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Demographic characteristics also seem to be an important determinant for career satisfaction in the healthcare field. For example, international medical school graduates have substantial representation among primary care physicians in the United States and consistently report lower career satisfaction compared with US medical school graduates (Morris et al. 2006). Chen et al. (2012) reported that career satisfaction among primary care physicians was 75.7%; but when US medical graduates were singled out, 82.3% expressed career satisfaction. This statistically significant difference persisted even after adjusting for a broad range of potential explanatory factors, including personal characteristics and variables related to the practice environment. Although international and US graduates differed on several potential explanatory factors – including language, cultural customs, board certification, and experience working in large metropolitan cities – no significant relationship was determined among these factors that would point toward lower career satisfaction reported by international medical school graduates.

Additional domains of experience may contribute in important ways to differences in career satisfaction between international and US graduates. These may include the impact of discrimination in the workplace, stresses of being an “outsider,” and lack of appropriate supportive structures in the workplace (Chen et al. 2011). Previous reports indicated that international medical graduates were more likely than US graduates to report experiences of discrimination in the workplace (Chen et al. 2010). Given the central role of international graduates in the US healthcare system, particularly for vulnerable populations, improved understanding of the causes of this differential satisfaction is important to appropriately support the healthcare workforce.