Umoren Rachel, Rybas Natalia, Frintner Mary Pat
Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash.
Department of Communication Studies, Indiana University East, Richmond, Ind.
Acad Pediatr. 2015 Sep-Oct;15(5):557-64. doi: 10.1016/j.acap.2015.06.005.
To compare job search experience and postresidency position of pediatric residents on the basis of childhood location (United States or international) and medical school location (American medical graduates [AMG] or international medical graduate [IMG]).
Annual national random samples of 1000 graduating pediatric residents from 2009 to 2013 were surveyed. Multivariable analyses, controlling for resident and program characteristics, compared job search experiences and postresidency positions among 4 groups categorized by childhood and medical school location: US-AMG, US-IMG, international-AMG, and international-IMG.
A total of 3027 graduating residents (61.1%) responded: 75.2% US-AMG, 15.8% international-IMG, 6.3% US-IMG, and 2.7% international-AMG. The 4 groups varied by demographics (age, race, gender, marital status, children, bi- or multilingual family), educational debt, residency program region and size, and Spanish proficiency (P < .01). The US-AMG were least likely to have a bi- or multilingual family (25.7%) or be proficient in Spanish (15.0%). One-third (34.5%) accepted fellowship positions. International-IMG and US-IMG were more likely than US-AMG to choose fellowship positions (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.52-2.74; aOR, 1.77; 95% CI, 1.25-2.52, respectively). Among residents who applied for general pediatric or hospitalist positions, 23.1% reported moderate to considerable difficulty in their job search, and 44.1% accepted positions in underserved areas. International-IMG and US-IMG were more likely than US-AMG to report job search difficulty (aOR, 2.49; 95% CI, 1.55-3.98; aOR, 1.78; 95% CI, 1.04-3.06, respectively), and international-IMG were more likely to accept positions in underserved areas (aOR, 1.68; 95% CI, 1.07-2.63).
Multiple factors are involved in pediatrician's career choices. When childhood location is considered with medical school location, there were differences between groups in demographics, job search difficulty, and career intentions.
根据童年所在地（美国或国际）以及医学院校所在地（美国医学毕业生[AMG]或国际医学毕业生[IMG]），比较儿科住院医师的求职经历和住院医师培训后的职位。
对2009年至2013年每年随机抽取的1000名即将毕业的儿科住院医师进行全国性调查。在控制住院医师和项目特征的多变量分析中，比较了按童年和医学院校所在地分类的4组人员的求职经历和住院医师培训后的职位：美国-AMG、美国-IMG、国际-AMG和国际-IMG。
共有3027名即将毕业的住院医师（61.1%）做出回应：75.2%为美国-AMG，15.8%为国际-IMG，6.3%为美国-IMG，2.7%为国际-AMG。这4组人员在人口统计学特征（年龄、种族、性别、婚姻状况、子女情况、双语或多语言家庭）、教育债务、住院医师培训项目地区和规模以及西班牙语熟练程度方面存在差异（P <.01）。美国-AMG拥有双语或多语言家庭的可能性最小（25.7%），精通西班牙语的可能性也最小（15.0%）。三分之一（34.5%）的人接受了专科培训职位。国际-IMG和美国-IMG比美国-AMG更有可能选择专科培训职位（调整后的优势比[aOR]分别为2.04；95%置信区间[CI]为1.52 - 2.74；aOR为1.77；95% CI为1.25 - 2.52）。在申请普通儿科或住院医师职位的住院医师中，23.1%的人报告在求职过程中遇到中度至相当大的困难，44.1%的人接受了服务欠缺地区的职位。国际-IMG和美国-IMG比美国-AMG更有可能报告求职困难（aOR分别为2.49；95% CI为1.55 - 3.98；aOR为1.78；95% CI为1.04 - 3.06），国际-IMG更有可能接受服务欠缺地区的职位（aOR为1.68；95% CI为1.07 - 2.63）。
儿科医生的职业选择涉及多个因素。当将童年所在地与医学院校所在地综合考虑时，不同组在人口统计学特征、求职困难和职业意向方面存在差异。
