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International Medical Graduates: Update on A Diversified Physician Workforce. Selim Krim, MD Assistant Professor of Medicine Division Of General Internal medicine Texas Tech University Health Sciences Center. Where I am from. Algeria/Location. Where I was born. Algeria/History.

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international medical graduates update on a diversified physician workforce
International Medical Graduates: Update on A Diversified Physician Workforce

Selim Krim, MDAssistant Professor of MedicineDivision Of General Internal medicineTexas Tech University Health Sciences Center

slide5

Algeria/History

500,000 and 700,000: Homo erectus

10,000 BC: Berbers

1000 BC: Numidia

200 BC: Part of the Western Roman Empire

300 AD:Part of the Byzantine Empire

800 AD:Muslim Arab Armies arrive

1510: Spain takes control

1516: Part of Ottoman Empire

1830: France invades Algeria

1954: Algerian War of Independence

1962: Independence of Algeria

slide6

Algeria

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%

slide16

My Journey

Paris

Lubbock

Pittsburgh

Algiers

slide18

DefinitionsIMGs 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
Where are they coming from?

Zoghbi, W. A. et al. J Am CollCardiol 2004;44:245-251

slide20

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
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

slide22

The NRMP “Match”

  • 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.
slide23

How many IMGs Apply for PGY1 position?

U.S. NRMP, Match results. 2007

slide24

How many IMGs Obtain a PGY1 Position?

U.S. NRMP, Match results. 2007

slide26

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
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
visas28
Visas

(Non-Clinical Visa Programs)

      • 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
slide29

Visas(Visa Programs for Clinical Training)

  • 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 durationRequires all 3 Steps of USMLE
slide30

Country of Medical School

Distribution

Patterns of Origins and Destinations

Demographic Characteristics

http://www.fammed.washington.edu/CHWS/

slide32

Distribution of IMGs in The U.S. in 2001, by County

http://www.fammed.washington.edu/CHWS/

slide35

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?
slide36

NCHS Data Brief ■ No. 13 ■ February 2009

Office visits by Patients

Race\Ethnicity

NCHS Data Brief ■ No. 13 ■ February 2009

slide37

Office visits by patients’ primary Expected sources of payment

NCHS Data Brief ■ No. 13 ■ February 2009

slide38

Characteristics of patient’s neighborhoods

NCHS Data Brief ■ No. 13 ■ February 2009

slide39

IMG vs. USMG By Race/Ethnicity

NCHS Data Brief ■ No. 13 ■ February 2009

slide40

Where do IMG they practice?

NCHS Data Brief ■ No. 13 ■ February 2009

slide41

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

slide42

Impact on U.S. healthcare

S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1

slide43

Impact on Countries of Origin

S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1

slide44

Impact on Countries of Origin

S. Agrawal. OPUS 12 Scientist 2008 Vol. 2, No. 1

slide45

Conclusion

  • 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
slide46

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
slide47

International Leaders

Salim Yusuf, MD

India

Huda Zoghbi, MD

Lebanon

Elias Zerhouni, MD

Algeria

Andreas Gruntzig, MD

Germany

Valentine Fuster, MD, PhD

Spain