Coming to America:Challenges Facing International Medical

Graduates

Gerald Whelan MD, FACEPWelcoming Center for New Pennsylvanians

Philadelphia PA

IMGs’ Requirements to Practice in U.S.

Graduate medical school listed in IMED (imed.faimer.org)

Primary source verification of diploma and transcripts

Competitive / Passing scores on USMLE examinations Knowledge based and clinical skills

Secure position in ACGME accredited residency

Appropriate visa – J-1 or H-1B

Successful completion of GME

State licensure

Permanent Resident / Citizenship

Primary source verification of diploma and transcripts

Done only by ECFMG

Potential political roadblocks

Forgeries

Administrative delays

Competitive / Passing scores on USMLE examinations

Step 1, Step 2CK, Step 3 Knowledge Computer based Test taking strategies

Step 2CS Clinical skills Medical history and physical exam Communication in spoken and written English

Test Preparation Courses

Secure position in ACGME accredited residency

Applications – ERAS

Observorships, Clerkships, Letters of Reference

Interviews – intense screening

“The Match” – National Resident Matching Program

Intense Competition GME cap USMGs, DOs, USIMGS get precedence Dwindling number of vacancies for NonUS IMGs

NRMP “All In” = no positions outside the Match

Competition!

CompetitionA Closer Look

Appropriate Visa

Post 9/11 Climate

J-1 – Exchange VisitorHome country statement of needEvidence of intent to return2 year return after residency

H-1B – non-immigrant foreign workerRequires program to sponsor IMG3-6 year limitPassing USMLE Step 3 is prerequisite

Successful Completion of GME

State licensure

Waiver Program

Eliminates 2 year return for J-1s

3 year commitment

Commonly leads to Permanent Resident status

Permanent Resident / Citizenship

Beyond Requirements:Acculturation

Language – conversational and “medicalese”

Discourse – “Talk the Talk”

Patient expectations, patient autonomy

New concepts Confidentiality Documentation Professionalism

The U.S. Healthcare System

Range of Healthcare Professionals

Obstacles to SuccessCompetition

Language skillsStep 2CS interviewing

Other USMLE Exams Computer based, challenging content in EnglishOnly one passing score allowed

New restrictions on attempts

7 year rule

More Obstacles to SuccessAge

Time out of medical school or practice

Dwindling success on repeated attempts

Money!!! Exam fees, course tuition Need to support self/family

Underlying xenophobia IMGs often felt to decrease prestige of programs

Visa issues

“Many are called but few are chosen”

Between 2000 and 2009, there were in excess of 20,000 ECFMG Certified IMGs who had not entered US GME training

Fully qualifiedPassed all required USMLE/ECFMG ExamsHad credentials verified

Unfortunately, no data on location or employment status

Time For…

Plan B

Plan BPlan A is exhausted or unrealistic

Allow IEHP to make use of unique medical knowledge, skills and experience

Knowledge, skills and experience will facilitate achieving Plan B

Reasonable likelihood of success

Reasonable expenditure of time, money and effort

Acceptable level of professional pride

Acceptable standard of living

Plan B ObstaclesResistance – never give up!

Unrealistic expectations Each healthcare profession has its own pride of identity

and will not readily accept shortcuts

Lack of good information Applications, requirements, processes

Exam preparation Knowledge, test taking skills and strategies

Interim support Financial, professional, personal

Plan B ResourcesCase managers

Accurate, up to date information

Clear strategy

Test preparation

Materials preparation assistance

Interview preparation

Networking

Counseling and monitoring

Welcoming Center for New Pennsylvanians

(www.welcomingcenter.org)Established track record with work legal immigrants

in employment and entrepreneurial assistance

No focused program for Healthcare Professionals

Consultation and Recommendations

Course - Introduction to the U.S. Healthcare System for Foreign Educated Healthcare Professionals

Focus Groups and focused interviews

Funding