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The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.

A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.

The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.

The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.

The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.

This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

US citizens who attend international medical schools (US IMGs) are more likely to be of Hispanic, Black American, or Asian descent compared to US medical students. As physicians, US IMGs contribute diversity to the health-care workforce; their experiences and perspectives have improved the health outcomes for populations typically underserved. To become a competent medical professional is a challenging experience, especially for IMGs who may have entered medical school with less than optimal academic histories. During this journey, some students develop academic and clinical deficiencies. Addressing these deficits through remediation interventions are critical to the student’s performance as a physician. This study measured the resiliency, self-efficacy, and self-compassion of IMGs who completed remediation while in medical school. Results indicate older students experienced failure more often and were found to have significantly higher levels of self-compassion compared to younger students. Males were assigned significantly more remedial interventions compared to the female participants. Finally, strong positive correlations suggested that the more remediation interventions students were provided, the more likely they were satisfied with their overall remediation experience. These findings indicate that by varying support strategies and encouraging student’s orientation to resiliency, self-efficacy, and self-compassion may assist them in overcoming their deficits.

The purpose of this paper is to examine the international mobility of physicians by comparing the regulations governing the practice of foreign physicians in the USA and eight other countries.

This is a comparative study of the regulations governing the practice of foreign physicians in eight countries: China, India, the Philippines, the UK, Germany, Denmark, Israel and Australia. Their requirements are then contrasted with the USA’s requirements for foreign physician licensure to evaluate the extent of reciprocity among these countries. We conclude the paper by outlining some recommendations to increase the international mobility of physicians in the future.

The results indicate that licensure for US physicians to practice in the nations above ranges from impossible (India), to difficult (China), to moderately difficult (the UK, Germany and Denmark), to easy and completely reciprocal (Australia, Israel and the Philippines).

The results and recommendations in this study are a valuable starting point for further research and policy changes that will ensure a more reciprocal relationship between the USA and other countries, in terms of opportunities for international medical practice.

The aim of this paper is to present a conceptual model on foreign-born health care workers from developing countries working in the US. The model covers their motivations for migration, the consequences in terms of the inequality and exclusion they may experience and the role of institutional responses at micro-, macro- and meso-level of intervention.

The paper is based on: (1) in-depth review of key literature studies on the foundation theories of international migration including sociology, economics, anthropology, psychology and human resource management, (2) analysis of theoretical approaches to medical migration across disciplines, (3) analysis of the international and national documentary sources of micro-, macro- and meso-level policies on migration and (4) analysis of evidence on best practices, solutions and aspirational changes across different levels of institutions.

(1) Migration of international medical graduates (IMGs) from developing countries to the US can be explained from a micro-, macro- and meso-level of analysis. (2) IMGs who identify as racial/ethnic minorities may experience unfair discrimination differently than their US-born counterparts. (3) Although political/legislative remedies have had some successes, proactive initiatives will be needed alongside enforcement strategies to achieve equity and inclusion. (4) While diversity management initiatives abound in organizations, those designed for the benefit of IMGs from developing countries are rare. (5) Professional identity groups and some nonprofits may challenge structural inequities, but these have not yet achieved economies of scale.

Although it is well-documented in the US health care literature how ethnic/racial minorities are unfairly disadvantaged in work and career, the studies are rarely disaggregated according to sub-groups (e.g. non-White IMGs and US-born MGs). The implication is that Black IMG immigrants have been overlooked by the predominant narratives of native-born, Black experiences. In placing the realities of native-born Blacks on the entire Black population in America, data have ignored and undermined the diverse histories, identities and experiences of this heterogeneous group.

An awareness of the challenges IMGs from developing countries face have implications for managerial decisions regarding recruitment and selection. Besides their medical qualifications, IMGs from developing countries offer employers additional qualities that are critical to success in health care delivery. Considering organizations traditionally favor White immigrants from Northern and Southern Europe, IMGs from developed countries migrate to the US under relatively easier circumstances. It is important to balance the scale in the decision-making process by including an evaluation of migration antecedents in comprehensive selection criteria.

The unfair discrimination faced by IMGs who identify as racial/ethnic minority are multilayered and will affect them in ways that are different compared to their US-born counterparts. In effect, researchers need to make this distinction in research on racial discrimination. Since IMGs are not all uniformly impacted by unfair discrimination, organization-wide audits should be in tune with issues that are of concerns to IMGs who identify as racial/ethnic minorities. Likewise, diversity management strategies should be more inclusive and should not ignore the intersectionality of race/ethnicity, nationality, country of qualification and gender.

Immigrant health care workers from developing countries are integral to the health care industry in the United States. They make up a significant proportion of all workers in the health care industry in the US. Although the literature is replete with studies on immigrant health care workers as a whole, research has rarely focused on immigrant health care workers from developing countries. The paper makes a valuable contribution in drawing attention to this underappreciated group, given their critical role in the ongoing pandemic and the need for the US health industry to retain their services to remain viable in the future.

The paper aims to analyse how the medical profession, the pro‐competition organisation, and the rural community have responded to the rural doctor shortage with reference to international medical graduates (IMGs) as reported in Australian newspapers.

Utilising the commercially available database LexisNexis during 2003, the author keyed in “overseas trained doctors” and retrieved 641 Australian newspaper articles. The qualitative data analysis software NVivo2 has assisted the author to organise the data, informed by critical realism and narrative analysis.

While the medical profession is undoubtedly committed to serving the health needs of the Australian public, the medical community is less than united in addressing the rural doctor shortage, especially through the employment of large numbers of IMGs. The handling of IMGs has led to tensions not only between the locally trained and IMGs, but also between rural and non‐rural doctors, and between younger and established doctors. The medical professional institutions seemed relatively detached from the adverse consequences of the shortage of doctors in the rural community. This contrasts the efforts demonstrated by the Rural Doctors Association and the rural community.

This paper concludes with a critical realist and narrative analysis and resolving of the rural doctor shortage and recommends close communication and consultation among the diverse interest groups rather than their engaging in blaming one another. This would be an obvious starting point to address the rural doctor shortage, which may partly be achieved by the effective use of services by IMGs.

Purpose – Health information technology (HIT) holds promise for improving the quality of health care and reducing health care system inefficiencies. Numerous studies have examined HIT availability, specifically electronic health records (EHRs), and utilization among physicians in individual countries. However, no one has examined EHR use among physicians who train in one country and move to practice in another country. In the United States, physicians who complete medical school outside the country but practice within the United States are commonly referred to as International Medical Graduates (IMGs). IMGs have a growing presence in the United States, yet little is known about the availability and use of HIT among these physicians. The purpose of this study is to explore the availability and use of HIT among IMGs practicing in United States.

Design/methodology/approach – The Health Tracking Physician Survey (2008) was used to examine the relationship between availability and use of HIT and IMG status controlling for several physician and practice characteristics. Our analysis included responses from 4,720 physicians, 20.7% of whom were IMGs.

Findings – Using logistic regression, controlling for physician gender, specialty, years in practice, practice type, ownership status and geographical location, we found IMGs were significantly less likely to have a comprehensive EHR in their practices (OR=0.84; p=0.005). In addition, findings indicate that IMGs are more likely to have and use several so-called first generation HIT capabilities, such as reminders for clinicians about preventive services (OR=1.31; p=0.001) and other needed patient follow-up (OR=1.26; p=0.007).

Originality/value – This study draws attention to the need for further research regarding barriers to HIT adoption and use among IMGs.

The purpose of this paper is to report on the dynamics of “identity leadership” with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients.

A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments’ perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months.

The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas.

More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity.

This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS.

Criminal Medicare and/or Medicaid fraud costs taxpayers $60‐250 billion annually. This paper aims to outline the characteristics of physicians who have been convicted of such fraud.

The names of convicted physicians were first gathered from public databases (primarily, the OIG exclusion list). The names were further cross‐checked and verified with other public records. Details regarding demographics and the particulars of the fraud were obtained by searching court documents, media reports, the internet, and records maintained by the American Medical Association and state medical licensing boards. The paper categorizes these doctors by: age, gender, geographic location, medical school attended, and medical specialty, and compares these demographics to those of the medical profession as a whole. The paper then identifies: the specific Medicare fraud these physicians were charged with; length of prison sentence and/or probation imposed; amount of fines assessed and/or restitution ordered; and professional sanctions imposed.

Physicians convicted of criminal Medicare and/or Medicaid fraud tend to be male (87 percent), older (average age of 58), and international medical graduates (59 percent). Family practitioners and psychiatrists are overrepresented. The amount of fraud averaged $1.4 million per convicted physician. Surprisingly, despite the fact that 40 percent of such fraud compromised patient care and safety, 37 percent of physicians convicted of felony fraud served no jail time, 38 percent of physicians with fraud convictions continue to practice medicine, and 21 percent were not suspended from medical practice for a single day despite their fraud convictions.

The paper makes several practical recommendations including: running as many claims as possible through predictive modeling software to detect fraud before claims are paid; developing metrics on the average rate of diagnoses and procedures by specialty to be used in the predictive modeling software; incorporating the basics of ethical billing and the consequences of fraud convictions into the medical school curriculum and testing this knowledge on the USMLE; and encouraging and/or pressuring state medical boards to hold physicians more accountable for fraud.

The paper categorizes doctors convicted of Medicare and/or Medicaid fraud and makes specific recommendations regarding physician training, licensing and discipline, to reduce the amount of Medicare fraud perpetrated by doctors in the future.

The rising cost of US health care has precipitated some close examination as to the supply, distribution, and specialty choice of the physician workforce. It is an issue of considerable concern as America struggles to control health‐care expenditures by shifting resources away from specialty medicine. Central to this problem are the various programmes and incentives which have encouraged an excess number of residency positions and specialty training. Examines the consequences of an unregulated medical school structure and provides an overview of current policy alternatives designed to increase the number of primary care physicians, correct the problems of physician maldistribution, and limit the overall number of medical school graduates.

Refugee healthcare professionals are a particular subset of refugees whose education and training requirements are specific to regulatory bodies in host countries. This chapter will use a UK-based organization (Refugee and Asylum Seeking Centre for Healthcare Professionals Education (REACHE) North West) as a case study to demonstrate the process of requalification, return to work, and integration. There are a variety of strands in this process which include language, clinical knowledge and practice, cultural influences, and experience of the asylum and refugee process. In this chapter, there is a model of education and training for working with refugee healthcare professionals which can be adapted to work with staff trained internationally to support the development of education and training material for successful integration into work.