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Malshy K, Khaleel S, Rourke K, Golijanin B, Thavaseelan S, Pareek G, Golijanin D. Investigation of Disparity of Urologic Fellowship Match Rates by Gender and US Versus International Medical Graduates Over the Past Decade. Urology 2024; 191:177-184. [PMID: 38969145 DOI: 10.1016/j.urology.2024.06.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/13/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE To investigate the influence of postgraduate medical education (US vs international) and gender on applicant matching for postgraduate training across different urologic sub-specialties. METHODS Match statistics of 5 societies that participated in the AUA fellowship match between 2010 and 2024 were retrospectively reviewed. Societies included: Endourology Society (EUS), Society for Urological Oncology (SUO), American Society of Andrology (ASA), Society of Genitourinary Reconstructive Surgeons (GURS), and Society of Pediatric Urology (SPU). Candidates were classified based on gender (male/female) and their postgraduate medical education: local graduates from the United States or Canada (US/Ca) and international medical graduates (IMGs). The match odds were analyzed using the Chi-square test, while trends were assessed through the Mann-Kendall test. RESULTS Overall, 2439 applicants applied for 1627 programs from 2010 to 2024, comprising 1998 males (81.8%), 399 females (16.4%), and 42 undisclosed (1.7%). There were 1486 US/Ca graduates (60.8%) and 953 IMGs (39.2%). Around 1471 (60.6%) applicants were matched with a program, compared to 958 (39.4%) unmatched. The likelihood of US/Ca graduates matching (83.8%) was significantly higher than IMGs (23.3%), OR= 17.5, 95% CI: (14.3, 21.5), P <.001. IMGs had the highest match rate with GURS (33.8%, 47/118) and the lowest with SPU (7%, 1/14). Female applicants had a significantly higher chance of matching 324/399 (81.2%) than male applicants 1139/1998 (57%), OR= 3.26, 95% CI: (2.5, 4.3), P <.001. US/Ca-to-IMGs ratios and the male-to-female ratios were stable throughout the match years. CONCLUSION Compared to IMGs, U.S./Ca graduates had remarkably higher matching rates. Matching outcomes were also significantly better for female applicants. Further assessment of international involvement and diversity in urological subspecialty roles is warranted.
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Affiliation(s)
- Kamil Malshy
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI.
| | - Sari Khaleel
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Keith Rourke
- Division of Urology at the University of Alberta, Edmonton, Canada
| | - Borivoj Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Simone Thavaseelan
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Gyan Pareek
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Dragan Golijanin
- The Minimally Invasive Urology Institute, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI
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Tyagi A, Sudah SY, Whitelaw K, Haislup BD, Joshi T, Sanchez-Urgelles P, Sanchez-Sotelo J, Menendez ME. Declining Rate of International Medical Graduates Matching Into Orthopedic Surgery Residency Programs in the United States: A 17-Year Analysis. JB JS Open Access 2024; 9:e24.00095. [PMID: 39309668 PMCID: PMC11412703 DOI: 10.2106/jbjs.oa.24.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Introduction International medical graduates (IMGs) continue to play an important role in the US health care system, but little is known about their trends of matching into highly competitive residencies such as orthopedic surgery. The purpose of this study was to analyze temporal trends of IMG applicants matching into US orthopedic residency programs between 2008 and 2024 and compare them with US allopathic (MD) and osteopathic (DO) graduates. Methods Orthopedic residency specific data for years 2008 to 2024 was obtained from the National Resident Match Program and Electronic Residency Application Service. Variables collected included total number of programs, total positions offered, number of applicants (MD, DO, and IMG), positions filled, and fill rate for each group. Trends were examined using simple linear regression modeling. Results The number of orthopedic residency programs increased from 160 (2008) to 218 (2024), with total positions increasing from 636 (2008) to 916 (2024). The IMG fill rate decreased from 2.99% in 2008 to 0.87% in 2024 (p < 0.01 for linear trend; β -0.069). This corresponds to an absolute number decrease of 19 IMGs in 2008 to 8 in 2024. More specifically, the proportion of US IMGs decreased from 0.94% to 0.66%, and the proportion of non-US IMGs decreased from 2.04% to 0.21%. Over the 17-year study period, a total of 105 US IMGs and 110 non-US IMGs matched into orthopedic surgery. The US MD applicant fill rate decreased significantly from 96.5% to 85.0% (p < 0.001; β -0.944). The DO applicant fill rate increased significantly from 0.31% to 13.97% (p < 0.0001; β 0.990). Conclusion The declining rate of IMGs matching into orthopedic residency programs in the United States underscores the growing challenges faced by IMGs in accessing training in this competitive specialty. The notable increase in DO graduates securing orthopedic residency positions likely reflects the integration of a unified accreditation system for MD and DO residency programs established in 2020. Level of Evidence Retrospective Cohort Study; IV.
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Affiliation(s)
- Anisha Tyagi
- Department of Orthopedic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Suleiman Y. Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, New Jersey
| | - Kathryn Whitelaw
- Department of Orthopedic Surgery, Icahn School of Medicine at Mt. Sinai, Manhattan, New York
| | - Brett D. Haislup
- Department of Orthopedic Surgery, MedStar Health, Columbia, Maryland
| | - Tej Joshi
- Department of Orthopedic Surgery, New Jersey Medical School, Newark, New Jersey
| | | | | | - Mariano E. Menendez
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
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Khoshpouri P, Mohseni A, Dabiri M, Ansari G, Zadeh FS, Ataeinia B, Saadat N, Sherbaf FG, Yousem DM. International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues. Acad Radiol 2023; 30:3124-3134. [PMID: 37183141 DOI: 10.1016/j.acra.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE AND OBJECTIVES The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them. MATERIALS AND METHODS We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered. RESULTS We received responses from 121 of 195 (62.1%) DR programs (121/149 =81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork. CONCLUSION Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas. SUMMARY SENTENCE Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.
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Affiliation(s)
- Parisa Khoshpouri
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada (P.K.)
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | - Mona Dabiri
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran (M.D.)
| | - Golnoosh Ansari
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | | | - Bahar Ataeinia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (B.A.)
| | - Niloufar Saadat
- Department of Radiology, University of Texas Southwestern, Dallas, Texas (N.S.)
| | - Farzaneh Ghazi Sherbaf
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, California (F.G.S.)
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.).
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Wadhwa V, Vilanilam GK, Chhabra A, Bhargava P, Rehani B, Zaheer A, Jambhekar K, Ram R. A 15-Year Analysis of International Medical Graduates Matching Into Diagnostic Radiology Residency Programs in the United States. Acad Radiol 2022; 29:137-143. [PMID: 33158699 DOI: 10.1016/j.acra.2020.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/09/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the trends in international medical graduates (IMGs) matching into diagnostic radiology residency programs in the United States (US). MATERIALS AND METHODS The National Resident Match Program data was accessed for years 2005-2020 and diagnostic radiology residency-specific data was extracted for US MD, osteopathic (DO), and IMG applicants. IMGs were categorized into US-citizen IMGs and non-US citizen IMGs per the National Residency Match Program. Variables collected for each year included the number of positions, number of applicants in each group, positions filled/unfilled, and fill rate of each group. Additional data for some years included USMLE Step 1 score, United States Medical Licensing Examination (USMLE) Step 2 clinical knowledge (CK) score, number of research experiences, number of abstracts/publications, and additional degrees obtained. Trends were analyzed using simple linear regression model and p value <0.05 was considered significant. RESULTS The number of diagnostic radiology residency programs increased from 203 (2006) to 212 (2020). The total number of diagnostic radiology residency positions increased from 1011 (2006) to 1113 (2020), with the peak of 1145 in 2014. The overall "match rate," that is, proportion of positions filled to positions available, increased from 96.4% (2006) to 97.3% (2020), with a brief decline to 86.7% in 2015. Among the filled positions, the proportion filled by US medical school graduates significantly declined from 89.7% (2006) to 69.2% (2020) (p < 0.001), and the proportion of positions filled by osteopathic seniors and graduates significantly increased from 2.2% (2006) to 15.1% (2020; p < 0.001). The proportion of US IMGs increased from 3.2% (2006) to 5.4% (2020), while the proportion of non-US IMGs increased from 4.4% (2006) to 9.4% (2020), with overall IMG match rate increased significantly from 7.6% to 14.9% (p = 0.009). The mean Step 1 scores of US IMGs and non-US IMGs were 238 and 237.3, and the mean Step 2 CK scores were 241.67 and 241, respectively. Cumulatively over the study period, a total of 736 US IMGs and 1051 non-US IMGs have matched into diagnostic radiology residency. CONCLUSION There is an increasing proportion of IMGs, especially the non-US citizen IMGs, matching into US radiology residency programs in the last decade. Diagnostic radiology remains a competitive specialty evidenced by average USMLE scores higher than national average and research experiences of matched candidates.
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Abstract
The future supply of urologists is not on pace to account for future demands of urologic care. This impending urologic shortage sits on a backdrop of multiple other workforce issues. In this review, we take an in-depth look at several pressing issues facing the urologic workforce, including the impending urology shortage, gender and diversity concerns, growing levels of burnout, and the effects of the coronavirus pandemic. In doing so, we highlight specific areas of clinical practice that may need to be addressed from a health care policy standpoint.
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Affiliation(s)
- Ryan Dornbier
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA.
| | - Christopher M Gonzalez
- Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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Naik R, Mandal I, Hampson A, Casey R, Vasdev N. A Comparison of Urology Training Across Five Major English-Speaking Countries. Curr Urol 2020; 14:14-21. [PMID: 32398992 DOI: 10.1159/000499265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/11/2019] [Indexed: 12/20/2022] Open
Abstract
Background Urology is a rapidly evolving specialty, although wide variations exist between training programs in different countries. We aimed to compare the status of urology training in 5 English-speaking countries. Materials and Methods Features compared include the training pathway structure, training requirements, competition levels and the process of moving country for international medical graduates. Results Length of training varied considerably across countries, ranging from 5 years in the USA and Canada, to 7 years in Australia and New Zealand and 9 years in the UK. Ease of entering urology training for international medical graduates also varies, with the UK relatively easier compared to other countries. All countries encourage participation in research during training as well as completion of non-urology and urology specific surgical examinations. Conclusion Following the Royal College of Surgeons Improving Surgical Training report, it is vital that the UK incorporates optimal elements of international programs in order to provide the best standards for trainees and world-class care in urology.
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Affiliation(s)
- Rishi Naik
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | - Indrajeet Mandal
- UCL Medical School, Faculty of Medical Sciences, University College London, London
| | | | - Rowan Casey
- Department of Urology, Colchester General Hospital, Colchester, UK
| | - Nikhil Vasdev
- UCL Medical School, Faculty of Medical Sciences, University College London, London
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Loughlin KR. The Confluence of the Aging of the American Population and the Aging of the Urological Workforce: The Parmenides Fallacy. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kevin R. Loughlin
- Department of Urology, Harvard Medical School, Boston, Massachusetts
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Duvivier RJ, Wiley E, Boulet JR. Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:47. [PMID: 30927914 PMCID: PMC6441164 DOI: 10.1186/s12875-019-0933-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/10/2019] [Indexed: 11/23/2022]
Abstract
Background To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in family medicine who provide patient care in the U.S. Methods A cross-sectional study design, using descriptive statistics on combined data from the Educational Commission for Foreign Medical Graduates and the American Medical Association, including medical school attended, country of medical school, and citizenship when entering medical school. Results In total, 118,817 physicians in family medicine were identified, with IMGs representing 23.8% (n = 28,227) of the U.S. patient care workforce. Of all 9579 residents in family medicine, 36.0% (n = 3452) are IMGS. In total, 35.9% of IMGs attended medical school in the Caribbean (n = 10,136); 19.9% in South-Central Asia (n = 5607) and 9.1% in South-Eastern Asia (n = 2565). The most common countries of medical school training were Dominica, Mexico, and Sint Maarten. Of all IMGs in family medicine who attended medical school in the Caribbean, 74.5% were U.S. citizens. In total, 40.5% of all IMGs in family medicine held U.S. citizenship at entry to medical school. IMGs comprise almost 40% of the family medicine workforce in Florida, New Jersey and New York. Conclusions IMGs play an important role in the U.S. family medicine workforce. Many IMGs are U.S. citizens who studied abroad and then returned to the U.S. for graduate training. Given the shortage of family physicians, and the large number of IMGs in graduate training programs, IMGs will continue to play a role in the U.S. physician workforce for some time to come. Many factors, including the supply of residency training positions, could eventually restrict the number of IMGs entering the U.S., including those contributing to family practice.
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Affiliation(s)
- Robbert J Duvivier
- Foundation for Advancement of International Medical Education and Research, 3624 Market Street, Philadelphia, PA, 19104-2685, USA. .,School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, Maastricht, MD, 6200, the Netherlands. .,Parnassia Psychiatric Institute, Kiwistraat 43, The Hague, DH, 2552, The Netherlands.
| | - Elizabeth Wiley
- Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - John R Boulet
- Educational Commission for Foreign Medical Graduates, 3624 Market Street, Philadelphia, PA, 19104-2685, USA
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Editorial Comment. Urology 2016; 95:44-5. [DOI: 10.1016/j.urology.2016.03.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Editorial Comment. Urology 2016; 95:44. [PMID: 27401714 DOI: 10.1016/j.urology.2016.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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