The internal medicine workforce, international medical graduates, and medical school departments of medicine

A review of demographic and infrastructural factors and potential solutions to the physician and nursing shortage predicted to impact the growing US elderly population

This review highlights several of the key demographic, infrastructural, and cultural factors associated with the predicted labor force shortage in the healthcare field. Population dynamics play a significant role in exacerbating the healthcare labor force shortage. These factors work to simultaneously increase the size and proportion of the population needing the most care, namely, the elderly, and also to reduce the availability of physicians and nurses to provide adequate care for the growing elderly population. Physicians and nurses have expressed consistent dissatisfaction with healthcare infrastructure and have cited decreased job satisfaction, further exacerbating the shortage. Potential solutions to the shortage, aside from dramatic changes to the healthcare system, include increased medical and nursing training in geriatrics and gerontology to increase interest, competency, and knowledge of health issues specifically pertaining to the elderly. Other solutions include monetary incentives for geriatric training for nurses and physicians. Any specific measures to remedy this growing problem should be implemented in a timely manner to reduce this critical shortage of healthcare workers that will only continue to grow in the coming decades.

Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs

PURPOSE

Approximately 25% of practicing physicians in the United States are graduates of medical schools in other countries; they are called international medical graduates (IMGs). Their transition into the U.S. health care system may be difficult and challenging. This study sought to identify the similarities and differences between IMGs and U.S. medical graduates (USMGs) working together in residency training programs.

METHOD

In 2006, the authors conducted a cross-sectional survey study of house officers (interns and residents) at six internal medicine (IM) community-based residency programs in Baltimore, Maryland. The survey asked about demographics, relocation for residency training, practice experience, and career plans and included four previously validated instruments: the Iowa Fatigue Scale, Cohen's Perceived Stress Scale, Rosenberg's Self-Esteem Scale, and the Personal Growth Scale.

RESULTS

Of 225 potential house officers, 176 (78%) responded. In multivariable modeling, independent characteristics that differentiated IMGs from USMGs were that IMGs had (1) a native language other than English (odds ratio [OR] 18.3, 95% CI: 5.8-57.3), (2) less debt (<$50K) upon graduation from medical school (OR 7.3, 2.5-21.2), and (3) experiences practicing medicine before residency training (OR 41.02, 1.6-1017). With modeling to control for these three differences, the authors found IMGs to have lower fatigue (OR 2.7; 1.2-6.0), higher self-esteem (OR 3.0; 1.2-7.5), and greater personal growth scores (OR 3.6; 1.6-8.2).

CONCLUSIONS

Differences exist between the IMGs and USMGs who are working together in community-based IM residency training programs. Considering such differences may help educators and program directors trying to support and train this diverse cadre of trainees.

An acculturization curriculum: orienting international medical graduates to an internal medicine residency program

BACKGROUND

The number of International Medical Graduate (IMG) applicants to residency programs has increased steadily over the past decade. Despite high motivation and significant medical knowledge, differences in training and cultural expectations can create knowledge gaps and influence how IMGs relate to patients and staff. This contributes to increased opportunities for medical errors, patient dissatisfaction, and frustration among colleagues.

DESCRIPTION

To improve this transition we introduced a required, 2-week precourse for IMGs entering our program. The curriculum focused around the Accreditation Council for Graduate Medical Education core competencies.

EVALUATION

Participants reported knowledge gains and rated favorably didactic sessions and small-group activities. Program directors and other key stakeholders reported positive experiences with the precourse, especially the reduction in transition stress and missed work time in July.

CONCLUSION

An intensive precourse for IMGs can attenuate transition stress and increase knowledge of core medical skills and competencies.

International medical graduates and the cardiology workforce

Recent publications have expressed the view that there is a shortage of cardiologists and it is growing worse. Both an increasing demand and a diminishing supply of cardiologists have been projected. An increase in the number of international medical graduates (IMGs) who enter cardiology practice has been proposed as a remedy for a projected shortage. The IMGs have to overcome challenges including clinical practice, language proficiency, and cultural differences before they are incorporated into the fabric of U.S. cardiology. With hard work, perseverance, excellence,compassionate care and support and mentoring, many have contributed to scientific and clinical cardiology in the U.S. Whether in the absence of a present crisis the projected shortage of cardiologists necessitates change in U.S. immigration policy is an open question.