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DOCTORS ON THE MOVE    TRENDS, IDENTITIES, PROBLEMS. Buz Cooper AcademyHealth San Diego June 5, 2004.    IMG TRENDS Certification by Educational Commission on Foreign Medical Graduates (ECFMG) and Participation in Residency Programs. RESIDENTS w/o PRIOR RESIDENCY 1950-2002.

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Doctors on the move trends identities problems

DOCTORS ON THE MOVE  TRENDS, IDENTITIES, PROBLEMS

Buz Cooper

AcademyHealth

San Diego

June 5, 2004


  

IMG TRENDS

Certification by Educational Commission on Foreign Medical Graduates (ECFMG)

and

Participation in Residency Programs


Residents w o prior residency 1950 2002
RESIDENTS w/o PRIOR RESIDENCY1950-2002

AMA, AAMC,AOA, AACOM


Residents w o prior residency 1950 20021
RESIDENTS w/o PRIOR RESIDENCY1950-2002

AMA, AAMC,AOA, AACOM


Events influencing first time img residents 1950 2002
EVENTS INFLUENCING FIRST TIME IMG RESIDENTS 1950-2002

1976

Health Professions Act restrictions

1991

Increase in H1b Visas

************

Proposed exam change

Period of medical school expansion

Post WW II demand

1998

CSA

1985

COBRA restrictions

*************************

Medicare IME


First time img pgy 1 residents and ecfmg certifications
FIRST TIME IMG PGY-1 RESIDENTS and ECFMG CERTIFICATIONS

1976

Health Professions Education Act

1998

CSA

introduced

1985

COBRA

restrictions

1991

Expanded access

to temporary

(H1-B)

visas

1992

Proposed

exam change

1995

Computerized

exam

ECFMG and JAMA


  

TRENDS in IMGs in the US

Who are they?


Ecfmg certificates 1960 2002
ECFMG CERTIFICATES 1960-2002

ECFMG


Average number of entering img residents 1995 2002 and ecfmg certificates 1994 2001
Average Number of Entering IMG Residents 1995-2002 and ECFMG Certificates 1994-2001

Entering residents = 246 (viapp) From ECFMG.


Img pgy 1 residents 1995 2002
IMG PGY-1 RESIDENTS1995-2002

ECFMG


  

Interest in the US Among Foreign Medical Students


Survey of Medical Students

at

Bangalore-Ramiah Medical College

and

Bangalore Medical College

INDIA

Raghu Rao and Richard Cooper

2004

Preliminary data analysis


Survey of indian medical students
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students1
Survey of Indian Medical Students

%

Rao and Cooper, 2004


Survey of indian medical students2
Survey of Indian Medical Students

%

Rao, 1998 Academic Psychiatry

Rao and Cooper, 2004


International Market for Medical DoctorsNational Primary Care Research and Development CenterManchester Center for Healthcare ManagementManchester, England2003

• A wide range of “demander countries” is looking to source a substantial proportion of their medical labour supply from outside their own health systems.

• The hegemonic position of the USA was perceived as unassailable.


  

Staying After Residency


AFTER RESIDENCY: J1 and H1b Visas

J1 Visa Waiver of 2-year return requirement (4,798 waivers) Primary care or general psych in underserved area-three yearsState Conrad-30 Program --- up to 30 waivers per state Delta Regional Commission --- 8 states, 240 counties Appalachian Regional Authority ~250 counties Veterans Administration, HHS --- few Pending Bills: J1 waivers for specialists in hospitals serving underserved Redistribution of unused waivers ---1,500 available, 1200 usedH1b VisasProgram expired Sept. 30, 2003: 195K  65K visas Exemptions: Conrad 30 waivers of J1 visa requirements while in waiver Residents in a “university Sponsorship by nonprofit, university or governmentOpportunities to Remain without an H1b visaNational interest waiver Tourist visa Extension of J1 to take exam Small business (Canadians) under NAFTA Bill pending to exempt former J1 visa holders from H1b cap


  

CONCLUSIONS

• The number of IMGs has varied with changes in immigration policy, reimbursement policy and exam-certification, but the trend has been upward.

• Half of all IMGs are from South Asia, North Africa and the Middle East, where visa problems are the greatest.

• Foreign medical students are encountering

increasing difficulty in accessing the US system, greater demand from the UK and Canada,

more obstacles to remaining in the US after training, and better opportunities at home.



Entering img residents 1995 2002 of graduates in home country
Entering IMG Residents 1995-2002, % of GRADUATES in HOME COUNTRY

Adapted from ECFMG and Eckhert, 2002


Survey of indian medical students3
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students4
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students5
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students6
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students7
Survey of Indian Medical Students

Rao and Cooper, 2004

%


Survey of indian medical students8
Survey of Indian Medical Students

Rao and Cooper, 2004

%


IMG CHALLENGES

ConcernsUS-IMGs vs. Foreign IMGsQuality of educational programsRate of disciplinary actionsHurdlesUSMLE Steps 1, 2, 3Clinical Skills Assessment (CSA) (cost, time)Visas to take CSA examVisas to enter for residencyDecreased availability of H1b visas (195K in 2003  65K in 2004)CompetitionEnglandCanadaAttractiveness of native countries




Residents 1995 2002
RESIDENTS1995-2002


Percent of imgs from before 1997 who are currently active in the ama masterfile
PERCENT of IMGs from before 1997 who are CURRENTLY ACTIVE in the AMA MASTERFILE


Imgs all years citizenship or visa status
IMGs(all years)Citizenship or Visa Status

Corrected for unknown


Imgs all years visa status
IMGs(all years)Visa Status

Corrected for unknown


First time pgy 1 residents and ecfmg certificates
First Time PGY-1 Residents and ECFMG Certificates

Potential

IMGs 

2,000

 F-IMGs 

 US IMGs 

DOs


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