Factors Affecting International Medical Graduates in the US Healthcare System

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International medical graduates play an important role in meeting the healthcare needs of the US population. Various studies place the number of IMGs practicing in the US at anywhere from 25 to 30 percent of the entire physician population. These physicians often end up practicing in underserved areas, such as with the Conrad program for J-1 medical doctors, in order to earn either non-immigrant status or US permanent residence status.

However, to even get to the point of being considered for residence, IMGs must first meet the US medical system’s training requirements.  While there are a number of residency spots in the US that often go unfilled each year, there are several factors that determine whether IMGs can fill those spots. Some of these factors include licensing standards and competitiveness of specialty.

Getting into the US System

The first step that IMGs must take to have a chance at entering the US medical training system is completing the United States Medical Licensing Examination (USMLE). Once IMGs successfully pass the UMSLE, and only a portion do, they must then be accepted into the Educational Commission for Foreign Medical Graduates (ECFMG).

Once accepted, there is no guarantee that an IMG will then be able to match into a US residency. Two crucial parts of the process are achieving high scores on the USMLE and having an exceptional academic record. IMGs are often expected to have higher scores than their American counterparts on these examinations due to the fact that they may not have had clerkships where they could earn an American physician’s letter of recommendation.

Even with these increased standards, IMGs are still able to match into a number of US residency spots. For example, A recent study by the Association of American Medical Colleges found that over half (53.4%) of New Jersey based residency spots were filled by doctors who trained abroad. 

Caribbean Schools

An increasing number of foreign trained doctors are actually US citizens who completed their training in the Caribbean, known as USIMGs. The competition to get into US medical schools ratchets up every year as students are expected to have achieved stellar MCAT scores and have extensive research experience. In fact, around 30,000 students who applied to medical schools in 2013 were turned down.

So what happens to these students who once dreamed of a career as a medical doctor? Some wait to reapply to US medical schools, while others are often accepted into Caribbean medical schools instead. The ECFMG has reported that the number of students opting for the Caribbean route has nearly doubled over the last 10 to 15 years.

After completing their training at foreign medical school, USIMGs must go through a similar process to FIMGs. However, Caribbean graduates have a distinct advantage in that their schools closely imitate the training of US medical schools and they often get to complete clerkships in the US. Depending on the quality and reputation of the school, Caribbean USIMGs can have as high as an 86% success rate in achieving ECFMG certification. While obtaining a certificate from the ECFMG isn’t a guarantee, it is a vital first step in matching into a US residency.

Choice of Residency and Career

IMGs face a very competitive situation in even being considered for residency positions. Once they can apply, they are oftentimes funneled into the less competitive residencies due to competition from US medical graduates. These residencies are in fields such as primary care, internal medicine and psychiatry, which all experience a dearth of physician services.

After completing these residencies, FIMGs on J-1 visas are required to return to their home country for two years. Many times, these newly trained physicians intended to return home to practice anyway. In some instances though, FIMGs who completed their training in the US can have this two-year requirement waived. This allows FIMGs to continue practicing in the US, as long as they practice in a medically underserved area. Keep in mind, the competition for these spots can be very intense and often they are in more rural areas. It is key that FIMGs start this process early and are proactive in searching for such openings.

Score High, Get In, Find Opportunities

International medical graduates’ path to US medical education is not an easy one. In many cases, they must score higher on their licensing exams than US medical graduates to have a shot at the same residency spots. Even if they do score well, it is likely that IMGs will end up completing less competitive residencies and practicing in medically underserved areas.

However, successfully navigating this process and finding desirable job opportunities is not impossible. Resolve guides IMG physicians through their job search, finding practices in your desired geographic region and negotiating on your behalf to ensure you receive the best deal possible. Visit this page to learn more aboutResolve’s J1 job search or get started here.