Primary care training and international medical graduates

I have had the pleasure as a medical student to complete my clinical clerkships in the Baltimore area community hospitals, the Johns Hopkins Hospital, and the National Institutes of Health.

I will forever cherish these experiences and lessons as I progress through my career. With an educated and wealthy suburban population and a large disadvantaged urban population; Baltimore is symbolic of the challenges and opportunities the healthcare field faces.

There are different measures that can be used to assess the strength of a nation from economic, educational, to standard of living indicators. The common variable is that the citizens must be healthy to have a positive effect on the well-being of the nation. For the nation to remain competitive in this increasingly globalized world the health of the American people is of significant national interest. Increasing residency training positions would help improve the health of the nation.

After I completed my undergraduate training at the University of Toronto I continued my studies by attending Aureus University School of Medicine in Aruba. I am part of a growing trend of individuals who attend medical schools based in the Caribbean. The growth of these schools is due to the fact that traditional medical schools have been unable to accommodate all qualified individuals who desire to be patient care providers.

Caribbean students are unique members of the International Medical Graduate community as our basic sciences are conducted outside the U.S. but our clinical experiences are conducted within the same healthcare systems as U.S. graduates. Thus, we are all well integrated into the U.S. medical system. It is well established that IMGs now represent 25% of practising physicians and they are more likely to train in primary care and rural medicine than U.S. counterparts.

From what I have seen, key to the promotion of primary care training is further integration of the IMG community. Many individuals regardless of their medical school origin will be attracted to speciality training because of market forces and ‘lifestyle’ issues. I feel that promoting primary care training through incentive programs may not be the best method, rather we should focus on the issue of the residency training shortage. 11,577 individuals went unmatched this year I am sure if given the opportunity a large majority of these individuals would be delighted to be in a residency position this July.

The future of medicine is bright as we enter this new era. The reforms promise a move away from the era of defensive medicine and towards increased patient care with the next generation of physicians leading the way.

Sajeet Sohi is a graduate of Aureus University School of Medicine in Aruba and author of International Medical Graduates – A Possible Solution to the Expected Physician Shortage.  This piece originally appeared on Primary Care Progress Notes.

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  • http://drsamgirgis.com Dr Sam Girgis

    I agree that there are many more qualified students in the US who would want to persue medical careers, but there is not enough first year medical school positions available. As a result, the carribean medical schools have seen a boom in enrollment. In addition, there is a big shortage of primary care physicians. As the populations ages, this problem will only worsen. The solution is to make medical school classes larger or open up new medical school in the US. I believe this is already happening, and will continue to happen.

    Dr Sam Girgis
    http://drsamgirgis.com

  • Sajeet Sohi

    I agree with your comments. The solutions are complex as the long term trends show that the amount of residency applicants are increasing faster than the increase in positions. It will require new and innovative thinking to accommodate all qualified individuals.

  • Steven Wynn

    IMG’s are more likely to enter primary care fields? True, but I suspect it’s because residency directors look more favorably on US grads. If they could, IMGs would do specialty medicine just like US grads.

    Increasing residency spots in primary care will result in more primary care doctors? Possibly, but the jury is still out. Family practice had a lot of unmatched spots last year after expanding the number of spots.

    Increasing IMG integration in the US medical system? I don’t see how this will change anything.

    • Sajeet Sohi

      I think your first point is correct if all “application factors” were equal then IMGs would also preferentially match into specialty medicine like U.S. grads. There is definitely a large sentiment in the IMG community that to enter the GME system primary care fields are the way.

      There are thousands of unmatched individuals every year. I think if programs were a bit more receptive to IMGs and other applicants there should be nearly no unmatched positions.

      Of special note is the non-US citizen IMG increasing access to visa programs like the J1 wavier/H1B would make primary care programs more attractive.

  • Aryan

    There are a lot of qualified IMGs currently in USA who are unable to obtain residency positions. I believe removing the cap on residency positions and increasing the slots would be effective in reducing the primary care physician shortage in USA. I understand that GME funding is decreasing. But the AMA or ACGME should be thinking about starting a pilot program where the qualified IMGs can obtain a primary care residency position by providing their own funding money. I know the American Dental association has already started a similar program for foreign trained dentists.

    • Sajeet Sohi

      I was not aware of this program by the American Dental Association sounds interesting. I guess it might be difficult for most individuals to obtain their own funding in these economic times, but new and innovative strategies are required to create more positions for qualified individuals for sure.