The Bias against International Medical Graduates and Foreign Medical Graduates

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On September 15th of every year, thousands of medical graduates submit their application for residency within the United States. United States Medical Graduates (USMG’s), International Medical Graduates (IMG’s), and Foreign Medical Graduates (FMG’s), along with Osteopathic and Allopathic applicants make up the pool of potential residents. Although they all flock to the same website, Electronic Residency Application Service (ERAS), to submit their application, their journey is drastically different according to which type of graduate they are. The consensus among the graduate medical community is that USMG’s are given leverage and favoritism when applying for residency. Graduating from a U.S. medical school and completing United States Clinical Experience, along with the notion that being trained in the United States makes a doctor more qualified are explanations as to why this is so. The next pool of applicants to consider are IMG’s, who are usually American born citizens travelling to for-profit institutions in the Caribbean. These schools usually have a weaker curriculum and accept students who were not able to get into schools here in the U.S. Foreign medical graduates are usually at the bottom of a Program Directors application pile, and they are much more scrutinized in regards to their exam scores and clinical experience. 


THE RESIDENCY BOTTLENECK

However, there is a daunting issue within the United States. This trend is becoming known as “The Residency Bottleneck”. Although not touched upon in the media, this is a pressing issue that will affect all American consumers and international medical community in the upcoming years. Currently, there is an influx of medical school students. More schools are opening in the Caribbean while the number of residency positions in accredited programs are not enough to meet this influx. At the same time, due to the Affordable Care Act, millions who were previously uninsured will now qualify for healthcare. There will be a shortage of doctors by 2025, from estimates of 90,000 to 130,000 physicians. “U.S. medical schools have been expanding enrollment and are on track to increase capacity by 30 percent by 2016,” says Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges. “But without an increase in federal support to create more residency slots, we will not be able to avert the expected shortage of 90,000 physicians by 2020.” The Census Bureau projects a 36% growth in the number of Americans over the age of 65, and as the aging and growing population requires healthcare, one-third of all doctors will retire in the next decade. This will also affect rural and inner-city residents; these areas have a health professional shortage already. Educating doctors’ takes up to a decade, therefore graduate medical education must be expanded now.


 SOLUTIONS 

The simpler solution would be to make the system easier to penetrate for IMG’s and FMG’s. Since these doctors are already trained, it would not cost American tax dollars to fund their education. They possess skills and qualifications to potentially save lives and alleviate the daunting doctor shortage. These foreign trained doctors are more willing to pick up specialties American trained doctors are leaving such as primary care. Experts also point out that utilizing the skills of these foreign trained position would allow the medical labor force to grow much faster. However, the process of attaining a residency for these FMG’s and IMG’s is much more arduous and discouraging. The following is taken from an article in the New York Times: “The process usually starts with an application to a private nonprofit organization that verifies medical school transcripts and diplomas. Among other requirements, foreign doctors must prove they speak English; pass three separate steps of the United States Medical Licensing Examination; get American recommendation letters, usually obtained after volunteering or working in a hospital, clinic or research organization; and be permanent residents or receive a work visa (which often requires them to return to their home country after their training). The biggest challenge is that an immigrant physician must win one of the coveted slots in America’s medical residency system, the step that seems to be the tightest bottleneck. That residency, which typically involves grueling 80-hour workweeks, is required even if a doctor previously did a residency in a country with an advanced medical system, like Britain or Japan. The only exception is for doctors who did their residencies in Canada.” 


IMG CONTRIBUTIONS

IMGs play a role in filling gaps that USMG’s are void in. According to the AMA, a IMGs are distributed more evenly than USMG’s. IMG’s practice in disparaged areas where there are high infant mortality rates, lower socioeconomic status, higher proportion of non-white population, and rural county designation (Politzer, 1978) Another study found that IMG’s are concentrated in counties with the following characteristics: - An infant mortality rate of 8.9/1,000 live births - An average to below average socio-econimc status score - A per capita income of $16,800 - A non-white population of greater than 12.5% - A 65+population greater than 14.9% - A designation as a partially or fully health professions shortage - A non-metropolitan population of less than 50,000 - A physician to population ratio of less than 120/100,000 It is vital to keep in mind this data is fairly outdated. However, it cannot be denied that if IMG’s previously played a necessary and crucial role in America’s healthcare system, their untapped skills should be utilized in the upcoming doctor shortage. There is an upcoming healthcare disaster if the doctor shortage is not addressed. Because it takes almost a decade to train and educate doctors from medical school until residency, utilizing the skills of IMGs and FMGs who are willing to go into specialties that USMG’s will not can only benefit our healthcare system. 


HOW RESIDENTS MEDICAL HELPS

A chance must be given to IMGs and FMGs. The bureaucracy and politics of graduate medical education has not yet changed, but Residents Medical has an anecdote. For 20 years, we have been helping Medical Graduates from all over the world including domestically. IMGs and FMGs need top quality Curriculum Vitae’s and personal statements, while turning in an error-free ERAS application. They must also prepare for the Interview process, which can be daunting and difficult for those whom English is not their first language. In addition to the residency training they must undergo in their home countries, FMGs and IMGs must go through board licensing and training here. Residents Medical can help alleviate the confusion that comes along with the processes of practicing medicine in America. Brooks, Karen. "Jefferson Medical College Alumni Residency Program Limits: Can We Break the Training Bottleneck?" Jefferson Medical Alumni. The Jefferson Foundation, n.d. Web. 24 Jan. 2014. Politzer, R., and J. Morrow. "Foreign-Trained Physicians in American Medicine." Medical Care Review (n.d.): n. pag. Web. 1978