International Medical Graduates in the United States : A Complete Guide to Challenges and Solutions

Thousands of international medical graduates come to the United States to start their career as physicians. Many of them, however, are not aware of the challenges and problems that they may encounter along the way. These difficulties can range from the language and cultural barriers to a lack of confidence and self-esteem. Many students are also unaware of the other career options besides getting into a clinical residency program. As a result of these issues, a great number of foreign medical students remain unmatched into the National Resident Matching Program. Not matching can be devastating for these graduates, both financially and medically. Students often suffer from psychological effects like major depression and generalized anxiety disorder. This book outlines the potential problems faced by these graduates and their possible solutions. Each chapter collects research evidence, interviews and surveys to gather information to work on each possible problem one by one and describes a solution in great detail. Comprised of thirty chapters, each chapter is broken down into smaller sub-sections to investigate the main theme in depth. Issues addressed include the different types of international medical graduates and their lives in the United States, differences in the education system and healthcare system, the triangle of residency, language and cultural barriers, lack of professional contacts, confidence, self-image and self-esteem issues, and restriction to specific fields and career paths. Written by experts in the field, International Medical Graduates in the United States is a first of its kind text that addresses the biggest issues faced by foreign medical graduates in today's world. Preface Contents About the Editors Contributors Chapter 1: International Medical Graduates (IMGs) and the Types of IMGs Who Are International Medical Graduates (IMGs)? Types of IMGs Role of IMGs in the US Healthcare System Characteristics of IMGs in the USA Diversity Practice Specialties Geographic Distribution Overview of Certification and Licensure Requirements IMGs and the Residency Application Process Special Considerations for Non-US IMGs: Immigration and Visas Conclusion References Chapter 2: Similarities and the Differences in the Education Systems Around the World Education System of the United States The US Education in General Early Education The Middle School and High School Higher Education Medical Education in the United States The Basic Structure Pre-medical Education Medical Education Graduate Medical Education and Licensure Medical Education in Canada European Education Systems British Education System Medical Education in Britain German Education System Medical Education in Germany French Education System Medical Education in France Italian Education System Medical Education in Italy Education Systems in Latin America Education System in Mexico Medical Education in Mexico Education System in Brazil Medical Education in Brazil Education System in Argentina Medical Education in Argentina Education Systems of Australia, Japan, and China Education System of Australia Medical Education in Australia Education System of Japan Medical Education in Japan Education System in China Medical Education in China Indian and Pakistani Education System The Indian Education System Pre-primary Education (Pre-elementary) Elementary or Upper Elementary/Middle School Secondary and Higher Secondary Education University or Medical College The USMLE Journey The Education System of Pakistan The Pre-primary and Primary Education The Secondary Education Higher Secondary Education or Intermediate College Education Alternate Education System The University or Medical School Life Other South Asian Countries, Middle East, and Nearby Countries Education in Africa Conclusion References Chapter 3: Healthcare Systems Around the World The General Outline of the US Healthcare System The US Healthcare System Private Healthcare Medicare Medicaid Veterans Health Administration The Affordable Care Act Debate Healthcare Outcomes in the USA Costs of the US Healthcare System The Total Spending How Much Individuals Spend on Healthcare Can Americans Afford These Costs? Medicare and Medicaid Spending What Makes the US Healthcare System So Expensive? Would Universal Healthcare Be More Expensive? Medical Workforce in the USA The Number of Healthcare Workers in the USA How the USA Compares with the Other Developed Countries The International Medical Graduates (IMGs) in the USA Increased Medical School Enrolment and International Medical Graduates Salaries of Physicians and Nurses in the USA High Salary, Expensive Living Resident/Fellow Salaries Attending Salaries Salaries of Nurses in the USA Healthcare System in Canada A Brief History The Role of the Government Funding and Expenditures Coverage of Services Structure of Canadian Healthcare Services Performance of Canadian Healthcare: Going Forward The NHS Costs NHS Sites Workforce The Healthcare System of India The Healthcare System of Pakistan Healthcare Systems in Continental Europe The European Union The German Healthcare System The French Healthcare System The Italian Healthcare System The Swedish Healthcare System Healthcare Systems in Latin America The Latin American Healthcare Systems The Mexican Healthcare System The Panamanian Healthcare System The Cuban Healthcare System The Brazilian Healthcare System The Argentinian Healthcare System The Colombian Healthcare System The Venezuelan Healthcare System Healthcare Systems of Japan, South Korea, Singapore, the United Arab Emirates, Australia, and New Zealand Wealthy Nations Outside of North America and Europe Healthcare in Japan Healthcare in South Korea Healthcare in Singapore Healthcare in the United Arab Emirates Healthcare in Australia Healthcare in New Zealand The Electronic Medical Records References Chapter 4: The Life of International Medical Graduates in the USA: A Psychiatrist’s Perspective Background The Struggle The Sacrifice The Fight with Fear The Residency Match The Residency Challenges: Cultural Issues Other Challenges: Paving the Way for Future Generations Conclusion References Chapter 5: The Triangle of Residency Introduction United States Medical Licensing Examination (USMLE) US Clinical Experience Internet Search Personal Connections Contacting Hospitals and Programs Types of Clinical Experience Electives Externships Volunteering Observership Other Opportunities How Can They Make the Most Out of It? Responsibility Respect of Time Improve Listening Grooming Be a Learner Positive Mental Attitude Expense Needed to Get US Clinical Experience Research Experience/Publications What Kind of Experience It Was? Where Was the Article Published? Importance of Writing a First-Author Paper Be Careful When Should They Start Finding Research Opportunities? How to Find It? How to Learn to Write? Types of Research Experience In-person Experience Remote or Online Research/Publication Opportunities Expense How to Make the Most Out of Research Opportunities? Conclusion References Chapter 6: The Problems That an IMG Faces When Moving to the United States USMLE Externships and Observerships Residency Interviews Language and Communication Electronic Health Records Scholarly Activities References Chapter 7: Cultural Barriers General Language Barriers Language Barrier Situations Nonverbal and Casual Communication Individual Versus Family System Types of Societies Examples Religious Barriers Barriers at the Patient Level Barriers at the Provider Level Cultural Daily Routine Differences Acculturation Conclusion References Chapter 8: Nobody Knows You: Become Somebody from Nobody by Establishing a Professional Network What Is Networking? Why Network? Where Can IMGs Network? Traditional Networking Rotation, Externship, and Observership Volunteer Work Research Position (Paid/Non-paid) Study Institution Conferences and Society Meetings Professional Subspecialty Associations Ethnic Physician Association Religion Communities Modern Networking Setting Overcoming Cultural Differences in Networking Etiquettes of Conversational Networking Etiquettes of Online Networking Conclusion References Chapter 9: “Confidence, Self-Image, Self-Esteem” Introduction Self-Image Characteristics of Low Self-Esteem Healthy Habits Diet Sleep Prayer, Meditation, and/or Mindfulness Your Inner Critic The USMLE Step 1 The USMLE Step 2 CK The USMLE Step 2 CS USMLE Step 3 Is It Okay to Have a Plan B? Conclusion References Websites Chapter 10: Restriction to Specific Fields Introduction Competitiveness Factors Availability of Residency Spots Willingness to Consider IMGs USMLE Steps US Clinical Experience and Letters of Recommendations Research Experience, Mentorship, and Dual Degrees Overcoming Financial, Language, and Visa Status Challenges IMGs Pathway Example for Successful Match into Competitive Specialties in the USA Conclusions References Chapter 11: Choosing a Specialty Just to Get a Job How Do IMGs Even Start Looking for a Job? What Happens When IMGs Do Not Get the Job on Their First Try? Where Do IMGs Go When the Job-Hunting Gets Tough? Systemic Barriers to Getting a Job Personal Challenges on the Way The Contributions of IMGs to US Healthcare How Can We Support IMGs on Their Job Search Moving Forward? The Road Ahead References Chapter 12: An Insight into the Journey of USMLE (United States Medical Licensing Exam): Understanding the Process Overview ECFMG Account Registration USMLE Step 1 Exam USMLE Step 2 CK Exam USMLE Step 2 CS Exam USMLE Step 3 Exam Commonly Used Resources Practice Materials by the USMLE Fees Structure for USMLE Examinations Some Points to Remember References Chapter 13: The Relationship Between Country of Origin and Performance on the USMLE USMLE Performance by Country of Origin Factors That Influence Country Performance Clinical Implications of USMLE Performance Upcoming Changes Conclusions References Chapter 14: Unique Considerations of Certain Countries Introduction USA (American Medical Graduates [AMGs]) Canada Caribbean UK European Union India, Pakistan, Bangladesh, Nepal, Sri Lanka and Afghanistan China, Taiwan, Japan and Korea Israel, Qatar, UAE and Arab Countries (Middle East) Israel and Palestine Qatar and UAE Africa Australia and New Zealand Countries with US Travel Restrictions English Language LoRs Visa (Electronic System for Travel Authorisation, ESTA) J1 Visa H1B Visa Finances Ethnic Physician Organisations Other Jobs Role of Observership/Externship/Electives IMG/FMG friendly specialities COVID-19 and Its Impact Conclusion References Chapter 15: The Role of International Medical Graduates (IMGs) in the US Healthcare System Introduction History of IMGs and Certification Policy in the United States Debate Regarding IMGs in the United States Current Status of IMGs in the United States Canadian Graduates Within the American Medical System Caribbean Medical School Graduates International Nursing Graduates Geographic Distribution of IMGs Current Policy and Regulations Outcomes and Level of Care Contribution to Biomedical Research Immigration Diversity Role in Medical Leadership Experience of IMGs Conclusions References Chapter 16: The Role of Mentoring and Tutoring Introduction General Introduction Overview of Mentors and Mentorship Overview of Tutors and Tutoring Mentors and Tutors for IMGs Specific Challenges Faced by IMGS Overview of IMGs as a Diverse Population Culture and Language Issues Faced by IMGs The Effect of Role Models in Mentoring IMGs Support Structures for IMGs Issues with Belonging Special Issues Faced by Female IMGs Practical Challenges Faced by IMGs and Becoming Certified to Train in the USA Important Changes to the USMLE Examinations Important Changes to the Certification Process of International Undergraduate Medical Schools Choosing a Specialty as an IMG Ways for IMGs to Strengthen Their Applications IMGs That Have Been Fully Certified Physicians in Other Countries US Citizens Who Graduate from Foreign Medical Schools Advising IMGs on Future Career Goals Specific Ways of Evaluating IMGs Review of Currently In-Place Programming for Mentoring and Tutoring IMGs Recognizing Signs of Mental Wellness and Burnout in IMGs Other Resources Available Conclusion References Chapter 17: Medical Ethics and International Medical Graduates Background Medical Ethics Values Autonomy Can Patients Lose Autonomy? Beneficence Good Samaritan Law Non-maleficence Justice Conflicts Autonomy Over Beneficence Informed Consent Confidentiality Can Confidentiality Be Breached Under Some Circumstances? The Health Insurance Portability and Accountability Act (HIPAA) Title 2 and HIPAA Privacy Rule Privacy Rule The Terminologies Use of Information Disclosure of Information Exceptions to the Privacy Rule The Type of Data Protected How Can IMGs Easily Be Compliant to HIPAA Privacy Rule? Cultural Ethics Religion and Medical Ethics Conflict of Interest Common Examples of Conflict of Interest Referral Receiving Gifts from Pharmaceutical Companies and Labs Receiving Gifts from Patients Intimate Relationship Between a Doctor and Patient Futile Medical Care Other General Ethics to Remember Dress Code Personal Hygiene Boundaries Professional Manners Interfering Discrimination Research Publications and Ethics Conclusion References Chapter 18: The Alternative Career Pathways for International Medical Graduates in Health and Wellness Sector Introduction Who Are IMGs? IMGs Across Different Countries Unlicensed IMGs in the United States and Canada Comparison of US-Citizen IMGs or Canada-Citizen IMGs with Immigrant IMGs Challenges of Licensure Alternative Career Pathways for IMGs Definition of Alternative Career Pathways Importance of Alternative Career Pathways Types of ACP in Health and Wellness Sector Regulated ACP in Health and Wellness Sector Regulated ACP: Clinical Jobs Regulated ACP: Non-clinical Jobs Non-regulated ACP in Health and Wellness Sector Management in Health Technical Occupations in Health Assisting Occupations in Health Care Providers in Health Educators/Promoters in Health The Challenges for ACP IMGs Are Not Happy or Eager to Choose an Alternative Career Waiting Too Long to Step Forward for an Alternative Career Build Up Lack of Due Diligence in Identifying Suitable Alternative Career Options Not Being Able to Accept/Tolerate Rejection or Failure During Alternative Career Building Process Financial Barriers, the Uncertainty of Finding Jobs, and Feeling Too Aged to Start Fresh Lack of Time to Gain Exposure and Networking Not Identifying the Transferable Skill Sets Unfamiliarity with the Job Search and Interview Techniques Gap of Knowledge for the Working Environment Language Ability and Cultural Competency Experiencing Discrimination in Non-physician Professions Employers’ Reluctance to Recruit IMGs in Alternative Career Non-recognition of Their Existing Knowledge and Skill Sets at the Alternative Path Lack of Job Market Information and Inflexibility Lack of Systematic Support or Non-responsive Programs Lack of Opportunities to Connect with Employers and to Showcase IMGs’ Abilities Lack of Sustained Funding Overcoming the Challenges Facilitators That Are Needed to Help IMGs to Overcome the Challenges to ACP Strategizing Through One-to-One Coaching/Consultation Profile Promotion and Employer Engagement Skill Building Workshops Improve Availability of the Information About ACP Early Develop Alternative Career Roadmaps and Tools for Supporting Organizations and IMGs Develop a Set of Illustrative Case Studies of IMGs in Different Types of Alternative Careers Targeted Bridging Programs with Workshop Placements Examples of Alternative Career Support Programs and Processes Currently Existing in the United States and Canada Surgical Assistant Training Research/Clinical Research Health Informatics Naturopathic Medicine Bridging Program for IMGs International Skills Applied for Geriatrics Bridge Training Program The Bridge to Registration and Employment in Mental Health (BREM) Program Health System Navigator Ultrasound Scanning Evaluation Bridging Program by the Michener’s Institute Accelerated Programs for IMGs to Become Nurse Practitioners Accredited Programs for IMGs to Become Physician Assistants (PAs) Alternative Careers in Health Promotion and Education for International Medical Graduates (IMGs) Program by Learning Enrichment Foundation, Ontario Alberta International Medical Graduates Association’s Career Transition Program Conclusion References Chapter 19: California Institute of Behavioral Neurosciences and Psychology and Its Role in Helping International Medical Graduates Introduction About the Founders The Challenges Our Story Why CiBNP Came into Existence? About the Institute and Its Foundation What Is Research and Why It Is Important? How Does CiBNP Help IMGs? How Is It Done Online? About the Faculty and the Team Our Services Research Courses by CiBNP Be a Published Author Program SPSS Statistical Data Analysis Training Other Courses Types of Article Writing Mode of Teaching Social Interaction Between the Students and Opportunity to Meet New People CIBNP and Its Social Media Platforms Some of the Publications by Our Talented Students CIBNP and Its Partnership with Scientific Journal CIBNP and the US Clinical Experience What Does the Future Hold? Why Is CiBNP the Future of Online Research? Conclusion References Chapter 20: Licensing Requirements by State and Territory for International Medical Graduates Overview of Licensing Requirements for IMGs to Enter an ACGME Residency Program The Process for Eligibility to Enter into an ACGME Residency Program Step 1: Educational Commission for Foreign Medical Graduates Certification Process Step 2: Medical Board Examinations Step 3: Medical Education Credentialing The Requirements of Obtaining an Initial Medical License by State and/or Territory State-by-State Listing of Licensure Requirements for IMGs Helpful Tips for Navigating the Initial Medical Licensure Process by State Conclusion References Chapter 21: Sources of Support for IMGs Cultural Norms and Expectations Career Development Individual and Personal Experiences Communication and Language Skills Test-Taking Skills Medical Knowledge and Practices What Is at Stake If IMGs Are Not Provided Adequate Support Systems? Current Models of Support Recommendations for a Standardized Program References Chapter 22: Thinking Strategically: How “ACE” Helps IMG Trainees Respecting the Journey Strategy Emphasis on LORs Preceptors One-on-One Guidance Practical Support Tele-Rotations Remote Research Locations Countries of Origin Challenges Conclusion References Chapter 23: The US Medical Licensing Examination The US Medical Licensing Examination The USMLE Step 1 Preparation The USMLE Step 2 Clinical Knowledge Preparation The USMLE Step 2 Clinical Skills Preparation The USMLE Step 3 Preparation References Chapter 24: The Residency Interview Introduction You Are Offered an Interview. Now What? Travel and Finances Interview Preparation Interview Day Reference Websites Chapter 25: The Match Process and SOAP Introduction Learning About Specialties and Training Programs Medical School USMLES The USMLE Examinations Study Resources Clinical and Research Experience Residency Application Components of the ERAS Application Interviews and Pre-match Month of March and Match SOAP July 1: Residency Starts Addendum: The Match Process and SOAP Chapter Reference Websites Chapter 26: How COVID Threatens IMGs’ Residency Training Introduction IMGs in the US Healthcare System Unmatched IMGs Living in the United States Retooling the Application Process References Chapter 27: International Medical Graduates and Their Specialties Reviewed Introduction and Background The Top Five IMG-Friendly Specialties Pathology, a Good Choice for IMGs Pathology Programs and Visas Home Country Specialty in Pathology– General Surgery (Preliminary) Internal Medicine (Categorical) Neurology (Categorical) Family Medicine Less IMG-Friendly Specialties Allergy and Immunology Anesthesiology Dermatology Diagnostic Radiology Emergency Medicine Genetics Nuclear Medicine Obstetrics and Gynecology Ophthalmology Pediatrics Physical Medicine and Rehabilitation Preventive Medicine Psychiatry Radiation Oncology Urology IMG-Friendly Trends Other IMG Factors Match 2019 General Statistics Importance of USCE/Research to Match Other Important Trends IMGs Should Be Aware Of Conclusion References Book Chapter or Article Within a Book Website Article Within a Journal Website Article Within a Journal Website Article Within a Journal Website Article Within a Journal Website Article Within a Journal Website Article Within a Journal Website Article Within a Journal Complete Book Article Within a Journal Website Chapter 28: The Book First Aid and USMLE/Scholar-RX: How They Have Been Instrumental in Serving International Medical Graduates? Introduction First Aid the Book Scholar-RX and Its Mission Mission Service Difference Between First Aid, Scholar-RX, and USMLE-RX The Interview of the First Aid Author and the CEO of Scholar-RX Dr. Tao Le References Chapter 29: Visa Hurdles Faced by IMGs Introduction Consular Experiences Borders Secondary Screening Electives Residency Interview Residency and Visa: Maintenance of Visa Status J1 Visa Limitations J1 Maintenance of an Active Visa Status: The DS-2019 J1 Wavier: The National Interest Waivers H1B F1 Student Visa O1 Visa Special Circumstances COVID-19 Pandemic and Travel Restrictions Presidential Proclamations Resulted in “Enhanced Vetting” of Certain Nationals Summary References Chapter 30: International Medical Graduates and the US Clinical Residency Match: The Editors’ Perspective Introduction The Helpful Strategies That IMGs Must Develop Strategies of Changing the Mindset Responsibility Attitude Change the Destructive Thought of What People Think Strategies of Taking Certain Action Integrity Self-Improvement Clinical Experience Research Publications Strong Letters of Recommendation Contacts and Social Connections Professional Help if Necessary Save Money to Apply Alternative Career Options COVID-19 and the Aftermath Conclusion References Index