In lieu of current political events restricting immigration, the dependence of the U.S. on foreign- born doctors is quickly coming to the surface. The country is already suffering from a shortage of physicians, especially primary care physicians. There are several factors that have led to this, but with an aging population there may be an even greater demand for doctors in the near future. Addressing cultural diversity in healthcare will become central to improving communication and treatment from foreign born doctors.
Physician Shortages, Foreign Born Doctors, and Cultural Diversity in Healthcare
The high costs of U.S. medical schools, and trends favoring higher paying specialties are some of the factors influencing the shortage of physicians in the states. One potential solution to the shortage is to allow work for more foreign doctors in USA health institutions. But stricter immigration policies and increased competition for U.S. residency programs have limited the number of foreign-born doctors allowed to stay and work in the country.
Despite the relatively low acceptance rate of foreign-born applicants in many U.S. residency programs, over one quarter of all medical doctors currently working in the United States are in fact foreign-born.
Over the last couple of decades, this percentage has become significantly higher in rural parts of the country as a result of new incentives. In 1994, the physician visa waiver program was set up to offer foreign-born doctors on J -1 student visas permanent residency in exchange for three years of practicing medicine in an under-served community.
This initiative has brought many foreign doctors to small agricultural towns around the country. However, the increase in the cultural diversity in healthcare settings has naturally lead to a few barriers in communication.
Cultural Diversity in Healthcare – Immigrating to Under-served Communities
For many under-served towns, such as Claiborne, Tennessee, employing foreign-born doctors may be the only viable solution.
Like other rural counties in eastern Tennessee, Claiborne has faced an ongoing shortage of physicians. Countywide, there are only 20 doctors, fifteen of whom provide primary care – about one doctor for every 2,000 or so residents.
The county hospital has three general surgeons, and there is only one OB/Gyn and three pediatricians – a slight improvement compared to ten years ago when there was only one pediatrician and no OB/Gyn. Today, about half of the physicians living and practicing in Claiborne County originally came from other countries.
In addition to changing their immigration status, there are other obvious advantages to moving to rural areas for foreign medical professionals. These include the slower pace of life and a lower cost of living. However, lack of cultural diversity in healthcare settings and limited exposure to foreigners among local residents often makes the initial adjustment period difficult.
Cultural Diversity in Healthcare – Culture and Language
In many rural parts of the United States, foreign physicians are increasingly encountering adjustment issues. The state of West Virginia, for example, has not been able to attract a sufficient number of doctors, even in more populated parts of the state.
Current statistics indicate that there are only 232 doctors per 100,000 residents in the entire state of West Virginia. In comparison, a neighboring state has more than 400 doctors for the same number of residents, causing the U.S. Department of Health to designate 51 out of 55 counties in West Virginia as “medically under-served areas”.
West Virginia has one of smallest immigrant populations in the country. According to U.S. census data, only 1.3% of the entire population in West Virginia is foreign-born, while one-third of the state’s doctors are foreigners.
The lack of cultural diversity in healthcare and general social settings can be intimidating for doctors coming to rural areas, as residents are not used to foreign accents or even interacting with minorities such as African-Americans or Hispanics.
Foreign trained doctors in the city of Logan West Virginia for example (population 1,779) have had difficulties during their periods of initial adjustment. These issues can be overcome, but recent events regarding the public image of Islam in the media are not helping the integration of many physicians who may be erroneously identified as coming from a Muslim country.
Stereotypes aside, language use can still present an issue. Many local residents are learning to adjust to their doctor’s foreign accents. However, physicians are discovering that they must still work hard to communicate with their patients despite their English proficiency.
The issue is not their ability to speak and understand English, but rather that they are unfamiliar with the local, U.S. culture.
Many of the doctors working in rural areas have trained in more urban and ethnically diverse parts of the United States. As such, in order to break the communication barrier, these physicians must make a special effort to familiarize themselves with the local lifestyle, culture, and idioms.
Doctor, Do You Speak Iowan?
The issue brings to mind an article in the Wall Street Journal, “Foreign-born doctors learn to speak Iowan”.
The article discussed a new program in Iowa aimed at helping foreign born doctors better understand the local Iowan culture.
Mason City, a town in Northern Iowa with a population of 30,000 people commonly employs physicians from other parts of the world. Although the majority of these doctors are used to working with a diverse patient population, and are fluent in English, they often struggle to understand the Iowan culture.
Two major factors influence Iowa’s culture: the state’s demographics and the population’s reliance on agriculture.
Iowan Demographics
The majority of Iowa’s population is American-born, and 91.3% of the state’s population is Caucasian, mostly of Western European descent: German (35.7%), Irish (13.5%), English (9.5%), Native American (6.6%), and Norwegian (5.7%).
In contrast, the majority of the physician population is composed of many different ethnicities and races. Those working in Mason City Iowa are primarily from Egypt, India and the Philippines. This has created a wide cultural gap between the doctors and their patients.
Agriculture in Iowa
Iowa is located in the heart of America’s Corn Belt. It is the nation’s largest producer of ethanol, corn and soybeans. The livelihood of the majority of the population in Mason City, Iowa is primarily dependent on farming. This has a direct impact on medical practices. Harvesting season, for example, will commonly determine when a patient accepts to undergo a medical treatment such as surgery.
Much of the vocabulary and local expressions are also related to farming. However, many of the perceptions and societal standards established over generations of Iowan farmers are not easily understood by newcomers.
In order to overcome this issue, some hospitals have initiated cultural training programs. Mason City’s major hospital, Mercy Medical Center, now has several required courses in Iowan culture that foreign-born physicians working there are expected to complete.
The focus of these courses is clearly evident from their titles. “Topics for Small Talk with Iowans” is a course on the Iowa character which teaches foreign-born doctors how to make small talk about farming, and local popular culture such as the Iowan’s loyalty to the University of Iowa Hawkeyes.
Common idioms used by the people of Iowa are also discussed to help them understand and communicate better. One example is the meaning of the common regional expression “Knee high by the fourth of July” which refers to a good crop of corn. Doctors are also taught how to recognize and respond when a patient is acting “Iowa nice,” or the excessively polite manner used by Iowans. This could be important for medical professionals, as Iowans may believe that it is not courteous to initiate a discussion about certain illnesses that might inconvenience their doctor.
Another course which addresses cultural differences between the patients and their foreign-born doctors is entitled “An Intro to Working Effectively with White Europeans in Iowa.” This course is designed to help eliminate the communication gap between doctors and patients from different racial backgrounds that often results in misunderstandings.
A Global Perspective
In many countries around the world physicians must complete a requirement in agricultural medicine – after residency doctors are expected to serve in a rural, under-served community for a time. However, both doctors and patients have the same nationality.
In the United States, physicians from many different countries are serving Americans living in rural communities. For the most part, residents are very appreciative of the fact that these doctors are helping improve their healthcare access.
Different accents and racial/ethnic backgrounds are increasingly viewed as normal in many of these communities. With greater emphasis placed on awareness training for cultural diversity in healthcare settings, such as that in Iowa’s Mason City hospital, the communication barriers can be overcome.
However, with current immigration policies, some physicians may choose to immigrate elsewhere rather than face growing attitudes against immigrants and a changing environment.
What effect will this have on under-served rural populations in the long run? Current estimates suggest that the country will face a serious shortage of physicians by the year 2025, and while over one quarter of doctors in the United States are foreign, the tightening of borders and attitudes towards immigrants may create an even greater shortage.
Greater awareness and exposure to cultural diversity in healthcare through various programs may help to decrease the barrier between foreign doctors in the U.S. and patients. This will not only improve healthcare access for otherwise undeserved communities, but also enrich the lives of local residents and doctors alike by contributing to greater diversity.
Learn more about our Translation Services and our Life Sciences Translation services!
About Language Connections:
Language Connections is one of the top language service companies in the US. Over the last 30 years, we’ve focused on providing the best business translation services, interpreting services, as well as interpreter training and customized language training programs. In addition to top-tier corporate language training, we offer certified corporate interpreters and professional business translation services in 200+ languages. Our network includes linguists with backgrounds in all major industries. They’re ready to meet your needs, whether they’re for technical translation services, legal translation, government translation services, international development translation services, education translation services, life sciences translation, or something else. Reach out to us today for a free quote on our cost-efficient and timely translation services, interpreters, or other linguistic services.
Language Connections Inc.
2001 Beacon Street, Suite 105,
Boston, MA 02135
Phone: +1-617-731-3510
Email: service@languageconnections.com