international medical graduates: update on a diversified physician workforce
TRANSCRIPT
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International Medical Graduates: Update on A Diversified Physician Workforce
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Where I am from
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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
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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
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Algiers The White
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Our Lady of Africa
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Ketchaoua Mosque
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My Journey
Lubbock AlgiersPittsburgh
Paris
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International Medical Graduates
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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
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Where are they coming from?
Zoghbi, W. A. et al. J Am Coll Cardiol 2004;44:245-251
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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).”
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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
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• 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”
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How many IMGs Apply for PGY1 position?
U.S. NRMP, Match results. 2007
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How many IMGs Obtain a PGY1 Position?
U.S. NRMP, Match results. 2007
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Challenges
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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
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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
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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)
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• 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)
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Country of Medical SchoolDistributionPatterns of Origins and DestinationsDemographic Characteristics
http://www.fammed.washington.edu/CHWS/
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http://www.fammed.washington.edu/CHWS/
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http://www.fammed.washington.edu/CHWS/
Distribution of IMGs in The U.S. in 2001, by County
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http://www.fammed.washington.edu/CHWS/
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http://www.fammed.washington.edu/CHWS/
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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?
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Office visits by PatientsRace\Ethnicity
NCHS Data Brief ■ No. 13 ■ February 2009
NCHS Data Brief ■ No. 13 ■ February 2009
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Office visits by patients’ primary Expected sources of payment
NCHS Data Brief ■ No. 13 ■ February 2009
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Characteristics of patient’s neighborhoods
NCHS Data Brief ■ No. 13 ■ February 2009
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NCHS Data Brief ■ No. 13 ■ February 2009
IMG vs. USMG By Race/Ethnicity
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Where do IMG they practice?
NCHS Data Brief ■ No. 13 ■ February 2009
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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
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Impact on U.S. healthcare
S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
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Impact on Countries of Origin
S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
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S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1
Impact on Countries of Origin
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• 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
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• 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
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International Leaders
Huda Zoghbi, MD
Lebanon
Salim Yusuf, MDIndia
Andreas Gruntzig, MD
Germany
Elias Zerhouni, MDAlgeria
Valentine Fuster, MD, PhD
Spain
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“Share our similarities,celebrate our differences”
M. Scott Peck, MD
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Thank you