International Medical Graduates of Idaho Meeting Notes

1. International Medical Graduates of Idaho Meeting Notes February 28th, 2015

2. Possible Next Steps • Develop collective study group options for USMLE; spread cost of study tools • Explore more about dentist model of taking US License Exam and then returning to medical school for 1-2 years to get the clinical experience – requires support from medical school • Invite US doctors to join the group and get involved in the conversation • Additional perspective • Figure out a more accessible model for doctor shadowing for individuals (US doctors are aware of how it works for program/system, but not for individuals) • Investigate expansion of WWAMI medical student support • Figure out how to be a state advocacy on behalf of IMG of Idaho - Two doctors from WWAMI presented to the legislature on the need for more doctors in Idaho – Nathanial will send the names • Develop a case that articulates the benefit(s) for the State of Idaho to use tax payer dollars to expand WWAMI, in part, to support IMG path to medical relicense in Idaho – For example… • IMG of Idaho are doctors who are more likely to stay, whereas others will leave to other states to practice • IMG of Idaho doctors have extensive experience (i.e.,100 patients/surgeries a day in a war zone for two year straight is more than most US surgeons might see in a career) • Invite other key contacts related to WWAMI, VA, University of Washington medical school to present to IMG of Idaho group

3. There are 3 Types of International Medical Graduates (IMG) • US IMG • Country Sponsored IMG • Refugee IMG • US Citizen • Planned to attend International Medical School • Goal is practice in US • Competitive in ERAS and w/ AMG • Wealthy countries partner with universities and hospitals - i.e., Gulf countries like Saudi Arabia, UAE, etc.. • Goal is practice in US • IMG but due to partnerships, students train/research in US & its paid by home country gov’t • US residency salary paid by home country gov’t • Competitive in ERAS & Match w/ AMG • Immigrated to US for safety due to unrest in home country • Never planned to come to US to practice medicine • Multiple barriers to get into a US residency program • - Certified credentials • - ERAS preference ranking • - US clinical experience • - Time since graduation from med school

4. Traditional Path to Medical License: AMG vs. IMG • American • Medical Graduate • (AMG) • Goes through National Medical Board Examination (NMBE) /American Medical Association (AMA) • Electronic Residency Application System (ERAS) • Match/ Interview Selections • Residency • United States Medical License Exam (USMLE) • 1. 1.Basic science, written - 13 system / 10 disciplines • 2. Clinical science - written & practical • 3. General Medical Knowledge Looks easy…it’s NOT if you are a IMG that is a refugee! Vs. • United States Medical License Exam (USMLE) • 1.Basic science, written - 13 systems/ 10disciplines. • 2. Clinical science - written & practical • 3. General Medical Knowledge • International • Medical Graduate (IMG) • NOT NMBE/AMA • Instead, Education Commission for Foreign Medical Graduates (ECGMG) • Electronic Residency Application System (ERAS) • Match/ Interview Selections • Residency Here is where the REAL CHALLENGE LIES… Selection Priority: 1) AMG 2) US IMG 3) Non-US IMG Selection preferences: highUSMLE Score, time since graduation to USMLE, clinical experience in US, recommendations from US doctors. Publication, Master and/or PhD Median USMLE Score is 220-225; IMG needs 240-245 to help even the playing field Arrive to US Credential Evaluation Unstable home country = long process (YEARS!) IMG is not getting ANY Clinical Hands-on Experience in US during this time NOT COMPETITIVE In ERAS & Match despite years of actually practicing medicine

5. International Medical Graduate (IMG) Barriers to Medical Residency • Not fresh medical school graduates • Process for getting foreign credentials evaluated can be long, particularly if issuing body is an unstable country with political unrest • Time between graduation date and USMLE • Time from ECFMG to USMLE w/o hands-on experience with patients since arriving to US • Lack of recommendations and/or recommendations that are relevant to program directors (i.e., demonstrates candidate’s competencies against residency program standards) • US medical students often have dual degree options (i.e., Medicine + PhD., Medicine + Masters, etc.) – IMGs lack this option • Doctors’ salary in residency in US is paid by Accreditation Council Graduate for Medical Education (ACGME) • Fund from ACGME comes from Medicare (tax payers’ $$), so there is A LOT of policy associated with this. • Residency Programs not motivate to take risk (go outside the bounds of traditional ranking) because they need maintain their program standards to maintain accreditation – ACGME requires an 80% medical boards pass rate • Physicians Assistant program is a alternative path BUT it proves challenging as well. • Program sees through motivation to become a practicing MD as opposed to a PA which can impact acceptance into program • Other??

6. Resources to Explore • A excellent new report from Massachusetts on the role of immigrant healthcare professionals. Includes 4 recommendations to improve opportunities for IMGs and the US healthcare system and economy. • http://www.miracoalition.org/images/stories/gac_task_force_report_final-12.18.14.pdf.   • A new advisory issued by ECFMG warning IMGs about new organizations that are illegitimately posing as certification agencies:   • http://origin.library.constantcontact.com/download/get/file/1113015049867-299/ECFMG-release-Sep-16-2014.pdf • Accelerated Nurse Practitioner program at Florida International University  • http://fep.fiu.edu/, • Accelerated Nursing program at Idaho State University • http://www.isu.edu/nursing/accelerated.shtml • Medscape report about the resident Salary and Debt 2014; slides, 2, 6, 10 & 28 provide a good snapshot • http://www.medscape.com/features/slideshow/public/residents-salary-and-debt-report#1 • ACGME website:  • https://www.acgme.org/acgmeweb/

7. Current Options to Get Doctor Interactions/ Clinical Experience/ Doctor Recommendations • IMG Prep- can be valuable experience & only requires passing 1 step in USMLE to participate BUT… • Expensive (to cover salary and liability insurance to allow for patient interactions) • Mostly focused in east coast • Limited selection of doctors • Observerships • Today MrwanSweedan (Boise) and Ali Makki (Twin Falls) are doing this, but it really does not provide benefit to residency application because there is not clinical patient interactions – its only observing the doctor • Physician Assistant (PA) or Nurse Practitioner programs • Challenges with getting into PA school and being able to get financial aid/loans to fund the 2 year program because already have an MD • Nurse Practitioner is less valuable than PA in gaining clinical experience because cannot prescribe medications

8. US Medical License Exam (USMLE) • USMLE will not release exam results without ECFMG • In 2022, ECFMG to implement a policy to not recognize any non-US medical school that do not follow American medical school system • Three Parts to USMLE • Basic (all theory) – 13 subjects • Clinical (2-part) • Clinical Knowledge (CK) – theory; 9 hour exam • Clinical Scale (CS) – medical knowledge, communication & ethics - practical exam with 12 patients; exam is pass/fail • General Medical Knowledge – can take before residency or during residency (usually AMGs take it during); 2-day exam that can be taken over two consecutive days or spread out. • There are agencies and resources across the country to help prepare and pass the USMLE

9. USMLE Tools (from Ali Makki’s Handout) • www.ecfmg.org - IWA/OASIS & For USMLE step 1, 2 CK-CS/Application & registration –www.usmle.org - Qbank (more than 2000 exam-like questions with detailed explanations) • www.kaptest.com – all the tools and prep to pass all 3 parts of the USMLE including online and live classroom options; Qbank (more than 2000 exam-like questions with detailed explanations) • www.medquestreviews.com – The amazing Dr. Conrad Fischer, MD; Steps 1,2 & 3 video lectures; Books to master the boards for step 2CK and step 3 • www.nbme.org – The most reliable and accurate assessment self-assessment exam for Steps 1, 2 & 3 • www.prometric.com – To schedule the LONGEST day in your life ever to take the big test

10. Helpful Residency Stats • Resident salary in NW averages ~$71K/year vs. other areas of us the at ~$55K/year. • But, ~73% of all residency programs are west of the Mississippi, so chances to get accepted in residency program in the NW is lower. • 1 in 5 doctors in the US had to work in the New England area (i.e., Boston etc.) at one point in their career. • http://www.medscape.com/features/slideshow/public/residents-salary-and-debt-report

11. Residency Programs General Overview • University hospital • Community hospital affiliated with a university • Community hospital without university affiliation There is a feasible alternative to the University Hospital residency programs… • VA (Veteran’s Affairs): the biggest healthcare system in the US with residency programs affiliated with various universities including University of Washington Medical School • University of Washington in Seattle is also a WWAMI medical school

12. Possible Areas Global Talent Idaho Can Help • Partnership with the Idaho Department of Labor (IDOL) in an effort to access funds for dislocated workers that alleviate some of the costs associated with relicensing and reestablishing a medical career. • Rosa in Twin Falls • Stacey Shegrud at the Boise Idaho Depart of Labor • English language resources • Global Talent Idaho Job Seeker Training Program • 1:1 coaching and workshops on the key components of the American job search. • Orientation to Global Talent Idaho & General American Cultural Norms • Marketing Yourself in the US Job Search • Interviewing Skills • Networking Skills • Practice Interviewing • Surviving the American Workplace • Mentor Program • job seekers can be matched with a volunteer mentor, a professional with American work experience, who provides individual coaching, resume and cover letter support, and industry knowledge