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International Medical Graduates: Update on A Diversified Physician Workforce
Where I am from
500,000 and 700,000: Homo erectus
10,000 BC: Berbers1000 BC: Numidia200 BC: Part of the Western Roman Empire300 AD: Part of the Byzantine Empire800 AD: Muslim Arab Armies arrive1510: Spain takes control1516: Part of Ottoman Empire1830: France invades Algeria1954: Algerian War of Independence1962: Independence of Algeria
Algeria/History
Country Name: People's Democratic Republic of Algeria
Government type: Republic
Independence: July 5, 1962
Population: 34,178,188
Age: 26.6 years (median), 65-0ver represent 5% of total Population
Ethnic groups: Arab-Berber 99%, European less than 1%
Languages: Arabic, French, Berber
Religions: Sunni Muslim (state religion) 97%, Christian and Jewish 3%
Algeria
Algiers The White
Our Lady of Africa
Ketchaoua Mosque
My Journey
Lubbock AlgiersPittsburgh
Paris
International Medical Graduates
Definitions
IMGs are physicians who have completed their medical education outside the U.S. or Canada. IMGs consist of:
Foreign nationals on special visa status (eg. J1 or H1B)
U.S. citizens or permanent residents who graduated from foreign medical schools
Where are they coming from?
Zoghbi, W. A. et al. J Am Coll Cardiol 2004;44:245-251
The Educational Commission for Foreign Medical Graduates (ECFMG)
“ Through its program of certification, the Educational Commission for Foreign Medical Graduates (ECFMG®) assesses the readiness of international medical graduates to enter residency or fellowship programs in the United States that are accredited by the Accreditation Council for Graduate Medical Education (ACGME).”
ECFMG Certification
Pass the USMLE: Medical Science Examination Step 1 Clinical Skills Assessment Step2 (CS) Clinical Knowledge Assessment Step2 Must pass all exams within a 7 year period!
ECFMG Verification of medical diploma with medical school
• The National Resident Matching Program (NRMP) is a private, not-for-profit corporation established in 1952 to provide a uniform date of appointment to positions in graduate medical education (GME).
• Each year, the NRMP conducts a residency match that is designed to optimize the rank ordered choices of students and program directors.
The NRMP “Match”
How many IMGs Apply for PGY1 position?
U.S. NRMP, Match results. 2007
How many IMGs Obtain a PGY1 Position?
U.S. NRMP, Match results. 2007
Challenges
Costs The USMLE:
Medical Science Examination Step 1= $ 710 Clinical Skills Assessment (Step2 CS)= $ 1200 Clinical Knowledge Assessment (Step2 CK)= $ 710
Interviews and travel: Program Applications: $ 2000 Cost of travel for step2 CS: $1000-$2000
Visas
Immigration Laws• Can affect training of IMGs and chances of joining the workforce • Increasingly pose obstacles for international travel for IMGs and their families
Employment• Primarily related to visa status• J-1 visa holders are at increasing risk of not finding waivers, particularly after Sept. 11th
Visas
• J-1 Research- 5 years maximum potential duration (Caution: 2-year rule may be attached)• H-1B – 6 years maximum duration• NAFTA – Canadian & Mexican nationals only
Universities, medical schools and research institutions may offer visa assistance for research activities
(Non-Clinical Visa Programs)
• J-1 ECFMG (Educational Commission for Foreign Medical Graduates) - 7 years maximum potential duration Caution: 2-year home rule is attached.
• H-1B – 6 years maximum duration Requires all 3 Steps of USMLE
Visas (Visa Programs for Clinical Training)
Country of Medical SchoolDistributionPatterns of Origins and DestinationsDemographic Characteristics
http://www.fammed.washington.edu/CHWS/
http://www.fammed.washington.edu/CHWS/
http://www.fammed.washington.edu/CHWS/
Distribution of IMGs in The U.S. in 2001, by County
http://www.fammed.washington.edu/CHWS/
http://www.fammed.washington.edu/CHWS/
Who are the patients of international medical graduates? • Race/Ethnicity• Expected source of payment• Characteristics of patient’s neighborhoods
Who are international medical graduates?
Where do international medical graduates practice?
Office visits by PatientsRace\Ethnicity
NCHS Data Brief ■ No. 13 ■ February 2009
NCHS Data Brief ■ No. 13 ■ February 2009
Office visits by patients’ primary Expected sources of payment
NCHS Data Brief ■ No. 13 ■ February 2009
Characteristics of patient’s neighborhoods
NCHS Data Brief ■ No. 13 ■ February 2009
NCHS Data Brief ■ No. 13 ■ February 2009
IMG vs. USMG By Race/Ethnicity
Where do IMG they practice?
NCHS Data Brief ■ No. 13 ■ February 2009
The purpose of this pilot project was to assess IMG perceptions in two major policy areas: (a) IMG impact on U.S. healthcare(b) IMG impact on countries of origin
Impact on U.S. healthcare
S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
Impact on Countries of Origin
S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
Impact on Countries of Origin
• IMGs represent about a quarter of the entire physician workforce
• India, the Philippines, Mexico and the Republic of Korea remain the leading countries of origin of IMGs
• There have been consistent patterns of IMG origin countries and destination states
• International medical graduates are more likely to practice in primary care shortage areas
• They are also more likely to have more Medicaid patients and minorities
Conclusion
• U.S. health care system continues to rely on international medical graduates to address primary care physician shortage outside of urban metropolitan statistical areas • However our system may face challenges if the future supply and use of international medical graduates are affected by changes in visa policy and other programs affecting physician supply • New policies may be needed in the future
Conclusion
International Leaders
Huda Zoghbi, MD
Lebanon
Salim Yusuf, MDIndia
Andreas Gruntzig, MD
Germany
Elias Zerhouni, MDAlgeria
Valentine Fuster, MD, PhD
Spain
“Share our similarities,celebrate our differences”
M. Scott Peck, MD
Thank you
