Experience of Foreign-Educated Physicians Transition to Family Nurse Practitioner Role in the United States

Purpose: The shortage of physicians in the USA is estimated to reach 91,000 by 2020 due to an increasing population and 32 million more Americans obtaining health insurance coverage in 2014 as a result of the Patient Protection and Affordable Care Act (AAMC, 2013). Foreign-educated and foreignborn health professionals such as physicians and nurses represent a sizable portion of the United States (US) health care workforce (Chen et al., 2014). A majority of foreign educated physicians imigrate to the US and are unable to secure medical residencies. This leaves foreign educated physicians unable to be licensed and to practice medicine. Foreign educated physicians are religated to lower waged jobs, such as medical assistants and certified nursing assistant. These menial jobs ignore the foreign educated physician's vast medical training and experience at a time in the US where more diverse, primary care providers are in high demand. Nurse practitioner programs could benefit from finding avenues that recognize and value the foreign educated physician's training and experience while expediting their transition to a primary care nurse practitioner role. This could help alivate a critical workforce gap in the US because primary care is the cornerstone for cost effective, high quality, and equitable health care services. The purpose of this study was to examine the challenges and satisfiers that promote the sucess of foreign educated physicians' transition from physician to nurse practitioner role. The specific research questions were: 1) what are the characteristics of foreign-educated physicians who graduated from a family nurse practitioner program? 2) What are the facilitators and barriers that sustain foreign-educated physicians’ successes as both family nurse practitioner students and practitioners?

Methods: The study used a non-experiential, descriptive, mixed methods design. Participants recurited from a single university located on the West coast of the US. Thirdy-eight participants completed an online survey. Eleven of the 38 agreed and participated in a focus group.

Results: The majority of the sample was women (63.9%) with ages ranging from 31-years to 70-years of age. Countries of origin included Mexico (45.8%) and Philippines (37.5%) followed by China, Iraq, Pakistan and Russia with 4.17% each. Just over half (52.8%) worked 9 or more years as a physician in their country of origin. The qualitative data resulted in two main focused areas related to the personal and the program. The personal theme was the experiences by the participants in completing the FNP program and practice. The personal themes included: 1) balancing roles, 2) peer support, 3) persistence in the face of challenges, 4) expanded thinking, 5) confidence to succeed, and 6) gratitude and opportunities. The program focused on the participants’ thoughts on the experience with the FNP program. The program themes included: 1) constant change, 2) competence of the clinical faculty, 3) understanding the US educational system, and 4) shared responsibility.

Conclusion: Nurse practitioner have added value to health care in the US by increasing access; demonstrating cost-efficient; decreasing health disparities; facilitating continuity of care, improving patient satisfaction; and, in comparison to physicians, have equivalent or superior outcomes and technical quality as well as better interpersonal skills (Stanik-Hutt et al., 2013). Foreign educated physicians as nurse practitioners enhance access to quality and cost-effective health care. Nurse practitioner programs could benefit from developing a program that addresses the unique needs of these students while appreciating the value added by their inclusion in nurse practitioner programs.