Pediatricians as Immigrant Children

Lynn M Olson, PhD and Mary Pat Frintner, MSPH

BACKGROUND:  The growing number of immigrant children in the U.S. (defined as child or parent born outside of U.S.) is becoming well known.  Unexplored is the portion of younger pediatricians themselves who were immigrant children.

OBJECTIVE:  Examine the immigrant status of pediatricians and the relationship with race and career choices.

METHODS: National, weighted data were drawn from the AAP PLACES longitudinal study of younger pediatricians with two cohorts: recent grad (2-4 years post residency) and early career (9-11 years post residency). Chi-square and t-tests examined the relationship between immigrant status and career choices and immigrant status and patient population, respectively.

RESULTS: 93% of PLACES participants completed the 2013 survey (n=1669).  22% of pediatricians report they were born outside the U.S. and 40% report that 1 or both parents were born outside the U.S.  Immigration status varied by pediatrician race, p<.001, with most Asian, Hispanic, and those selecting "other" race reporting a parent born outside the U.S.  [table1] 

Immigrant pediatricians (self or parent) were more likely than non-immigrant pediatricians to report proficiency in a language other than English (62% vs 25%, p<.001), and more likely to care for a higher proportion of patients with limited English proficiency (mean % = 28 vs 17, p<.001) and patients with public insurance (mean %=52 vs 45, p<.001).  

Among those not in fellowship training, (n=1415), immigrant pediatricians were just as likely as non-immigrant pediatricians to report general pediatrician (50% vs 51%, p=.82), hospitalist (10% vs 13%, p=.08), or subspecialist (32% vs 29%, p=.29) as their current primary position.  However,  they were more likely to report working in an urban, inner city area (31% vs 23%, p<.01) and less likely to be working in a rural area (6% vs 12%, p<.001

CONCLUSION: Among pediatricians within 11 years of having completed residency, 40% would have been considered to be an "immigrant child," reflecting substantial diversity of background among younger pediatricians. Racial and ethnic minorities are especially likely to come from an immigrant background.