is currently in preparation for submission to the journal Academic Medicine.

Expected student outcomes

  • Undergraduate paper or poster presentation, Eastern Sociological Society Annual Meeting (March 2020, Philadelphia)
  • Conference presentation, Mid-Atlantic Undergraduate Social Research Conference (March 2020)

Tasks

  • Transcribe and code interviews (with NVivo)
  • Write memos about interviews
  • Create and expand databases of resources available to this population (private for-profit and not-for profit, public, government and non-government assistance programs; state and national legislation)

Location

Sociology Department (3201 Arch St., Suite 240)

Possibility to Work Post Fellowship

Yes.