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Coming to America: Challenges Facing International Medical Graduates

Coming to America: Challenges Facing International Medical Graduates. Gerald Whelan MD, FACEP Welcoming Center for New Pennsylvanians Philadelphia PA. IMGs’ Requirements to Practice in U.S. Graduate medical school listed in IMED (imed.faimer.org)

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Coming to America: Challenges Facing International Medical Graduates

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  1. Coming to America:Challenges Facing International Medical Graduates Gerald Whelan MD, FACEP Welcoming Center for New Pennsylvanians Philadelphia PA

  2. 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

  3. Primary source verification of diploma and transcripts • Done only by ECFMG • Potential political roadblocks • Forgeries • Administrative delays

  4. 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

  5. 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 NonUSIMGs • NRMP “All In” = no positions outside the Match

  6. Competition!

  7. CompetitionA Closer Look

  8. Appropriate Visa • Post 9/11 Climate • J-1 – Exchange Visitor • Home country statement of need • Evidence of intent to return • 2 year return after residency • H-1B – non-immigrant foreign worker • Requires program to sponsor IMG • 3-6 year limit • Passing USMLE Step 3 is prerequisite

  9. Successful Completion of GMEState licensure

  10. Permanent Resident / Citizenship • Waiver Program • Eliminates 2 year return for J-1s • 3 year commitment • Commonly leads to Permanent Resident status

  11. 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

  12. Obstacles to Success • Competition • Language skills • Step 2CS • interviewing • Other USMLE Exams • Computer based, challenging content in English • Only one passing score allowed • New restrictions on attempts • 7 year rule

  13. More Obstacles to Success • Age • 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

  14. “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 qualified • Passed all required USMLE/ECFMG Exams • Had credentials verified • Unfortunately, no data on location or employment status

  15. Time For… Plan B

  16. Plan B • Plan 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

  17. Plan B Obstacles • Resistance – 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

  18. Plan B Resources • Case managers • Accurate, up to date information • Clear strategy • Test preparation • Materials preparation assistance • Interview preparation • Networking • Counseling and monitoring

  19. 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

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