International medical graduates and patient-centered indicators of primary care quality

Background. Improving primary care quality in the U.S. would improve health outcomes, decrease healthcare costs and reduce disparities across population subgroups. International Medical Graduates (IMGs) comprise 25% of the physician workforce, and overwhelmingly choose primary care over other specialties; however, few studies examine the effect of IMG status on communication behaviors and the quality of primary care.;Research goal. This study proposes to explore the association of physician international medical graduate (IMG) status with communication behaviors and patient views of care.;Methods. Secondary analysis of audiotapes and physician and patient questionnaires for 51 primary care physicians and 279 of their patients. The audiotapes were used to create a Measure of Accented and Non-fluent American-English (MANA) and conduct an assessment of frequency and type of miscommunication incidents.;Physicians' IMG status was related to MANA scores, miscommunication incidents, as well as patient-centered communication behaviors (verbal and nonverbal), assessed using the Roter Interaction Analysis System (BIAS), and patients' ratings of trust, satisfaction, and participatory decision making.;Results. IMGs have more accented speech than USMGs (1.79 vs. 1.04, p<.001) but neither IMG status nor MANA scores were related to miscommunication incidents. IMG physicians' visits were shorter than those of USMG physicians (12.39 vs. 17.36 minutes, respectively (p=.009)); however, this difference was no longer statistically significant in analysis with covariates.;Patients of IMG compared to USMG physicians were less positive in their communication, both verbally and nonverbally. They expressed less emotional and procedural talk and engaged in more biomedically-focused talk. Patients of IMG physicians provided less biomedical, psychosocial, and emotional talk than those of IMG physicians. (p-values range from <.05 to .10).;Patients of IMG compared to USMG physicians also tended to have less "complete trust" in their physicians in bivariate analysis (.59 vs. .70, p=.075), but the relationship was substantially diminished when covariates were considered. No statistically significant differences in patient ratings of participatory decision-making, or satisfaction were evident.;Conclusion. There are differences in the communication dynamics of IMG and USMG medical visits, however, many of these differences are diminished and no longer statistically significant when covariates are considered.