Summary

Building Strength in Cultural Care

Recruiting Refugee Physicians

Overview: Minnesota’s population is increasingly diverse. A body of research shows that outcomes improve when there is a cultural/racial match between providers and patients. Many refugee populations have limited access to doctors with deep knowledge of their language and traditions. Refugee doctors could provide concordant care to the state’s substantial immigrant population. However, their path to practice in the US is blocked by barriers that could be reduced or eliminated.

Changing State Population: The Minnesota state demographer’s best estimate of recent immigrants in 2004 put the number of recent immigrants at 325,000, with Latinos, Hmong, Somalis and Vietnamese ranked as most numerous.

Where Minnesota Physicians Come From: 80 percent of Minnesota physicians are born in the US. The largest number of foreign-born Minnesota doctors are from India, Canada, Pakistan, Germany and China. Recent immigrants face substantial difficulty in finding a physician who deeply understands their language and culture. For instance, there is one Somali-born doctors for every 2,857 Somali-born residents of Minnesota. Refugee doctors have scant success gaining access to residency programs — a critical step in achieving a medical license. According to the AMA, 99 of the country’s 106,012 medical residents are refugees.

Why It Matters: Patient/Doctor Racial Concordance: An extensive body of research establishes that patients are more satisfied and in many instances receive better care when there is concordance between the race or ethnicity of the provider and patient. A national study of African-American, White, Hispanic and Asian-American patients found that when there is a racial match between provider and patient, patients are more likely to use needed health service, less likely to postpone needed treatment and more likely to report more use of medical service.

Barriers to Medical Residency for Refugee Doctors: A Minnesota survey of refugee doctors found that barriers to practice included high testing costs, language, difficulty gaining access to education and professional information from often hostile foreign governments, and a lack of coaching, advocacy and family support. A survey of surgical residency directors also established that international medical graduates are the victims of discrimination. Half of the surveyed residency directors said their programs prefer US medical graduates over international medical graduates, and that they purposefully avoid matching with IMGs.

Providing Help: Several US medical institutions have initiated programs to increase the odds of success for IMGs under consideration or accepted to their residency programs. The AMA has produced a detailed, model IMG observership program that can be adapted by hospitals. A version of these programs could be constructed to match the needs of Minnesota institutions and refugee populations.