International Medical Graduates in Pediatrics

Abstract

A day of reckoning looms for international medical graduates (IMGs) on receipt of their final DS-2019. The document, issued by the US Department of State to all trainees on the exchange program of the J-1 Alien Physician visa, is inexorably tied to their annual contract. The dates on the very last one issued, whether as a senior resident or fellow, remind of a decision to be made: whether to return to their home country and use their newly acquired skills or to seek opportunities within the workforce in the United States.According to data from the Educational Commission for Foreign Medical Graduates, in 2017, 10 953 physicians were approved for graduate medical education training in the United States through the J-1 Exchange Visitor Sponsorship Program. It is defined as an exchange program by its condition that visa holders return to their home country for a minimum of 2 years following completion of training. Despite this, a number of opportunities allow these now highly qualified physicians to stay and seek employment in the United States. The most commonly used outlet, the waiver program, is to practice in state-determined underserved areas for a minimum of 3 years, thus waiving the home country return requirement. The role of IMGs in care for underserved populations (most frequently in primary care roles) as part of a fulfillment of this requirement has been described elsewhere. 1 International medical graduates practicing in health care professional-shortage areas serve as an instrumental way for access to medical care for underserved populations and as an important mechanism for workforce retention. Data are lacking on how many IMGs return to their home country as part of the exchange program return clause. In addition, the number of graduates that remain in the United States under a waiver visa (H-1B specialty occupation visa) or different nonpermanent immigrant visas (such as the O-1A for individuals with an extraordinary ability in the sciences) is also unknown.The decision of what road an IMG should choose at the end of training is often not a simple one. Many IMGs come to the United States seeking stability and opportunities for their professional growth that are sparse or nonexistent in their home countries. Data presented at the Pediatric Academic Societies meeting in 2015 outlining the experiences IMGs at a major academic children's hospital suggested that educational structure and opportunities (reported by 44% of IMGs) and availability and variety of resources (endorsed by 30%) were the major differences in pediatric training when compared with their home country. 2 Often, the countries of origin have precarious sociopolitical structures and are highly underserved in terms of access to medical care and education. Many IMGs feel a responsibility and debt to-VIEWPOINT

Growth and changes in the pediatric medical subspecialty workforce pipeline

“…1,28,37 New restrictions in US immigration policy in 2018 and the impact of the COVID-19 pandemic may influence both the number of pediatricians from outside the United States who enter fellowship and the number who go on to practice in the United States after completion of training may decrease. 38 Access to pediatric subspecialists, particularly in medically underserved areas, may be hindered if there are fewer individuals with J-1 visa service requirements. 39,40 There are fields including Child Abuse, Developmental Behavioral, Infectious Disease, Nephrology, Pulmonology, and Rheumatology with smaller numbers of first-year fellows, lower fill rates, and higher proportions of first-year fellows in small programs.…”