Why the Need?

There is an increased need for clinical clerkship sites in US healthcare. The reasoning is multifactorial, but let’s first focus on one aspect of increased diversity in MedEd; the International/Foreign Medical Graduates (IMGs/FMGs). There is some debate about the exact meaning of these terms, but for this post, I’ll use IMG to mean a medical graduate from any non-US school.

In the 2019 IMG Recognition Week, the AMA pointed to some interesting and frequently overlooked statistics. IMGs make up a significant portion of the US physician workforce. There are around 216k IMG physicians or 22.7% of the workforce. There was also a 14.6% increase in IMGs in practice since 2010 (compared to 12% US grads). Despite these, arguably necessary, trends IMSs (-students) receive very little attention from many in medical education.

The Evolving Academic Medicine Environment

Students from Caribbean and Canadian schools make up an increasingly large share of the IMG population and eventual US physician population. The World Directory of Medical Schools has over 3000 medical schools listed world-wide, many of which are sponsored by the ECFMG to apply for the USMLE. Interestingly, 42% of active IMG Match applicants in 2019 were born in America and, for one reason or another, studied abroad.

No matter if the student is from the US or not, a negative stigma is often attached. Their schools may also be limited in the resources they can provide to support their students academically, financially, and psychologically. Should we then eliminate this future physician candidate pool? I argue against this.

Interestingly, 42% of active IMG Match applicants in 2019 were born in America and, for one reason or another, studied abroad.

Serving our Community

Broadening the range of students that may ultimately qualify to become a physician provides many community benefits. It helps to fill several reported physician shortage needs in certain fields and demographics, especially those that are underserved. IMGs are more likely to work in community hospitals and small clinics than their US counterparts.

Now, with the USMLE Step 1 soon to become pass/fail (to be discussed in a future post), many questions remain about assessing the qualifications of IMG vs US graduates.

Education Protects Patients

Clinical experience is one area that is likely to play a significant role in future residency selection processes. However, students from smaller schools or schools with fewer resources are at a distinct disadvantage. They do not have the university-hospital relationship mandated by the LCME for US accreditation. This often leaves students crammed a dozen or more per preceptor.

This alone may not be unusual but when mixed with other potential factors (lack of faculty development, limited learning environment, narrow clinical experiences, financial instead of education-driven incentives) the student may find themselves falling farther behind in clinical knowledge than their peers. This, ultimately, may affect patient care.

Expanding the Clinical Database

Many experiential limitations can be overcome, or at the very least mitigated, by expanding the quantity, quality, and diversity of clinical site options. Physicians do not need to be a part of an academic institution to provide much-needed services to current students. They do not need to go through a potentially complicated VSLO application process. Some have taken it upon themselves to offer their clinics, their knowledge, and even their telemedicine practice (in current times) to students in need.

If you think this is something you would be interested in learning more about, reach out to your local medical schools for advice. You can also contact me anytime with questions and to see what options may be best for you. By educating the next wave of physicians, you are personally helping shape the future of healthcare.