International medical graduates and the physician workforce
Bridging gaps
Despite there being overall more physicians in the workforce than 10 years prior, data suggest that there is still a shortage of physicians in the US – an issue that can result in difficulties accessing care.
Significant gaps persist in certain specialties and geographic regions, leaving many communities underserved. International medical graduates (IMGs) represent a crucial part of the solution to these challenges, offering both expertise and diversity to the physician workforce.
IMGs are physicians, either US-citizens or non-US-citizens, who have obtained their medical degree from a school outside the United States or Canada. Currently, there are over 230,000 licensed IMGs practicing in the US, originating from more than 2,000 medical schools across 169 countries. They bring with them extensive research and training experience, diverse cultural backgrounds and a versatility in clinical practice that are essential in a globalized healthcare environment.
Challenges
A recent article published in JAMA highlights the various barriers that exist for IMGs seeking to further their training or practice in the US. The paper, by Dr. Oliver McElvaney, second year Pulmonary and Critical Care fellow, and Dr. Graham McMahon, Feinberg School of Medicine, Northwestern University, also emphasizes the benefits that IMG clinicians and applicants to training programs bring to the profession.
IMGs often face a number of barriers when seeking to practice medicine in the US. These barriers include navigating complex licensing and credentialing processes, securing appropriate immigration status, and variability in previous training program structure that can make it difficult for program directors to evaluate their qualifications. IMGs may also be required to repeat previously completed postgraduate training such as a residency or fellowship. These challenges can delay or deter established and qualified IMGs applying to US residency and fellowship programs.
The paper also demonstrates that IMGs often bring clinical experience and subspecialty training that meet or exceed those of their US-educated counterparts.
“In 2022, non–US citizen IMG residency applicants reported an average of 6.3 prior work experiences (mainly composed of formal postgraduate clinical training) compared with 5.3 prior work experiences among US citizen IMGs, 3.6 among US MD seniors, and 3.6 among US DO seniors,” the authors find.
Non-US citizen IMGs also had more researcher publications on average than other groups of applicants.
However, despite comparing favorably to US-educated physicians, IMGs are significantly less likely to match to residency or fellowship programs when matched for objective measures of performance and competency such as USMLE test scores.
“Throughout history, IMGs have contributed substantially to clinical and academic medicine in the United States,” said McElvaney. “This contribution is not limited to leading academic centers.”
“Indeed, IMGs have consistently supported health care delivery in underprivileged communities and areas of geographical isolation, and less lucrative specialties commonly overlooked by U.S. applicants. These are highly trained, diverse, experienced professionals, but a combination of process factors and administrative barriers makes it increasingly difficult for them to practice here, at a time that we need them more than ever. Streamlining this arduous process makes sense on all sides."
expanding workforce
Beyond their clinical skills, IMGs play a critical role in promoting workforce diversity and addressing health disparities. As IMGs often carry less educational debt than their US medical graduate counterparts, they may have more financial flexibility to practice in a variety of settings.
Ensuring that all populations have access to quality healthcare services
Many choose to practice in communities with high proportions of racial and ethnic minorities and to serve in rural and economically disadvantaged areas. This willingness to work in underserved regions helps mitigate the geographic maldistribution of physicians and ensures that all populations have access to quality healthcare services.
This experience not only enriches the overall competency of the physician workforce but also contributes valuable perspectives and insights that enhance patient care.
Expanding opportunities for IMG’s in the medical workforce and alleviating administrative barriers can not only alleviate shortages in critical specialties and underserved areas but also enhance the overall quality and diversity of healthcare delivery.
Systemic policy changes, the authors propose, are vital for recognizing and supporting IMGs seeking to enter the US physician workforce and expanding care in key areas.
“At a time of worsening disparity, IMGs are more necessary than ever, and represent an opportunity for institutions to enhance their programs, bolster academia, promote diversity, and maintain competitiveness in the coming decades rather than a last resort.”