International medical graduates report high rates of discrimination in US
Key takeaways:
- International graduates reported having to change the way they spoke and the way they dressed.
- Over half did not plan to return to their home country.
Representation of immigrant and Puerto Rican minority medical graduates has increased in the U.S.; however, they continue to experience frequent discrimination, according to study results presented at ASCO Annual Meeting.
Researchers recommend the implementation of changes beyond diversifying the medical field and to strive for equity to create a more conducive environment for minority physicians.
‘Born out of nostalgia’
“This research was born out of nostalgia,” Coral Olazagasti, MD, assistant professor of medical oncology at Sylvester Comprehensive Cancer Center at University of Miami Miller School of Medicine, told Healio. “I was born and raised in Puerto Rico and went to medical school in Puerto Rico. I always thought that I would go back home after training, but because of life circumstances, that didn’t end up happening.”
After her fellowship, Olazagasti said she weighed the decisions of staying in the U.S. or going back home but ultimately decided to stay.
“It was not an easy decision to make and when I was doing my research to see if there were other people with similar backgrounds and journeys who had similarities in their decision making, I couldn’t find much, so I decided to take it upon myself to conduct this study.”
Investigators conducted the first cross-sectional study to understand the challenges and experiences of international and Puerto Rican oncology medical graduates across the U.S.
They launched an anonymous online Survey Monkey questionnaire on X (formerly known as Twitter) and used promotional materials to invite participants to complete the survey. Researchers additionally compiled a list of international and Puerto Rican medical graduates and emailed an invitation with the survey link to the list.
Experiences of respondents
The study included 97 immigrant (95.9%) and Puerto Rican (5.2%) medical graduates (50.5% women; 62.9% attendings).
Overall, 79.4% of participants migrated after medical school and 90.7% still resided in the U.S. The most common reasons for migrating to the U.S. included looking for better training (63.9%), seeking professional gains (57.7%) and lack of opportunities in home country (49.5%).
Over half of respondents reported having to adapt to new cuisine (51.5%), community (53.6%), traditions (54.6%) and celebrations (58.8%). They also reported having to change the way they spoke (51.5%), how they conducted themselves (49.5%), their tone of voice (39.2%) and the way they dressed (33%).
Results also showed that respondents faced racial/ethnic (54.5%), language (41.9%) and gender (29.7%) discrimination during medical training in the U.S., as well as racial/ethnic (46.8%), gender (32.8%) and language (24.6%) discrimination during independent practice in the U.S.
Over half of participants (53.7%) did not plan to return home, whereas 27.4% did plan to return home, and 10.5% had returned home. Among those who returned home, the most common reasons included family (67%), quality of life (28.9%) and feelings of isolation/lack of community in the U.S. (22.7%).
Of note, 57% of participants reported moderate personal and 57.4% reported extreme professional satisfaction in the U.S.
“We found that the majority of the reasons why international and Puerto Rican medical graduates, like myself, migrated to the United States was to look for a better education,” Olazagasti said. “Unfortunately, many reported experiencing high rates of discrimination in the U.S. during their training and also during independent practice. This unfortunately was not too surprising. Judging from my own experience, my journey was not without its challenges. I experienced some degrees of racial/ethnic, language and gender discrimination during my training.
“At the same time, I was a bit surprised of the amount of people who had gone through similar journeys and challenges — especially now in 2024 and the fact that there’s still so much racial and ethnic discrimination — but the intersectionality with gender discrimination also for minority women was something that was very disturbing to learn,” she added.
Continued work
“Despite the progress made, we still have a long way to go,” Olazagasti told Healio.
“It’s important to continue to diversify our training programs and faculty positions so that we have a good representation within our programs that reflect the population of the United States,” she said. “It is also important for individual organizations and programs to understand what the challenges are within that organization to be able to then implement changes, because not everyone goes through the same experiences.
“We need to understand the challenges within an organization to be able to create change,” she continued. “Hearing feedback and learning from those of us who are in these positions and experiencing these challenges and sometimes these rates of discrimination is key. Many times, not everyone is open to hearing feedback. In turn, many of us feel that we must change who and what we are as to not make any ‘waves.’ But we shouldn’t have to do that. We should be celebrated for who we are and be able to express ourselves and our journeys.”
Future research plans include examining the data beyond oncology and on a larger scale to better understand what the situation is like across all specialties and subspecialties, Olazagasti added.
“We recognize that strides have been made, but it is still a work in progress,” she said. “It is important to show this data and to know that this still exists so we can continue to move into a healthier and more equitable environment for all.”
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Olazagasti C, et al. Abstract 9001. Presented at: ASCO Annual Meeting; May 31-June 4, 2024; Chicago.