Experiences of International and Puerto Rican Medical Graduates in the United States: A Cross-Sectional Survey

International medical graduates (IMGs) and Puerto Rican medical graduates (PRMGs) are integral to the United States (U.S.) physician workforce yet face unique immigration-related and professional challenges. We conducted a study to investigate reasons for migration, perceived barriers, discrimination, satisfaction, and factors influencing IMGs' and PRMGs' decisions to remain in the U.S. versus return to their home countries.

We conducted a cross-sectional, online survey of foreign-born physicians who obtained their medical degrees outside the continental United States and were currently training or practicing in the U.S. The survey captured demographic and professional characteristics, migration history, cultural adaptation, discrimination, and overall professional experiences. Descriptive statistics summarized responses. Among physicians who completed training and were practicing independently in the U.S., we compared overall experience ratings and discrimination-related distress between the training and independent practice phases using the Wilcoxon signed-rank test and McNemar's test.

Of 352 respondents, most were IMGs (82.1%) and 16.8% were PRMGs. Nearly half reported racial and/or ethnic discrimination (49.6%) and language discrimination (37.8%) during training. In paired analyses among those currently in independent practice, overall experience ratings shifted from the training to independent practice phase, with "excellent" ratings more common during training than independent practice. Among participants who experienced language discrimination in both phases, distress levels decreased over time. Despite high rates of discrimination and pressure to assimilate, most participants reported excellent (63.6%) or good (52.9%) overall experiences during training and practice, respectively. Only 9.3% had returned to their home country, most of whom reported extreme happiness after returning.

High rates of racial, ethnic, gender, and language discrimination, along with pressures to assimilate, characterize IMGs' and PRMGs' journeys in the U.S. healthcare system. Nevertheless, most report high professional satisfaction. Interventions are needed to address discrimination, support cultural identity, and promote sustainable careers for this essential segment of the U.S. workforce.