Exploring experiences of work-related inequitable treatment among international medical graduates (IMGs): A sequential explanatory mixed methods study.

backgroundInternational medical graduates (IMGs) are an essential workforce for many high-income countries worldwide and are often recruited to fill workforce shortages. Studies identify workplace discrimination as a major challenge for IMGs. However, little detailed exploration has been undertaken on this issue.

methodsWe designed a sequential explanatory mixed methods study to explore details of inequitable treatment perceived by IMGs in Australia. An online survey was distributed to IMGs across Australia. We analysed data descriptively and tested for significant demographic differences against the primary discrimination variable using tests of association (t-test and chi-squared tests). Following analysis, individual interviews were undertaken by telephone, teleconference or face-to-face. Thematic analysis was conducted on qualitative study components. All data was triangulated to assess areas of congruence and difference and to gain fuller understanding of the data.

resultsWe surveyed and interviewed 286 and 36 IMGs respectively. Most survey respondents reported that IMGs were disadvantaged when compared to Australian graduates, primarily due to registration and bureaucratic processes. Institutions/organisations and senior staff were implicated as major perpetrators of discrimination. Subtle experiences of interpersonal discrimination were reported by > 75% of those reporting discrimination in the last five years. Statistically significant associations (p < 0.05) were identified between the primary discrimination variable and ethnicity, native language, country of primary medical qualification and employment status. Negative sequelae of discrimination on IMG health and career progress were reported. Four themes were identified: i) Disadvantage as an independent construct to discrimination; ii) Structural and institutional discrimination facilitates exploitation; iii) Workplace bullying is a manifestation of inequitable treatment; iv) Inequitable treatment has physical and mental health implications for IMGs. High congruence was detected on triangulation of the quantitative and qualitative results.

conclusionsIMGs describe various aspects of discrimination and disadvantage in Australia, warranting further investigation and action. Institutions are responsible for supporting a more equitable and inclusive environment for IMGs.