DOCTORS ON THE MOVE ? ? ? TRENDS, IDENTITIES, PROBLEMS

1
DOCTORS ON THE MOVE? ? ?TRENDS, IDENTITIES,
PROBLEMS

• Buz Cooper
• AcademyHealth
• San Diego
• June 5, 2004

2
? ? ? IMG TRENDS Certification by Educational
Commission on Foreign Medical Graduates
(ECFMG) and Participation in Residency Programs
3
RESIDENTS w/o PRIOR RESIDENCY1950-2002
AMA, AAMC,AOA, AACOM
4
RESIDENTS w/o PRIOR RESIDENCY1950-2002
AMA, AAMC,AOA, AACOM
5
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
6
FIRST TIME IMG PGY-1 RESIDENTS and ECFMG
CERTIFICATIONS
1998 CSA introduced
1976 Health Professions Education Act
1991 Expanded access to temporary (H1-B) visas
1992 Proposed exam change
1985 COBRA restrictions
1995 Computerized exam
ECFMG and JAMA
7

• ? ? ?
• TRENDS in IMGs in the US
• Who are they?

8
ECFMG CERTIFICATES 1960-2002
ECFMG
9
Average Number of Entering IMG Residents
1995-2002 and ECFMG Certificates 1994-2001
Entering residents 246 (viapp) From ECFMG.
10
IMG PGY-1 RESIDENTS1995-2002
ECFMG
11

• ? ? ?
• Interest in the US Among Foreign Medical Students

12
Survey of Medical Students at Bangalore-Ramiah
Medical College and Bangalore Medical
College INDIA Raghu Rao and Richard
Cooper 2004 Preliminary data analysis
13
Survey of Indian Medical Students
Rao and Cooper, 2004

14
Survey of Indian Medical Students

Rao and Cooper, 2004
15
Survey of Indian Medical Students

Rao, 1998 Academic Psychiatry Rao and Cooper, 2004
16
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.
17

• ? ? ?
• Staying After Residency

18
J1 Visa Waiver of 2-year return requirement
(4,798 waivers) Primary care or general psych
in underserved area-three years State 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 Visas Program expired
Sept. 30, 2003 195K ? 65K visas Exemptions C
onrad 30 waivers of J1 visa requirements while in
waiver Residents in a university Sponsorship
by nonprofit, university or governmentOpportuni
ties to Remain without an H1b visa National
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
AFTER RESIDENCY J1 and H1b Visas
19
? ? ? 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.

20

• Thank you.

21
(No Transcript)
22
Entering IMG Residents 1995-2002, of GRADUATES
in HOME COUNTRY
Adapted from ECFMG and Eckhert, 2002
23
Survey of Indian Medical Students
Rao and Cooper, 2004

24
Survey of Indian Medical Students
Rao and Cooper, 2004

25
Survey of Indian Medical Students
Rao and Cooper, 2004

26
Survey of Indian Medical Students
Rao and Cooper, 2004

27
Survey of Indian Medical Students
Rao and Cooper, 2004

28
Survey of Indian Medical Students
Rao and Cooper, 2004

29
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)CompetitionE
nglandCanadaAttractiveness of native countries
IMG CHALLENGES
30
ECFMG Certificates 1993-2002
31
ECFMG CERTIFICATES1995-2002
32
RESIDENTS1995-2002
33
PERCENT of IMGs from before 1997 who are
CURRENTLY ACTIVE in the AMA MASTERFILE
34
IMGs(all years)Citizenship or Visa Status
Corrected for unknown
35
IMGs(all years)Visa Status
Corrected for unknown
36
First Time PGY-1 Residents and ECFMG Certificates
Potential IMGs ?
2,000

• ? F-IMGs ?
• ? US IMGs ?

DOs