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International med school grads get new respect with worsening physician shortage

As baby boomers age out of the workforce, hospitals are turning to U.S. citizen international medical school graduates to fill much-needed roles.

Jeff Lagasse, Associate Editor

The ongoing physician shortage is causing staffing and recruitment headaches for hospitals and providers, particularly in the field of primary care medicine. Because of that, many institutions are taking a new look at U.S. citizen international medical school graduates, or USIMGs, to help fill the void.

USIMGs are U.S. citizens who do their training internationally. Until recently, recruiters for residency slots didn't given them the same weight as graduates of traditional U.S. medical schools.

That's beginning to change.

A new mindset about international med school grads

Not only is the training they receive more than sufficient, but a higher percentage of USIMGs go into the field of primary care medicine. As baby boomers age en masse and there are fewer and fewer physicians to tend to them -- particularly in rural areas -- hospitals are relying on these graduates to fill much-needed roles, and are likely to do so more and more in the coming years.

Neal Simon, president and co-founder of the American University of Antigua College of Medicine, said one of primary drivers of the physician shortage is that there aren't enough medical school spots to train the needed volume of physicians, On top of that, the number of residency positions, with some exceptions, have been capped at 1996 levels.

"The issue here is that in order to get licensure, you need three years of residency training, and the number of residency slots has not increased by any real measure," said Simon.

Physicians have the ability to treat more illnesses these days, but because of the freeze on residency slots there aren't enough doctors to take advantage of new technologies and advancements in medicine. And there aren't enough doctors to address the many healthcare shortages already gripping pockets of the country, especially rural locations.

According to Simon, the number of retiring physicians and physicians older than 60 is greater than the number of physicians younger than 40. The Association of American Medical Colleges predicts an 80-100,000 physician shortage by 2030.

"If you have that bottleneck at residency positions, you're not going to have more doctors," said Simon. "The number of new, practicing physicians can really only go up by about 28,000a year. The number of physicians leaving the profession is greater than that. Not only will we not be able to deal with the shortages predicted for 2030, we can't deal with the shortages now."

Meet the USIMGs

Dr. Jason Nehmad does inpatient care full time at Jersey Shore University Medical Center in Neptune City, New Jersey. He pursued his medical training at AUA, he said, because it had relationships with a number of good hospitals, and contrary to the notion that USIMGs often don't get good residency spots, the school was placing graduates into competitive and attractive residency programs.

"There used to be a wrong stigma that IMGs were not as competitive," said Nehmad. "Jersey Shore is a teaching hospital, so every year we have 24 new residents who come in. We're involved very much with the training of the residents, and I'm involved in that. And every year we see more and more IMGs coming in. They're succeeding and getting good spots. They're also very competitive after residency, and they're getting a lot of good fellowships."

Nehmad knew early on that he wanted to pursue a career in primary care medicine. He found the field appealing because the high demand and low supply was creating some attractive job offers -- good positions in areas that were well-suited to raising a family. It also gave Nehmasd the ability to see a little bit of everything, and maintain a high level of interest.

Still, relatively few people choose to go into primary care medicine as opposed to one of several subspecialities.

"One of the reasons might be compensation," said Nehmad. "Back a decade ago, or a decade and a half ago, there was a huge gap between primary care doctors and other specialists. Hematology/oncology used to be a very attractive field, now less so because more people are getting their chemotherapies at huge centers. They used to get their chemo at the outpatient centers of the hematologists. That cut down on their compensation greatly. The gap has been narrowed.

"Quality of life is also a part of it," he said. "Primary care has become kind of a Monday-through-Friday kind of a gig. Not only is the compensation good, there's also quality of life. I'm home with my family every weekend. I'm home every night for dinner with my family."

Dr. Patrick Michael, another AUA graduate, is the associate program director at St. Joseph's University Medical center in Paterson, New Jersey. He pursued a career in primary care medicine largely because of the long-term relationships that develop with patients. But he also noticed that relatively few people go into primary care.

"One major trend I did notice is that most students, when they're completing medical school, they owe a lot of money," said Michael. "Hospitalists is becoming a popular field right now, so they can start working right away and start paying off their loans. I did see a lot of students heading into that field.

"Also, I see a lot of people going into subspecialties," he said. "Some people like to narrow it down to one area and not be concerned with the rest. I believe compensation may also have something to do with it. For specialists, there's much higher compensation at this moment."

Hospitals are leaning more and more on USIMGs to help fill the primary care gap, including Michael's own. St. Joseph's has 19 positions for which to recruit each year, and Michael estimates about 60 percent of those spots are filled by USIMGs. But there are still obstacles.

"When it comes down to it, the two major things that drive people are compensation and the ratio off debt," said Michael. "I think giving some incentives to reducing debt, especially college loans and medical school loans, would help fill this gap, and would encourage a lot of people."

Nehmad said it has become easier for USIMGs to break into the field, and the trend will likely continue as shortages increase.

"It's already on the way," said Nehmad. "It used to be that some programs had some obstacles. Nowadays it just goes based on your resume, and your scores. If you have the same scores as your U.S. medical school peers, you're in the same boat. They're not differentiating. And I'm saying that as a physician at a teaching hospital, looking at resumes. Gone are the days of paying attention to who's a U.S. medical student."

Demand will only grow greater

Some U.S. states have begun funding their own residency programs, including Georgia and Florida. That will help open the floodgates a bit, but there's still one issue: While it's true that someone is more likely to practice in the state in which they completed their residency, it's no guarantee, so states that self-fund residency slots risk paying for the residencies of doctors who eventually end up elsewhere.

Prodding the feds to unfreeze those 1996 residency funding levels would be the only sure-fire solution, but Simon said pressure from advocacy groups such as the American Medical Association haven't gotten anywhere.

"This is not a secret, yet there doesn't seem to be the willpower by the legislature to increase funding," said Simon.

Nevertheless, there's still an ever-widening opportunity for USIMGs -- and, as the physician shortage worsens, an ever-widening need.

"I think there's going to be even more demand," said Nehmad. "Next year there will be more hospitals looking to fill those gaps. There's no place where a USIMG can't get in. There are definitely opportunities."

Twitter: @JELagasse
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