Where Do International Medical Graduates Fit in the US Healthcare Picture?

Leigh Page

Disclosures

February 03, 2016

In This Article

Shut Out of the System for Good

Whereas many IMGs go back home after they fail to get a residency position, many others stay in America. In many cases, their spouses are US citizens or hold green cards, or they've obtained refugee status, according to José Ramón Fernández-Peña, MD, associate professor of health education at San Francisco State University.

Dr Fernández-Peña, an IMG from Mexico who made it into the US system, is the founder of the Welcome Back Initiative, a nonprofit organization that helps doctors and other healthcare professionals educated abroad find work here. Despite their healthcare training in their native countries, most of these people wind up doing menial work when they arrive in the United States, such as driving taxis or working as janitors, Dr Fernández-Peña says. "Highly trained people are sitting around unable to use their expertise. It's a great waste of brainpower."

Welcome Back helps many participants find healthcare work, but it's much harder to help foreign doctors get into their profession. Of more than 4600 foreign-trained physicians who have participated in Welcome Back, only 130 have subsequently won US residency slots, Dr Fernández-Peña reports. That translates to a success rate of under 3%.

These IMGs get shut out of the system quickly, often because they didn't understand how it works, Dr Fernández-Peña says. For example, many decided to take the USMLE without adequate study. If they fail, they can try again, but the initial score goes onto their permanent record. Even if they score well later, their chances of getting into a residency are almost zero.

Dr Fernández-Peña helped found a free program for Spanish-speaking IMGs at the University of California, Los Angeles. Entrants get test-preparation courses and clinical observerships to help them get into the US system, and in return, they agree to spend 2-3 years in family medicine programs that treat underserved populations. But owing to the cost of the program, just a few slots are available, which hardly puts a dent in the need for Hispanic doctors in California. Dr Fernández-Peña says that although 35% of Californians are Latino, only 5% of California doctors share their ethnicity.

Doctors from the Middle East are another group of IMGs who fall into limbo here, according to Wael Al-Delaimy, MD, an Iraqi-born IMG who works in the Department of Family Medicine and Public Health at the University of California, San Diego.

Many of these IMGs "came here in mid-career as refugees with a green card," he says. "They had no job and no income, and that's devastating on multiple fronts. Imagine, you were the lead surgeon at home and now you have become an assistant to an assistant." He tries to find contacts for these doctors with US training programs—he helped host a jobs forum for about 50 FIMGs last year—but he says it remains an uphill struggle for these doctors.

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