Sunday 12 February 2012

No more IMGs in the future?

The Future of IMGs in USA

International medical graduate (IMG) is a umbrella term for any physician who received his/her basic medical degree or qualification from a medical school outside of the U.S. or Canada, regardless of citizenship, This includes any U.S. citizen who received a medical degree from a school outside of the U.S. or Canada. This working ECFMG definition leaves many questions unanswered like, which countries are the most prolific in contributing to the international medical graduate pool. Where are these applicants coming from?

US physician shortage is a real concern. According to projected estimates by Association of American Medical Colleges by 2020, US will face a serious shortage about 45,000 work force in both primary care and specialist physician jobs. These projected estimates are based on the current job numbers where there is a shortage of 13700 physicians including primary care, surgical, and medical specialties. Even with the push to increase the number of graduating American medical graduates, the disparity in the physician demand and supply is huge. The cause of this accelerated deficit of physician work force is multifactorial with combination of increase in the ageing US population and increase in the number of insured patients. Attrition of the physician pool by older doctors retiring also compounds to the problem.

In view of this alarming projected shortage international medical graduates are still going play an important role in taking care of the ail and elderly US patient population. According to white paper published by the American Medical Association (AMA) called the “International medical graduates In American medicine: Contemporary challenges and opportunities” [A position paper by the AMA-IMG Section Governing Council, January 2010], most of IMGs are citizens of India, followed by Philippines, Mexico and Pakistan. About one fifth of the IMG population constituted of physicians from India.

The question then was, do all the people who are pursuing their dream to practice in the USA start out from their home country. To answer this question, the country of origin of the visitors to this website  was analyzed. This blog specifically caters to the international medical graduates and has on average 1700 unique visitors each month. The most interesting result of this analysis was , that most of the applicants who are wishing to pursue medical residency in United States are already in the US! 82% of page views were from USA followed by India (9%), Canada (3%) and Pakistan (2.2%). United Kingdom, Ukraine, Philippines, Peru, South Korea and France each had less than 1% page views. This was a very illuminating piece of information as it indicates that though foreign graduates might belong to another country they still apply for residency from within USA itself.

Getting into a medical residency is a tough process. There are 3 USMLE (US medical licensing exam) that need to be aced followed by a laborious process of being ECFMG certified. Once this is done, application to various hospital programs begins via the Electronic residency application service (ERAS). Being invited for interviews is difficult because of tremendous competition and if candidate ends up being interviewed, they have to be ranked by the program to get a spot. There are many advantages to applying for residency while being in the US. It is easier to make contacts, build a network, seek volunteer opportunities, do clinical observerships and expedite some of the logistical issues. This proximity to US health care system puts foreign physicians applying from their homeland at a geographical disadvantage.

In conclusion, physician workforce deficit is going to be a huge problem in the near future. Foreign medical graduates are going to continue being important in filling this gap and the future of IMGs seems still unshaken. Most of the foreign medical graduates these days begin the process of applying for medical residency from with in US, a trend that has significantly changed over the years.


  1. Replies
    1. physician workforce deficit is going to be a huge problem in the near future. Foreign medical graduates are going to continue being important in filling this gap and the future of IMGs seems still unshaken in contrast to rumors that IMGs have no future in US.


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