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DOCTORS ON THE MOVE    TRENDS, IDENTITIES, PROBLEMS

DOCTORS ON THE MOVE    TRENDS, IDENTITIES, PROBLEMS. Buz Cooper AcademyHealth San Diego June 5, 2004.    IMG TRENDS Certification by Educational Commission on Foreign Medical Graduates (ECFMG) and Participation in Residency Programs. RESIDENTS w/o PRIOR RESIDENCY 1950-2002.

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DOCTORS ON THE MOVE    TRENDS, IDENTITIES, PROBLEMS

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  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 1976 Health Professions Education Act 1998 CSA introduced 1985 COBRA restrictions 1991 Expanded access to temporary (H1-B) visas 1992 Proposed exam change 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. AFTER RESIDENCY: J1 and H1b Visas J1 Visa Waiver of 2-year return requirement (4,798 waivers) Primary care or general psych in underserved area-three yearsState 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 VisasProgram expired Sept. 30, 2003: 195K  65K visas Exemptions: Conrad 30 waivers of J1 visa requirements while in waiver Residents in a “university Sponsorship by nonprofit, university or governmentOpportunities to Remain without an H1b visaNational 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

  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. Entering IMG Residents 1995-2002, % of GRADUATES in HOME COUNTRY Adapted from ECFMG and Eckhert, 2002

  22. Survey of Indian Medical Students Rao and Cooper, 2004 %

  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. IMG CHALLENGES 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)CompetitionEnglandCanadaAttractiveness of native countries

  29. ECFMG Certificates 1993-2002

  30. ECFMG CERTIFICATES1995-2002

  31. RESIDENTS1995-2002

  32. PERCENT of IMGs from before 1997 who are CURRENTLY ACTIVE in the AMA MASTERFILE

  33. IMGs(all years)Citizenship or Visa Status Corrected for unknown

  34. IMGs(all years)Visa Status Corrected for unknown

  35. First Time PGY-1 Residents and ECFMG Certificates Potential IMGs  2,000  F-IMGs   US IMGs  DOs

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