International medical graduate adjustment to Australian health care teams

International medical graduates (IMGs), also called overseas trained doctors (OTDs), are vital to the delivery of health care services in Australia. Often with years of experience in clinical practice, IMGs help alleviate Australia’s acute and growing doctor shortage. IMG wellbeing is important in its own right. IMG wellbeing, in the form of psychological adjustment to working in an Australian health care environment, is also crucial to effective patient care, as unwell doctors make more errors. However, IMGs face several challenges to their adjustment. First, these doctors face the same stresses as other doctors, such as high workloads, ongoing training, and required continuing medical education. Second, IMGs face the same stresses as other expatriate workers, including adjusting to work in a new culture, and interacting with Australian colleagues and patients. Third, IMGs face unique stresses. IMGs run into a negative bias towards their overseas training, which Australian-trained doctors do not encounter. Compared to other expatriate workers, IMGs must contend with more onerous English language requirements, additional required training, and greater scrutiny of their qualifications, with no financial or other support from a home institution. Like other doctors and expatriate workers, IMGs are potentially prone to depression, anxiety or stress. This study examined the relationship between IMG adjustment and performance, and IMG perceptions of their work environment, including support and discretion, managing ambiguity, and influencing outcomes. Adjustment was viewed as the absence of depression, anxiety or stress. Good performance involved adapting and successfully completing tasks as both individuals and team members. Discriminant function analysis was used to assess dimensions along which IMGs with various levels of depression, anxiety, or stress, from diverse language backgrounds, and from different health systems differ. A qualitative component of the study was used to help interpret findings. Quantitative results suggest those IMGs with lower anxiety or who are from countries with health care systems highly similar to Australia’s, experience greater comfort with ambiguity and stronger belief in their ability to influence outcomes in their work environment. These results also suggest that language background influences IMG adjustment and performance. Qualitative results suggest several measures to improve the IMG experience in Australia, such as a greater focus on competencies in assessment, mentoring, supervision by Australian trained doctors, and support in developing relationships with supervisors and co-workers. Results could usefully inform initial and ongoing support and training opportunities for IMGs upon their arrival and throughout their careers in Australia. For example, training focusing on the cognitive processes of tolerance for ambiguity and locus of control to improve comfort with ambiguity and belief in their ability to influence outcomes could benefit some IMGs. The major contribution of this work is its focus on IMG wellbeing, drawing together theories from organisational and health psychology, and medical education in a unique way and in direct relevance to the Australian health care context.