S.744 – Transforming The Process to Practice Medicine in the U.S. for International Medical Graduates

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The New York Times recently reported on the process that physicians who are international medical graduates must complete to practice medicine in the United States.

For most, the multi-year process involves:

  • Being certified by the ECFMG.  This confirms fluency in English and graduation from a recognized medical school.
  • Getting recommendation letters from an American institution –  often through unpaid volunteer work.
  • Completing a minimum three year U.S. residency program, even if the physician has completed a program outside the U.S.
  • With the J-1 Exchange Visitor Visa, after the residency program, you must then return to your home country for two years.

There are current federal policies such as the Border Security, Economic Opportunity, and Immigration Modernization Act (S.744) that would transform the above process. S.744 passed the Senate in June, and will be sent of the House of Representatives.

S.744 permanently reauthorizes the Conrad-30 J-1 Visa Waiver Program, waiving the requirement to return to a home country for two years after residency. Additional related waivers and provisions are outlined by the American Medical Association, supporters of S.744 (AMA). The AMA cites that the act will help address U.S. physician shortages.

Organizations such as IntraHealth highlight the negative impact physician migration can have on the country of origin, citing that, “The countries that people come from are left without healthcare workers to take care of their pressing needs”.

Academicians like the former Dean of the Medical College of Wisconsin support further streamlining the process, by eliminating the U.S. residency requirement for select physicians. Other academicians such as Fitzhugh Mullan of George Washington University believe that “reliance on foreign physicians” has prevented policy from focusing on longer-term solutions to U.S. physician shortages.

While long term solutions are necessary to solve the U.S. physician shortage and ethical issues must be addressed, international medical graduates are a well-qualifed source to help meet our population’s healthcare needs.  S.744 is a positive first step in facilitating the process of allowing international medical graduates to practice in the United States.

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7 Responses to “S.744 – Transforming The Process to Practice Medicine in the U.S. for International Medical Graduates”

  1. annebert623 Says:

    I agree that international physicians could help solve the physician shortage in the US. But I wonder, are they any more willing than most US-trained physicians to work in rural areas and Indian reservations?

  2. eokpeva Says:

    I think it’s a bit hypocritical that the resolution being adjusted is that which may profit the U.S. In my opinion the entire process should re-assessed. While i agree that every nation reserves the right to set acceptable standards for its educational and health sector, i think it redundant to make trained Physicians re-do a training they have have once completed. While in support of the observer-ship program that will result in acquiring recommendation letters, i completely frown at the fact that most of this is achieved through unpaid work. I would not call it volunteer. Has the board ever given thought as to how these medical graduates support themselves while engaging in unpaid “volunteer” work? Change, however, is often a multi-step process and i applaud the baby steps that have begun in modifying the entire process.

  3. fhuang2013 Says:

    I have worked as a physician in 3 Canadian provinces, with clinical work in the US during my training as well. I have also been on the receiving end of health care on 3 continents.

    Whenever I come across discussion about health workforce, physician migration, and medical credentialing issues, I always wonder: is anyone paying attention to how well a medical professional from a different jurisdiction can advocate for the local patients?

    Biology, physiology and anatomy may be (more or less) universal, but the “art” of medicine is finely tailored to the environment in which it is taught. Not every medical culture values patient advocacy in the same way. Even in typical North American patient-centered models of care, where there is an entrenched expectation for more than just “doctoring”, customs and standards vary from jurisdiction to jurisdiction. This can be as much a factor of local resources/infrastructure, as simple tradition. I’m just not sure that current policies and processes (US and Canadian alike) for foreign medical graduates promote as smooth an integration into the physician workforce as they are assumed to. We can do better for both our patients and our colleagues trained elsewhere. The health system must meet the needs of the former, but cannot survive without the latter.

    Thanks for the post.
    At least the changes mean that there is recognition of a disconnect between the process and the intended outcome–

  4. globalgal123 Says:

    I agree, this is a small step for improving the process for foreign-trained doctors to practice in the U.S. There are more changes that are needed.

  5. globalgal123 Says:

    I agree, the policy is a small step and many more improvements are needed in the process – in regard to both streamlining (eliminating duplicate residencies) and helping physicians integrate into the U.S. medical environment. You make a very good point about the science and art of practicing medicine. However, while the U.S. is progressing towards a more patient-centered model, I think there is a significant issue in the U.S. not training local/domestic doctors to be advocates. For example, the courses for learning about health literacy and working with multicultural populations, or Medicaid/Medicare populations are usually not mandatory in U.S. medical schools, but are elective courses.

  6. duggals2013 Says:

    This is an interesting point that you bring up. I agree that hiring international physician would help decrease, maybe even eliminate, the shortage of physicians in rural areas. Yet, I am a little weary on the changes that are being made for the steps that foreign trained physicians must take in order to practice in the US. Certain steps are put into place in order to ensure that the physician would be cable of performing his/her duties when needed, but if the foreign-trained physicians do not undergo training in the US, how do they know what the norms are when practicing medicine in the US? Granted medicine is medicine practiced in the US or practiced in Spain, but there are certain rules and procedures that US hospitals follow to ensure optimal level of care in a US based society. These rules and procedures maybe different in a foreign country because their society and norms are different than the US. I believe a foreign medical graduate should have some form of training in the US that would allow him/her to understand the social norms that are put in place in the US hospitals.

  7. martinljohnson1 Says:

    Residency training in the US has been facing major challenges due to the increase in the number of graduates from USMD/DO schools, while the the number of residency slots in the US has not kept pace. While discussions continue to try to increase that portion of Medicare payments to hospitals to offset the higher cost of medical education, there is an uphill battle in light of austerity concerns in Washington. The state of Texas (according to several sources, including the president of one medical school) now graduates more medical students than available resident positions in that state. In light of the huge public expenditure for medical education, the priority should be for the USMD/DO medical students.

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