ORCID

https://orcid.org/0000-0002-1454-2738

Date of Award

Winter 2026

Language

English

Embargo Period

1-9-2027

Document Type

Dissertation

Degree Name

Doctor of Public Health (DrPH)

College/School/Department

Department of Health Policy, Management and Behavior

Program

Public Health

First Advisor

Christine Bozlak

Committee Members

Christine Bozlak, Eric Rose, Robert Martiniano

Keywords

Health Workforce, Recruitment and Retention, Non-U.S. International Medical Graduates, IMGs, Public Health

Subject Categories

Health Services Administration | Other Public Health | Primary Care | Public Health

Abstract

International medical graduates are physicians who received their medical school education outside the United States. International medical graduates, comprised of both U.S. citizens and citizens of foreign countries, have bridged physician workforce needs for decades. Most international medical graduates tend to practice in ten states (including New York), in larger cities and metropolitan areas, and in primary care specialties. Physician workforce analyses project significant workforce shortages in the coming decades (HRSA, 2023; Robert Graham Center, n.d.). International medical graduates contribute greatly to the U.S. healthcare system, caring for vulnerable populations, and serving in underserved areas (Malayala et al., 2021). International medical graduates, comprising nearly a quarter of all physicians, face significant challenges both during their residency training, and while transitioning to post-residency practice. International medical graduates who are not U.S. citizens (non-U.S. international medical graduates) face challenges including navigating the US culture, adapting to the US graduate medical education collective and the US healthcare system, communication skills, racial discrimination, emotional distress, finances, and planning and advisement for post residency work (Zepeda et al., 2022). There is limited research about challenges faced by non-U.S. international medical graduates, and there is very little to no research that discuss challenges faced by non-U.S. international medical graduates specific to New York.

The aims of the study were to describe the barriers and facilitators that inform whether non-U.S. international medical graduates will continue to stay in New York post-residency; to describe the motivations for some non-U.S. international medical graduates in New York to permanently leave their residency program after being offered a residency training position or during any point of their residency training in New York; and to propose evidence-based policy and program recommendations to support non-U.S. international medical graduates in New York during their residency and improve retention of non-U.S. international medical graduates in New York post-residency.

The quantitative component of the study included an analysis of 21,136 responses from New York Resident Exit Surveys between 2014-2023. Visa sponsorship emerged as the strongest predictor of job acceptance among non-U.S. international medical graduates, particularly for J-1 physicians. Cost of living and proximity to family also significantly influenced retention. The qualitative component included 12 key informant interviews with non-U.S. international medical graduates, four J-1 visa waiver program staff, and one residency program director. Qualitative findings highlighted non-U.S. international medical graduates’ strong commitment to career development, the critical role of program culture and mentorship, and the impact of workload, bias, and other systemic barriers which impact well-being and retention in residency. The perspective of J-1 visa waiver program staff highlighted the current policy and regulatory landscape, inequitable waiver utilization, administrative challenges, and inadequate monitoring of long-term outcomes.

As healthcare needs of the population increase and evolve, it is more crucial than ever to ensure there is a sufficient physician workforce to meet the emergent health needs of New Yorkers. Understanding facilitators and mitigating the effects of barriers impacting the in-state retention of non-U.S. international medical graduates in New York can improve retention of non-U.S. international medical graduates in their residency and post-residency in New York.

License

This work is licensed under the University at Albany Standard Author Agreement.

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Available for download on Saturday, January 09, 2027

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