Flood International Consulting Agency Analysis of the International Route to U.S. Medicine

History of the International Medical Graduate (IMG) System During the 1950s there was an explosive growth for health care services and trained medical personnel. During the 1950s there was an explosive growth for health care services and trained medical personnel. A large number of positions became available in U.S. residency programs and U.S. medical schools could not fulfill this demand since they were under-training the number of physicians. A large number of positions became available in U.S. residency programs and U.S. medical schools could not fulfill this demand since they were under-training the number of physicians. This demand for more doctors was compounded by the Korean and Vietnam wars. This demand for more doctors was compounded by the Korean and Vietnam wars. This led to the recruitment of physicians from foreign countries. This led to the recruitment of physicians from foreign countries.

Development of the ECFMG In 1954, the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the American Medical Association (AMA), and the Federation of State Medical Boards (FSMB) formed the Cooperating Committee on Graduates of Foreign Medical Schools (CCGFMS). In 1954, the Association of American Medical Colleges (AAMC), the American Hospital Association (AHA), the American Medical Association (AMA), and the Federation of State Medical Boards (FSMB) formed the Cooperating Committee on Graduates of Foreign Medical Schools (CCGFMS). The CCGFMS recommended that a system be developed to evaluate the qualifications for international medical graduates. The CCGFMS recommended that a system be developed to evaluate the qualifications for international medical graduates. Evaluation of medical education included examinations in the medical sciences and in the English language. Evaluation of medical education included examinations in the medical sciences and in the English language.

Development of the ECFMG (Continued) In 1956, the CCGFMS formed a private, nonprofit organization called the Evaluation Service for Foreign Medical Graduates (ESFMG). In 1956, the CCGFMS formed a private, nonprofit organization called the Evaluation Service for Foreign Medical Graduates (ESFMG). The ESFMG was going to implement the CCGFMS’ recommendations on how to assess international medical graduates for accredited programs of graduate medical education. The ESFMG was going to implement the CCGFMS’ recommendations on how to assess international medical graduates for accredited programs of graduate medical education. At the end of 1956, the ESFMG decided to change their name to the Educational Council for Foreign Medical Graduates (ECFMG). At the end of 1956, the ESFMG decided to change their name to the Educational Council for Foreign Medical Graduates (ECFMG). From 1958 to 1973, the ECFMG evaluated the readiness of international medical graduates to enter U.S. residency programs. From 1958 to 1973, the ECFMG evaluated the readiness of international medical graduates to enter U.S. residency programs.

Development of the ECFMG (Continued) This evaluation process included examinations and the validation of medical credentials. This evaluation process included examinations and the validation of medical credentials. International medical graduates who successfully completed this evaluation process became ECFMG Certified for U.S. residency programs. International medical graduates who successfully completed this evaluation process became ECFMG Certified for U.S. residency programs. In 1974, the ECFMG merged with the Commission on Foreign Medical Graduates. It expanded its role by following visa sponsorships and researching IMGs. In 1974, the ECFMG merged with the Commission on Foreign Medical Graduates. It expanded its role by following visa sponsorships and researching IMGs. The combined organization kept the ECFMG acronym but was renamed to the Educational Commission for Foreign Medical Graduates. The combined organization kept the ECFMG acronym but was renamed to the Educational Commission for Foreign Medical Graduates.

Improving Evaluation Methods for International Medical Graduates In 1986, the ECFMG began to verify credentials directly with the 1,300+ medical schools worldwide. In 1986, the ECFMG began to verify credentials directly with the 1,300+ medical schools worldwide. From 1988 to 2007, the ECFMG introduced clinical skills testing to the ECFMG certification process. From 1988 to 2007, the ECFMG introduced clinical skills testing to the ECFMG certification process. Eventually, the clinical skills component became incorporated into the United States Medical Licensing Examination (USMLE) for both U.S. and international medical graduates. Eventually, the clinical skills component became incorporated into the United States Medical Licensing Examination (USMLE) for both U.S. and international medical graduates.

Profile of the IMG population So after 50+ years how did the IMG program affect U.S. health care? So after 50+ years how did the IMG program affect U.S. health care? The total physician population increased by 350,386 between 1970 and 1994 (or 104.9%), while IMGs accounted for over one fourth (27.8%) of this increase by gaining 97,359 physicians The total physician population increased by 350,386 between 1970 and 1994 (or 104.9%), while IMGs accounted for over one fourth (27.8%) of this increase by gaining 97,359 physicians In this 24-year period, non-IMGs grew by 91.4%, while IMGs increased by 170.2%. In this 24-year period, non-IMGs grew by 91.4%, while IMGs increased by 170.2%.

Profile of the IMG population (Continued) In 2005, there were 185,234 IMGs out of 794,893 physicians in the U.S. In 2005, there were 185,234 IMGs out of 794,893 physicians in the U.S. IMGs currently make up 23 to 25% of the U.S. physician population. IMGs currently make up 23 to 25% of the U.S. physician population. Among the top four primary specialties, IMGs account for 30.8% of total physicians in internal medicine, 29.9% in anesthesiology, 29.8% in psychiatry, and 28.6% in pediatrics. Among the top four primary specialties, IMGs account for 30.8% of total physicians in internal medicine, 29.9% in anesthesiology, 29.8% in psychiatry, and 28.6% in pediatrics.

IMGs by Specialty The following information represents the percentage of the IMG population within each specialty: Internal Medicine % (59,974). Internal Medicine % (59,974). Anesthesiology % (12,802). Anesthesiology % (12,802). Psychiatry % (14,849). Psychiatry % (14,849). Pediatrics % (19,298). Pediatrics % (19,298). Other % (27,410). Other % (27,410). General/Family Practice % (19,868). General/Family Practice % (19,868). Obstetrics/Gynecology % (7,492). Obstetrics/Gynecology % (7,492). Radiology % (5,962). Radiology % (5,962). General Surgery % (17,579). General Surgery % (17,579). Source: AMA Membership Department Fact Book

IMGs by country The following list the top 5 countries where the largest numbers of U.S. physicians trained. India % (44,585) India % (44,585) Philippines % (19,656) Philippines % (19,656) Mexico - 6.7% (12,448) Mexico - 6.7% (12,448) Pakistan - 5.7% (10,689) Pakistan - 5.7% (10,689) Dominican Republic - 3.8% (7,147) Dominican Republic - 3.8% (7,147) Source: 2005 AMA Membership Fact Book

IMG distribution by U.S. States 1. New Jersey10,904(39.6%) 1. New Jersey10,904(39.6%) 2. New York25,603(38.6%) 2. New York25,603(38.6%) 3. Florida16,056(33.6%) 3. Florida16,056(33.6%) 4. Illinois10,609(32.3%) 4. Illinois10,609(32.3%) 5. Maryland 5,768(26.9%) 5. Maryland 5,768(26.9%) 6. Michigan 7,021(26.7%) 6. Michigan 7,021(26.7%) 7. Massachusetts 5,432(26.7%) 7. Massachusetts 5,432(26.7%) 8. Connecticut 3,022(25.1%) 8. Connecticut 3,022(25.1%) 9. Ohio 7,623(24.4%) 9. Ohio 7,623(24.4%) 10. California21,426(22.6%) 10. California21,426(22.6%) 11. Texas10,478(22.4%) 11. Texas10,478(22.4%)

Current Trends in U.S. Medicine U.S. allopathic medical schools continue to produce more specialist than primary care physicians. U.S. allopathic medical schools continue to produce more specialist than primary care physicians. Osteopathic and international medical graduates have been increasing to compensate for this. Osteopathic and international medical graduates have been increasing to compensate for this. Patient populations will continue to become more diverse but U.S. medical schools are still unable to produce under-represented physicians that closely approach their proportional share of the general population. Patient populations will continue to become more diverse but U.S. medical schools are still unable to produce under-represented physicians that closely approach their proportional share of the general population. Latino/Hispanic populations will continue to increase dramatically and cultural differences will affect American health care. Latino/Hispanic populations will continue to increase dramatically and cultural differences will affect American health care. More Americans will be uninsured and will not have equal access to health care. More Americans will be uninsured and will not have equal access to health care.

IMGs as the Solution IMGs satisfy the needs of the primary health care system and balance the excessive training of specialist by U.S. medical schools. IMGs satisfy the needs of the primary health care system and balance the excessive training of specialist by U.S. medical schools. They fill the gaps where U.S. medical schools can’t and provide service to difficult areas of the country. They fill the gaps where U.S. medical schools can’t and provide service to difficult areas of the country. They provide affordable health care to the needy and keep community programs operational. They provide affordable health care to the needy and keep community programs operational. They are more diverse and representative of the general population of the United States. They are more diverse and representative of the general population of the United States. They can be more cost effective to train than U.S. graduates. They can be more cost effective to train than U.S. graduates.

FICA’s role in the IMG system FICA can facilitate the clinical training of international health care workers in the State of Louisiana. FICA can facilitate the clinical training of international health care workers in the State of Louisiana. This can help produce jobs and keep community hospitals economically stable. This can help produce jobs and keep community hospitals economically stable. FICA can also improve standards in medical education and create clinical centers of learning. FICA can also improve standards in medical education and create clinical centers of learning. These centers of learning can lead to more funding for medical centers and medical research. These centers of learning can lead to more funding for medical centers and medical research. This can enhance our lives and improve the standard of living in Louisiana leading to a boom in the local economy. This can enhance our lives and improve the standard of living in Louisiana leading to a boom in the local economy.

The Typical U.S. Problem LSU and Tulane have been training hundreds of medical students a year but most of them fail to remain in the State of Louisiana. LSU and Tulane have been training hundreds of medical students a year but most of them fail to remain in the State of Louisiana. Most graduates are attracted to other large cities in the United States because of its economic and social benefits. Most graduates are attracted to other large cities in the United States because of its economic and social benefits. Hundreds of millions of dollars is wasted each year because the retention of Louisiana’s U.S. graduates is low. Hundreds of millions of dollars is wasted each year because the retention of Louisiana’s U.S. graduates is low. Community hospitals suffer and the quality of health care decreases. Community hospitals suffer and the quality of health care decreases.

FICA is the solution Louisiana has to seek IMGs in order to fill its demand for primary health care workers. Louisiana has to seek IMGs in order to fill its demand for primary health care workers. FICA can help maintain this supply and improve it with its strong connections with international medical schools. FICA can help maintain this supply and improve it with its strong connections with international medical schools. FICA can focus on attracting U.S. citizens who are training overseas in order to minimize the need for visa sponsorships. FICA can focus on attracting U.S. citizens who are training overseas in order to minimize the need for visa sponsorships. This solution is cost effective and easy for the U.S. health care market. This solution is cost effective and easy for the U.S. health care market.