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Facilitating integration of international medical graduates into neonatal-perinatal medicine: a critical strategy to meet workforce demands

Journal of Perinatology (2024)Cite this article

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There is a severe shortage of pediatric subspecialty providers nationally, with significant geographical maldistribution challenging equitable healthcare access for children [1,2,3,4]. Although neonatal-perinatal medicine (NPM) encompasses over 20% of American Board of Pediatrics (ABP) certified subspecialists, staffing challenges have been highlighted due to the expansion of clinical networks, increasing clinical volume and acuity, and an aging workforce [5, 6]. Needs cannot be sufficiently met by US citizen American medical school graduates [7].

International medical graduates (IMGs), including both US citizen and non-US citizen graduates of international medical institutions, are an essential component of the pediatric workforce. IMGs may hold MD degrees from international schools (17%) or international degrees (20%; e.g., MBBS, MBChB) [3]. IMGs bring valuable diversity to the U.S. physician workforce, including cultural sensitivity and language proficiency, better meeting diverse patient needs [8, 9]. Physician workforce diversity has been linked to improved patient outcomes and enriched educational experiences for medical trainees [10]. Moreover, IMGs are more inclined to practice in rural areas, mitigating geographic disparities in healthcare access [11,12,13].

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Fig. 1: Visa waiver timeline: recommendations with an expected timeline for obtaining the waiver.

References

  1. Mayer ML. Are we there yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118:2313–21.

    Article  PubMed  Google Scholar 

  2. Wong CA, Kan K, Cidav Z, Nathenson R, Polsky D. Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans. Pediatrics. 2017;139:e20163117.

  3. Horowitz E, Hudak ML, Peña MM, Vinci RJ, Savich R. Child Health and the Neonatal-Perinatal Medicine Workforce: 2020-2040. Pediatrics. 2024;153:e2023063678O.

  4. National Academies of Sciences E, Medicine, Division of B, Social S, Education, Health et al. The Future Pediatric Subspecialty Physician Workforce: Meeting the Needs of Infants, Children, and Adolescents. National Academies Press (US) Copyright 2023 by the National Academy of Sciences. All rights reserved: Washington (DC). 2023.

  5. Trzaski JM, Kiefer AS, Myers P, Johnston LC. Essentials of neonatal-perinatal medicine fellowship: careers in neonatal-perinatal medicine. J Perinatol. 2022;42:1135–40.

    Article  PubMed  PubMed Central  Google Scholar 

  6. ABP. American Board of Pediatrics: Pediatric physicians workforce data book. 2020–2021. [cited January 25, 2024]. Available from: https://www.abp.org/sites/public/files/pdf/workforcedata2020-2021.pdf

  7. National Academies of Sciences E, Medicine. The future pediatric subspecialty physician workforce: meeting the needs of infants, children, and adolescents. Washington, DC: The National Academies Press; 2023.

  8. Norcini JJ, van Zanten M, Boulet JR. The contribution of international medical graduates to diversity in the U.S. physician workforce: graduate medical education. J Health Care Poor Underserved. 2008;19:493–9.

    Article  PubMed  Google Scholar 

  9. Duvivier RJ, Gusic ME, Boulet JR; International Medical Graduates in the Pediatric Workforce in the United States. Pediatrics. 2020;146:e2020003301.

  10. Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making. Pediatrics. 2013;132:e1105–16.

  11. Thompson MJ, Hagopian A, Fordyce M, Hart LG. Do international medical graduates (IMGs) “fill the gap” in rural primary care in the United States? A national study. J Rural Health. 2009;25:124–34.

    Article  PubMed  Google Scholar 

  12. American Academy of Pediatrics Committee on Pediatric Workforce. Pediatrician workforce statement. Pediatrics. 2005;116:263–9.

  13. Fink KS, Phillips RL Jr., Fryer GE, Koehn N. International medical graduates and the primary care workforce for rural underserved areas. Health Aff (Millwood). 2003;22:255–62.

    Article  PubMed  Google Scholar 

  14. National Resident Matching Program, Results and Data: Specialties Matching Service 2024 Appointment Year. 2024. [cited April, 2024]. Available from: https://www.nrmp.org/wp-content/uploads/2024/02/2024-SMS-Results-Data-1.pdf

  15. Graduates ECfFM. IMGs Show Strong Performance in 2024 Match. 2024. [cited 2024 April]. Available from: https://www.ecfmg.org/news/2024/03/18/imgs-show-strong-performance-in-2024-match/#:~:text=A%20total%20of%209%2C045%20IMGs,175%20compared%20to%20last%20year

  16. Association AM. International Medical Graduates (IMG) toolkit: Types of visas & FAQs. [cited 2024 January 10] Available from: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

  17. J1 Visa Exchange Program. [cited January 10, 2024] Available from: https://j1visa.state.gov/

  18. H1-B Program. [cited January 10, 2024]. Available from: https://www.dol.gov/whd/immigration/h1b.htm

  19. AMA. American Medical Association: International Medical Graduates (IMG) toolkit: Types of visas & FAQs. [cited January 10, 2024]. Available from: https://www.ama-assn.org/education/international-medical-education/international-medical-graduates-img-toolkit-types-visas

  20. Al Ashry HS, Kaul V, Richards JB. The implications of the current visa system for foreign medical graduates during and after graduate medical education training. J Gen Intern Med. 2019;34:1337–41.

    Article  PubMed  PubMed Central  Google Scholar 

  21. S.898—Conrad State 30 and Physician Access Reauthorization Act. [cited January 10, 2024]. Available from: https://www.congress.gov/bill/115th-congress/senate-bill/898.

  22. Hagopian A, Thompson MJ, Kaltenbach E, Hart LG. Health departments’ use of international medical graduates in physician shortage areas. Health Aff (Millwood). 2003;22:241–9.

    Article  PubMed  Google Scholar 

  23. Batalova J. Migration Policy Institute (MPI): Immigrant Health-Care Workers in the United States. 2023. [cited 2024 April]. Available from: https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states

  24. Kohrs FP, Mainous AG 3rd. The relationship of health professional shortage areas to health status. Implications for health manpower policy. Arch Fam Med. 1995;4:681–5.

    Article  CAS  PubMed  Google Scholar 

  25. Schlak AE, Poghosyan L, Liu J, Kueakomoldej S, Bilazarian A, Rosa WE, et al. The Association between Health Professional Shortage Area (HPSA) status, work environment, and nurse practitioner burnout and job dissatisfaction. J Health Care Poor Underserved. 2022;33:998–1016.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hayashi AS, Selia E, McDonnell K. Stress and provider retention in underserved communities. J Health Care Poor Underserved. 2009;20:597–604.

    Article  PubMed  Google Scholar 

  27. Scheurer D, McKean S, Miller J, Wetterneck T. U.S. physician satisfaction: a systematic review. J Hosp Med. 2009;4:560–8.

    Article  PubMed  Google Scholar 

  28. O-1 Visa: Individuals with Extraordinary Ability or Achievement. 2023. [cited 2024 April]. Available from: https://www.uscis.gov/working-in-the-united-states/temporary-workers/o-1-visa-individuals-with-extraordinary-ability-or-achievement

  29. Conrad 30 Waiver Program. Available from: https://www.uscis.gov/working-united-states/students-and-exchange-visitors/conrad-30-waiver-program

  30. Appalachian Regional Commission J-1 Visa Waivers. Appalachian Regional Commission. [cited January 10, 2024]. Available from: https://www.arc.gov/program_areas/J1VisaWaivers.asp

  31. Delta Regional Authority: Delta Doctors. [cited January 10, 2024]. Available from: https://dra.gov/programs/human-infrastructure/health/delta-doctors/

  32. Southeast Crescent Regional Commission: J-1 Visa Waiver Program. [cited January 10, 2024]. Available from: https://scrc.gov/wp-content/uploads/2022/09/Southeast-Crescent-Regional-Commission-J-1-Guidelines.pdf

  33. J-1 Visa Waiver Program—Northern Border Regional Commission (NBRC). 2024. [cited 2024 April 1]. Available from: https://www.nbrc.gov/content/J1Visa

  34. J-1 Visa Basics. [cited 2024]. Available from: https://j1visa.state.gov/basics/

  35. U.S. Citizenship and Immigration Services (USCIS): Green Card for Employment-Based Immigrants. Available from: https://www.uscis.gov/green-card/green-card-eligibility/green-card-for-employment-based-immigrants

  36. U.S. Citizenship and Immigration Services (USCIS): Green Card for Family Preference Immigrants. [cited 2024 April]. Available from: https://www.uscis.gov/green-card/green-card-eligibility/green-card-for-family-preference-immigrants

  37. U.S. Department of State (DOS): Green Card -Visa Availability and Priority Dates. [cited 2024 April]. Available from: https://www.uscis.gov/green-card/green-card-processes-and-procedures/visa-availability-and-priority-dates

  38. Rashid M, Nguyen J, Foulds JL, Djordjevic G, Forgie SE. International Medical Graduates’ perceptions about residency training experience: a qualitative study. Int J Med Educ. 2023;14:4–10.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Wong A, Lohfeld L. Recertifying as a doctor in Canada: international medical graduates and the journey from entry to adaptation. Med Educ. 2008;42:53–60.

    Article  PubMed  Google Scholar 

  40. Kalra G, Bhugra DK, Shah N. Identifying and addressing stresses in international medical graduates. Acad Psychiatry. 2012;36:323–9.

    Article  PubMed  Google Scholar 

  41. USCIS: Waiver of the Foreign Residence Requirement. [cited 2024 April]. Available from: https://www.uscis.gov/policy-manual/volume-2-part-d-chapter-4

  42. Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97:467–77.

    PubMed  PubMed Central  Google Scholar 

  43. Fiscella K, Frankel R. Overcoming cultural barriers: international medical graduates in the United States. JAMA. 2000;283:1751–1.

    Article  CAS  PubMed  Google Scholar 

  44. Allen M. Doctors exploited; patients suffer, too. 2007 [cited 2024 April] Available from: https://lasvegassun.com/news/2007/dec/23/doctors-exploited-patients-suffer-too/

  45. Kahn TR, Hagopian A, Johnson K. Retention of J-1 visa waiver program physicians in Washington State’s health professional shortage areas. Acad Med. 2010;85:614–21.

    Article  PubMed  Google Scholar 

  46. Chaiban JT. My new country: a journey to belonging. J Grad Med Educ. 2015;7:498–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Vidyasagar D. Integrating international medical graduates into the physician-scientist pool: solution to the problem of decreasing physician-scientists in the United States. J Investig Med. 2007;55:406–9.

    Article  PubMed  Google Scholar 

  48. Rao NR. “A little more than kin, and less than kind”: U.S. immigration policy on international medical graduates. Virtual Mentor. 2012;14:329–37.

    PubMed  Google Scholar 

  49. Kirkendoll SD, Carmody JB, Rhone ET. Information quality for residency applicants in fellowship and residency electronic interactive database (FREIDA) and program websites. Cureus. 2021;13:e13900.

    PubMed  PubMed Central  Google Scholar 

  50. National Institutes of Health: Research Career Development Awards (K) Kiosk. [cited January 5, 2024]. Available from: https://researchtraining.nih.gov/programs/career-development

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Author notes

  1. These authors contributed equally: Suganthinie Velagala, Shruti Gupta.

Authors and Affiliations

  1. Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA

    Suganthinie Velagala, Shruti Gupta, Christie J. Bruno & Lindsay C. Johnston

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LCJ, SV, and SG conceptualized this work, and all authors drafted the initial manuscript. All authors reviewed and revised the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Shruti Gupta.

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Velagala, S., Gupta, S., Bruno, C.J. et al. Facilitating integration of international medical graduates into neonatal-perinatal medicine: a critical strategy to meet workforce demands. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02002-5

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