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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 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 RESIDENCY1950-2002 AMA, AAMC,AOA, AACOM
RESIDENTS w/o PRIOR RESIDENCY1950-2002 AMA, AAMC,AOA, AACOM
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 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?
Average Number of Entering IMG Residents 1995-2002 and ECFMG Certificates 1994-2001 Entering residents = 246 (viapp) From 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 Rao and Cooper, 2004 %
Survey of Indian Medical Students % Rao and Cooper, 2004
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 Adapted from ECFMG and Eckhert, 2002
Survey of Indian Medical Students Rao and Cooper, 2004 %
Survey of Indian Medical Students Rao and Cooper, 2004 %
Survey of Indian Medical Students Rao and Cooper, 2004 %
Survey of Indian Medical Students Rao and Cooper, 2004 %
Survey of Indian Medical Students Rao and Cooper, 2004 %
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
PERCENT of IMGs from before 1997 who are CURRENTLY ACTIVE in the AMA MASTERFILE
IMGs(all years)Citizenship or Visa Status Corrected for unknown
IMGs(all years)Visa Status Corrected for unknown
First Time PGY-1 Residents and ECFMG Certificates Potential IMGs 2,000 F-IMGs US IMGs DOs