Perspective: The need for practice socialization of international medical graduates-an exemplar from pain medicine

One in four actively practicing physicians in the United States is a graduate of an international medical school. International medical graduates (IMGs) account for one-quarter of all visits to office-based physicians in the United States and are more likely than U.S. medical graduates to practice in primary care shortage areas outside of metropolitan statistical areas. IMGs fill critical gaps in the U.S. health system. However, the authors maintain that IMGs face important challenges in transitioning to the U.S. health system. Most debate surrounding IMGs' transition focuses on overcoming cultural and linguistic barriers. Little attention has been paid to the influence of educational and practice socialization of IMGs on their medical encounters and other aspects of their U.S. clinical practice. The existing credentialing requirements do not prepare individuals for unique challenges-presented by the U.S. health system-that IMGs may not be exposed to during medical training or practice in their home countries or countries of training. Anecdotal evidence of the vastly disparate ways in which pain is approached and managed in major source countries of IMGs is a case in point. Using pain treatment as an exemplar, the authors contrast the capacity and emphasis placed on pain treatment in the United States and in major source countries of IMGs to illustrate the special clinical challenges faced by IMGs in their transition to U.S. practice. The authors conclude with recommendations to close this transitional gap, emphasizing the need for targeted assessment and training for IMGs.