Medical migration: A qualitative exploration of the atypical path of Japanese international medical graduates

Abstract

Background: International Medical Graduates (IMGs) are commonly understood to move from low to high resource countries with motivations including improved financial situations and cultures of emigration. A presumable exception to the above themes would be the Japanese IMG population. The aim of this study was to develop an understanding of the Japanese IMG experience.

Methods: Using a grounded theory approach, we interviewed 19 Japanese IMGs working in the US and 16 Japanese IMGs working in Japan who had completed US clinical training. Questions addressed decision-making to pursue US clinical training, goals for the training, and career decision-making upon completing the training. Data collection and constant comparative analysis were conducted iteratively to identify emerging themes.

Results: The emerging model of the Japanese IMG experience is focused around pivotal experiences that often include dissatisfaction with the quality of Japanese clinical training and personal exposures to US clinical education. Further decision-making in the pursuit of US residency is influenced by educator training quality, and clinical training and career opportunities. The desire to improve Japanese clinical training commonly influences career decision-making after US training.

Conclusions: The Japanese IMG experience contrasts numerous perceptions of international physician migration and, in turn, enhances understanding of this paradigm.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Glossary

International Medical Graduate (IMG): The definition varies. Commonly the term is used in regard to physician migration to the United States and refers to a physician in training or in practice in the United States who graduated from a medical school elsewhere. The term is also used more broadly to describe a physician who graduated from medical school in a country other than the country where he/she is practicing.

Mullan, F., Politzer, R. M., & Davis, C. H. (1995). Medical migration and the physician workforce. International medical graduates and American medicine. JAMA, 273(19), 1521-1527.

Mullan, F. (2005). The metrics of the physician brain drain. N Engl J Med, 353(17), 1810-1818.

Notes on contributors

Brian Heist, MD, MSc, is an Assistant Professor of Medicine at the University of Pittsburgh School of Medicine, Division of General Internal Medicine. He also serves as Adjunct Teaching Faculty at Teine Keijinkai Hospital, Sapporo, Japan, where he worked full-time from 2007 to 2010.

Haruka Matsubara Torok, MD, MSc, is an Assistant Professor of Medicine at the University of Minnesota Medical School. During the data collection for this study, she held the same position at Johns Hopkins School of Medicine.

Additional information

Funding

This study was funded by the Shadyside Hospital Foundation.