IMGs in U.S. Health CareIMG Advisors Network (IAN)

Peer-reviewed research can provide you with credible information about IMGs in U.S. GME and the health care workforce. The articles listed below contain informative data about IMGs in the United States, including practice locations, specialty choice, performance, and trends over time. Click on the title of an article below to view its PubMed listing or the full text, if freely available. You may be able to access the full article through your library.

Boulet JR, Norcini JJ, Whelan GP, Hallock JA, Seeling SS. The international medical graduate pipeline: Recent trends in certification and residency training. Health Affairs. 2006;25(2):469-477.

This study examines trends in ECFMG certification volume and IMG characteristics between 1980 and 2004, including the most common countries of citizenship of certificate holders over that time period. The authors also report the percentages of certificate holders who obtained GME positions and the most commonly pursued medical specialties among those residents.

Boulet JR, Cassimatis EG, Opalek A. The role of international medical graduate psychiatrists in the United States Healthcare System. Academic Psychiatry. 2012;36:293-299.

Psychiatry is one of the most commonly pursued specialties among IMGs. This article describes the characteristics of IMG psychiatrists in the United States, including their countries of origin, locations of practice, and rates of specialty board certification. IMGs were found to make up 31% of the psychiatrist workforce nationally, and as much as 52% of the workforce in some states. The authors also report that IMG psychiatrists were less likely to be board-certified than psychiatrists who graduated from U.S. and Canadian schools.

Brotherton SE, Etzel SI. Graduate medical education, 2011-2012. JAMA. 2012;308(21):2264-2279.

This detailed annual overview of the characteristics of physicians in U.S. graduate medical education (GME) programs appears in The Journal of the American Medical Association (JAMA). The article primarily consists of data tables presenting statistics on the current “class” of residents by gender, race/ethnicity, specialty, location, school type (U.S. MD, U.S. DO, Canadian, and international), and citizenship status.

Fordyce MA, Doescher MP, Chen FM, Hart LG. Osteopathic physicians and international medical graduates in the rural primary care physician workforce. Family Medicine. 2012;44(6):396-403.

To determine the extent to which the rural U.S. population is served by graduates of international and U.S. osteopathic medical schools, the authors of this study analyzed practice locations of primary care physicians in the AMA and AOA Masterfiles. The authors report that both DOs and IMGs were more likely than U.S. allopathic physicians to practice primary care in rural locations, and that IMGs in primary care were more likely than their U.S. MD and DO counterparts to practice in counties defined as locations of persistent poverty.

Jolly P, Boulet J, Garrison G, Signer MM. Participation in U.S. graduate medical education by graduates of international medical schools. Academic Medicine. 2011;86(5):559-564.

In this joint study of the AAMC, ECFMG, and NRMP, the progress over time of IMGs certified in the 2005-2006 academic year is presented. The authors examined this IMG cohort’s ERAS and NRMP participation between 2005 and 2009 and found that more than 75% eventually obtained a GME position.

Jolly P, Garrison G, Boulet JR, Levitan T, Cooper RA. Three pathways to a physician career: applicants to U.S. MD and DO schools and U.S. Citizen applicants to international medical schools. Academic Medicine. 2008;83(12):1125-1131.

This study examines the various pathways taken by students pursuing a medical career in the United States via a combined data set of applicants to U.S. schools (via AAMC and AACOM) and to ECFMG, including repeat applicants to different types of medical schools. An analysis of data from 2004 showed that the majority of first-time applicants applied only to U.S. MD schools (77%), with 5% applying only to U.S. DO schools, 5% applying only to international schools, and the remaining 13% applying to more than one type of school. Implications for a predicted future shortfall of physicians in the United States are discussed.

Norcini JJ, Boulet JR, Dauphinee WD, Opalek A, Krantz ID, Anderson ST. Evaluating the quality of care provided by graduates of international medical schools. Health Affairs. 2010;29(8):1461-1468.

To investigate the relative performance of IMGs in the U.S. workforce, this study examined data for patients with acute myocardial infarction or congestive heart failure in Pennsylvania over a four-year period. The authors found that there were no significant differences between the mortality of patients treated by graduates of U.S. medical schools and those treated by graduates of international medical schools.

Norcini JJ, van Zanten M, Boulet JR. The contribution of international medical graduates to diversity in the U.S. physician workforce: Graduate medical education. Journal of Health Care for the Poor and Underserved. 2008;19(2):493-499.

This study examined the race/ethnicity and gender distribution of IMGs qualified to enter U.S. GME and those currently in U.S. GME. Results showed that compared to graduates of U.S. medical schools, IMGs are more likely to be Asian and Hispanic and less likely to be Black, White, or American Indian/Pacific Islander. The groups had comparable percentages of women.

van Zanten M, Boulet JR, Simon FA. Flexner’s global influence: medical education accreditation in countries that train physicians who pursue residency in the United States. Academic Medicine. 2010;85(2):324-332.

On the 100th anniversary of Abraham Flexner’s groundbreaking report on medical schools in the United States and Canada, this article examines the accreditation systems of the top 10 countries that educate physicians seeking ECFMG Certification. These international systems are compared using Flexner’s framework for evaluating medical education programs.

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