Burnout among international versus domestic medical graduates in the United States and United Kingdom: a systematic review and meta-analysis of trainees and early-career physicians.

Authors

Fahd Niaz Shaikh, Muhammad Hasnain Mankani, Amal Mahmood, Hanzla Asim, Mariam Shahabi, Hasan Fareed Siddiqui, Muhammad Muntazir Mehdi Khan

Published in

BMC medical education. Jul 15, 2026. Epub Jul 15, 2026.

Abstract

International medical graduates constitute a substantial fraction of the physician workforce in high-income destination countries. Whether their burnout rates differ from those of domestic medical graduates has not been quantitatively synthesized in any prior meta-analysis we identified through searches of PubMed/MEDLINE, Embase, PsycINFO, Scopus, and CINAHL conducted on 27 March 2026 and re-run with expanded population terms on 27 April 2026 (Supplement S1).
To synthesize available comparative burnout estimates between international and domestic medical graduate trainees and early-career physicians.
Studies were eligible if they reported burnout as a dichotomous outcome with extractable odds ratios. Effect sizes were pooled on the log-OR scale using random-effects meta-analysis with Paule-Mandel τ² estimation and Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment to confidence intervals, paired with a 95% prediction interval. DerSimonian-Laird is reported as a comparability analysis only. Risk of bias was assessed using a modified Newcastle-Ottawa Scale; certainty of evidence was rated using GRADE.
We identified five effect sizes from four studies comprising 92,235 physician-responses. Because two UK survey waves may include overlapping respondents, the primary meta-analysis used four independent effect sizes from four studies comprising 73,049 physician-responses (Al-Haddad 2021); the five-effect all-wave analysis is reported as sensitivity. Under the primary HKSJ-Paule-Mandel random-effects model, international medical graduate trainees and early-career physicians had lower odds of reporting burnout than their domestic counterparts (pooled OR 0.65, 95% CI 0.49-0.87; 95% prediction interval 0.37-1.15; I²=90.3%). The prediction interval crosses 1.0; certainty of evidence was rated VERY LOW (GRADE).
Across this small evidence base, all effect sizes favoured international graduate trainees, but the magnitude is uncertain (HKSJ 95% CI 0.49-0.87; 95% prediction interval 0.37-1.15) and the certainty of evidence is VERY LOW. Given the small evidence base, conceptually non-equivalent burnout instruments across studies, mixed adjustment status across studies, English-language eligibility restriction, and confinement to predominantly trainee populations in two destination countries (US, UK), this finding should be interpreted as a hypothesis-generating signal rather than a settled conclusion.

PMID:
42458407
Bibliographic data and abstract were imported from PubMed on 16 Jul 2026.

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