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Comparing United States versus International Medical School Graduate Physicians Who Serve African- American and White Elderly

Authors

  • Daniel L. Howard,

    1. Institute for Health, Social, and Community Research at Shaw University, 118 E. South Street, Raleigh, NC 27601,
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    • Address correspondence to Daniel L. Howard, Ph.D., The Institute for Health, Social, and Community Research at Shaw University, 118 E. South Street, Raleigh, NC 27601. Carol D. Bunch, Ph.D., is with the Department of Social Sciences, Shaw University, Raleigh, NC. Wilberforce O. Mundia, Th.D., is with the Department of Religion and Philosophy, Shaw University, Raleigh, NC. Thomas R. Konrad, Ph.D., is with the Cecil G. Sheps Center for Health Services Research, Program on Health Professions and Primary Care, The University of North Carolina, Chapel Hill, NC. Lloyd J. Edwards, Ph.D., is with the Department of Biostatistics, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC. M. Ahinee Amamoo, M.S., and Yhenneko Jallah, M.S., are with The Institute for Health, Social, and Community Research, Shaw University, Raleigh, NC.

  • Carol D. Bunch,

    1. Department of Social Sciences, Shaw University, Raleigh, NC
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  • Wilberforce O. Mundia,

    1. Department of Religion and Philosophy, Shaw University, Raleigh, NC,
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  • Thomas R. Konrad,

    1. Center for Health Services Research, Program on Health Professions and Primary Care, The University of North Carolina, Chapel Hill, NC,
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  • Lloyd J. Edwards,

    1. Department of Biostatistics, School of Public Health, The University of North Carolina,
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  • M. Ahinee Amamoo,

    1. Institute for Health, Social, and Community Research, Shaw University, Raleigh, NC
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  • Yhenneko Jallah

    1. Institute for Health, Social, and Community Research, Shaw University, Raleigh, NC
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Abstract

Objective. To examine the relationship that international medical school graduates (IMGs) in comparison with United States medical school graduates (USMGs) have on health care-seeking behavior and satisfaction with medical care among African-American and white elderly.

Data Sources. Secondary data analysis of the 1986–1998 Piedmont Health Survey of the Elderly, Established Populations for the Epidemiological Study of the Elderly, a racially oversampled urban and rural cohort of elders in five North Carolina counties.

Study Design. Primary focus of analyses examined the impact of the combination of elder race and physician graduate status across time using a linear model for repeated measures analyses and χ2 tests. Separate analyses using generalized estimating equations were conducted for each measure of elder characteristic and health behavior. The analytic cohort included 341 physicians and 3,250 elders (65 years old and older) in 1986; by 1998, 211 physicians and 1,222 elders.

Data Collection/Extraction Methods. Trained personnel collected baseline measures on 4,162 elders (about 80 percent responses) through 90-minute in-home interviews.

Principal Findings. Over time, IMGs treated more African-American elders, and those who had less education, lower incomes, less insurance, were in poorer health, and who lived in rural areas. White elders with IMGs delayed care more than those with USMGs. Both races indicated being unsure about where to go for medical care. White elders with IMGs were less satisfied than those with USMGs. Both races had perceptions of IMGs that relate to issues of communication, cultural competency, ageism, and unnecessary expenses.

Conclusion. IMGs do provide necessary and needed access to medical care for underserved African Americans and rural populations. However, it is unclear whether concerns regarding cultural competency, communication and the quality of care undermine the contribution IMGs make to these populations.

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