ERIC ED428636: International Medical Graduates. Immigration Law and Policy and the U.S. Physician Workforce. Council on Graduate Medical Education Resource Paper. A COGME Panel Discussion (Washington, DC, March 12, 1996).

56 Pages·1997·0.94 MB·English

by  ERIC

DOCUMENT RESUME
ED 428 636
HE 031 970
TITLE
International Medical Graduates. Immigration Law and Policy
and the U.S. Physician Workforce. Council on Graduate
Medical Education Resource Paper. A COGME Panel Discussion
(Washington, DC, March 12, 1996).
INSTITUTION
Health Resources and Services Administration (DHHS/PHS),
Rockville, MD. Bureau of Health Professions.; Council on
Graduate Medical Education.
REPORT NO
HRSA-97-37
PUB DATE
1997-00-00
NOTE
55p.
PUB TYPE
Collected Works - Proceedings (021) -- Opinion Papers (120)
EDRS PRICE
MF01/PC03 Plus Postage.
DESCRIPTORS
Compliance (Legal); Federal Legislation; *Foreign Students;
*Graduate Medical Education; Higher Education; *Immigration;
Labor Force; *Labor Market; *Medical Education; *Physicians;
Public Policy; Trend Analysis
ABSTRACT
This report includes presentations and discussions by the
Council on Graduate Medical Education (COGME) addressing issues related to
the current supply of physicians in the United States and the role of
international medical graduates (IMGs). The presentations focused on the
following areas: the exchange visitor program and the use of waivers, the
complexities of temporary and permanent visas, the entry of IMGs into U.S.
graduate medical education programs (GME) and the funding of GME, and the
impact of IMGs on the U.S. physician workforce. The program was divided into
two segments. The first, on data, trends, and physician education and
workforce policy, was moderated by David A. Kindig. The following papers were
presented: "COGME's Role in the International Medical Graduate Issue"
(Fitzhugh Mullan); "Dimensions of the International Medical Graduate Presence
in the U.S." (Stephen S. Mick); and "The Role of International Medical
Graduates in Graduate Medical Education: A New York Perspective" (Patricia J.
Wang). The second segment, on immigration law and policy and participation in
the U.S. workforce, was moderated by Sergio A. Bustamente. Papers include:
"Immigration Legislation: An Overview" (Sophia Cox); "Visa Classifications"
(John W. Brown); "Waivers" (Joyce E. Jones); "Role of the Educational
Commission for Foreign Medical Graduates" (Nancy E. Gary and Marie L.
Shafron); "U.S. Immigration Policy Reforms" (Susan Martin); and "Personal
Perspective of an International Medical Graduate" (AppaRao Mukkamala). Also
included are a summary of questions and comments, public comments, and
a list
of abbreviations.
(DB)
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Reproductions supplied by EDRS are the best that can be made
from the original document.
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H
COUNCIL ON GRADUATE MEDICAL EDUCATION
er
AL
1
I AL
Immig
ion Law and Policy
and the U.S. Physician Workforce
A COGME Panel Discussion
MIME
U S DEPARTMENT OF EDUCATION
Office of Educational Research and Improvement
BEST COPY
EDU ATIONAL RESOURCES INFORMATION
CENTER (ERIC)
This document has been reproduced
as
received from the person or organization
originating it,
0 Minor changes have been made
to
improve reproduction quality.
2
Points of view or opinions stated in
this
document do not necessarily represent
official OERI position or policy.
COUNCIL ON GRADUATE MEDICAL EDUCATION
Resource Paper
INTERNATIONAL
MEDICAL
GRADUATES
Immigration Law and Policy
and the U.S. Physician Workforce
A COGME Panel Discussion
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Health Resources and Services Administration
The views expressed in
this document
are solely those of the Council on Graduate
Medical Education and do not necessarily
represent the views of the Health Resources
and Services Administration nor the U.S.
Government.
i
4
Background
Introduction
1
Background
1
COGME Deliberations
1
Charge to the Council
3
Participants
4
Opening Remarks
6
David A. Kindig, M.D., Ph.D
Part I. Data, Trends, and Physician Education and Workforce Policy
6
David A. Kindig, M.D., Ph.D. Moderator
COGMEs Role in the International Medical Graduate (IMG) Issue
6
Fitzhugh Mu Ilan, M.D.
Place of IMGs in graduate medical education (GME) and physician workforce
J-1, H-1B
Temporary resident visas
COGMEs proposal for residency reduction
Dimensions of the International Medical Graduate Presence in the U.S
12
Stephen S. Mick, Ph.D.
Historical description and comparison between USMGs and IMGs
Geographic, specialization, and practice distribution of IMGs
Impact of policy and changes in examinations
IMGs and managed care
Potential impact of cutbacks of IMG physicians
The Role of International Medical Graduates in Graduate Medical Education:
A New York Perspective
20
Patricia J. Wang, Esq
Description of Greater New York Hospital Association and population served
Direct and indirect medical education payments and disproportionate share hospitals
IMGs in residency programs and importance in health care service to indigents
Comments and Discussion
24
Part II. Immigration Law and Policy and Participation in the U.S.Workforce
28
Sergio A.Bustamante, M.D., Moderator
II
Immigration Legislation: An Overview
28
Sophia Cox
Purpose and background of exchange visitor program
Requirements for J-1 visa status
Waiver channels
Visa Classifications
31
John W. Brown
Descriptions of visas and their uses
Waivers
32
Joyce E. Jones
Explanation of waiver program and role of Interested Government Agency
Philosophy of Department of Health and Human Services on use of waivers
Problems with use of waivers
Role of the Educational Commission for Foreign Medical Graduates (ECFMG)
33
Nancy E. Gary, M.D., and Marie L. Shafron
History and role of ECFMG
Certification process of IMGs
Role of J-1 visa sponsor of exchange visitors
U.S. Immigration Policy Reforms
36
Susan Martin, Ph.D.
Description and purpose of U.S. Commission on Immigration Reform
Levels of immigration
legal and illegal
Nonimmigrant entrants to U.S.
J,H, and other visas
Admittance criteria for immigrants
Review of nonimmigrant system
Personal Perspective of an International Medical Graduate
40
AppaRao Mukkamala, M.D.
Questions and Comments
42
Public Comments
43
Abbreviations
47
Bibliography
48
6
III
Background
The number of International Medical
uates (USMGs) has remained stable, increasing
Graduates (IMGs) in the U.S. today is a result
the proportion of IMGs in graduate medical edu-
of an interplay over the past 50 years of multi-
cation (GME) and practice.
ple factors. Some of these factors include the
exchange visitor program and the accompany-
As explained by the panelists in this resource
ing process for obtaining waivers to the require-
paper, the entry of IMGs into the physician
ment for exchange visitors to return home, des-
workforce shares all of the complexity of the
ignations for occupational shortage preferences
U.S. system of temporary and permanent visas
established during the 1980s, changes in visa
and immigration, leading to the various routes
regulations inaugurated under the Immigration
of return to and entry into the physician work-
Act of 1965, and the marked increase in physi-
force in this and other countries. In sum, how-
cian demand associated with the passage of
ever, IMGs play a very direct role in physician
Medicare legislation in the early 1970s. As a
distribution and supply as well as the allocation
result, the number of IMGs has risen dramati-
of resources in meeting future health care needs.
cally, whereas the number of U.S. medical grad-
COGME Deliberations
Many private and public health policy ana-
meeting, presided by COGME Chair David A.
lysts who consider the current supply of physi-
Kindig, COGME members and staff were joined by
cians in the U.S. more than adequate view with
a panel of experts in the fields of immigration and
concern the augmentation of the U.S. physician
medical education. The panelists presented and
workforce by IMGs. Reflecting this concern,
discussed issues involving the following areas:
the Council on Graduate Medical Education
(COGME), in its Seventh Report, recommended
The exchange visitor program
that Medicare payments to hospitals for IMG
and the use of waivers
residents gradually be reduced to 25% of 1995
levels, to encourage decreasing the number
The complexities of temporary
of IMG first-year residents to 110% of U.S.
and permanent visas
graduates. COGME has subsequently recon-
sidered this recommendation, and issued new
The entry of IMGs into GME
recommendations which are incorporated in
and the funding of GME
the COGME Report on IMGs to be issued in
late 1997.
The impact of IMGs on the
U.S. physician workforce
To assist COGME in its consideration of matters
related to IMGs, a panel discussion was held
March 12, 1996, during a COGME meeting at the
Governors House Hotel in Washington, DC. At that
1
The program was divided into two segments.
Immigration Law and Policy and Participation in
The first session, Data, Trends, and Physician
the U.S. Workforce, was moderated by Dr.
Education and Workforce Policy, was moderat-
Sergio Bustamante, chair of COGME's
ed by Dr. Kindig. The second session,
Workgroup on International Medical Graduates.
COGME believes the dis-
Figure 1: Patient Care Physician Supply and Ratios per 100,000 Population Under
course of these panel members
Current PGY1 Scenario and Specialty Output: Actual 1950-1990 and
provides a valuable and sub-
Projected 2000-2020
stantive contribution to the
218.9
213.8
understanding of these complex
203.3
Physicians per
issues. Furthermore, it is
100,000 Population_
181.
believed this information should
708.2
668.4
be made available to the public
149.
-8
interested in these issues.
570.8
Thus the proceedings of this
114.7
111.5
111.0
456.1
panel discussion have been
assembled in this report to
344.9
provide information, education,
238.7
and insight into the critical role
203.4
TA-1
I
I
of IMGs in the physician supply
17
in the U.S.
1950
1980
1960
2000 2010
1970
2020
1990
These proceedings and
other research dealing with the
Note: Projections assume output of physicians at 140% of USMGs with 30% generalists and 70% spedalists.
Source: 1950-1990 data adjusted by MP, from AMA Physidan; Masterfile and unpublished AOA data.
role that IMGs play in providing
Projections from BIM. Physician supply model.
health service in the U.S. have
contributed to a clarification of
these issues by COGME. In
its continuing dialogue on this
Figure 2: Generalist and Specialist Patient Care Physician Supply Ratios per 100,000
Population Under Current PGY1 Scenario and Specialty Output*:
subject, COGME has continued
Actual 1965
1992, Projected 2000 - 2020
to refine and define these
160
issues, and developed recom-
147.7 151.6
151.6
148.0
140.4
mendations for reducing resi-
140
Specialists
123.3
dency positions, revising the
113.3
120
106
temporary visa programs but
94.4
100
reaffirming the U.S. commit-
79.2
ment to international medical
80
65
59
education, and improving the
60
66.5
67'3
65.9
67'5
62.9
62.6
66'5
59.5
U.S. practice environment for
55.8
40
49.8
54.7
51.1
USMGs. The new recommen-
Generalists
20
dations were issued on June 4,
1997, and will appear in the
0
COGME report on IMGs to be
ct,
0 0 0 0
0
c)
le
le
le
issued in late 1997.
"sv
PG1'1 at 140% IJSMGs, resident output of 30% generolists970% spdialists
Source: 1965.1992 data by BHP, from AMA Physician
unpublished AOA data.
Masted-do and
Projecdon from BUN physkian oupply model.
2
8
BEST COPY AVMLABLE
Previous COGME 1MG Recommendations
COGME was established to advise the U.S.
the impact of COGMEs earlier recom-
Congress and the Secretary of Health and
mendations of moving the nations physi-
Human Services on matters of GME and physi-
cian workforce toward a GME program
cian workforce policy, in physician supply and
consisting of (1) limiting the annual
requirements, women in medicine, and GME
number of first-year training positions to
programs and financing.
In addition to IMGs,
110% of U.S. medical school graduates
COGME currently is assessing geographic
and (2) moving toward a better balance of
physician distribution, medical education con-
generalists and specialists. These two
sortia, minorities in medicine, and physician
recommendations constitute the 110:50/50
competencies in managed care.
recommendation. The reader of this
Resource Paper will find the rationale
Several COGME reports have included rec-
behind these proposed changes in earlier
ommendations relevant to IMGS:
COGME reports, particularly the Third
Report and the Fourth Report.
The First Report (July 1988) devoted
considerable attention to issues related to
The Report to Congress entitled "Process
IMGs (then called foreign medical gradu-
by which International Medical Graduates
ates or FMGs). Dr. Mu Ilan describes
are Licensed to Practice in the United
the IMG portions of the report.
States," produced by the COGME Medical
Licensure Workgroup noted one particular
The Fourth Report (1994) identified a
salient finding: processing times were
shortage of generalist physicians, poor
longer for IMGs for initial licensure. Other
geographic distribution of physicians, and
relevant findings were also noted. The
potential surplus of physicians in general.
Medical Licensure Workgroup recom-
It called for moving toward 50% generalist
mended that standardization of licensure
physicians in the physician workforce, and
policies and processes among States be
limitation of first-year residency positions
a goal and that States should share and
to 110% of U.S. medical school graduates
retain information about credentials of
in 1993.
IMGs to facilitate licensure processing
and portability.
The Seventh Report (1995) included a
recommendation to reduce Medicare
COGME is pleased to offer this Resource
GME payments to 25% of 1995 levels, to
Paper, to provide a greater fund of information
encourage hospitals to lower the number
in an extremely complex area.
of residents
The Eighth Report (Rev 1996) presents
a
series of statistical analyses that assess
3
OGME Members
David A. Kindig, M.D., Ph.D., Chairman
Jack M. Colwill, M.D.
Center for Health Sciences
Professor and Chairman
University of Wisconsin
Department of Family and
Madison, Wisconsin
Community Medicine
University of Missouri-Columbia
Stuart J. Marylander, Vice Chairman.
Columbia, Missouri
Vice President, Hospital Services Division
Country Villa Services Corporation
Lawrence V. Haspel, D.O.
Culver City, California
Executive Vice President
Midwestern University
Judy Ann Bigby, M.D.
Olympia Fields, Illinois
Division of General Medicine
Brigham & Womens Hospital
Robert Knouss, M.D.
Boston, Massachusetts
Special Assistant to the Principal
Deputy Assistant Secretary to Health
George T. Bryan, M.D.
Department of Health and Human
Dean Emeritus
Services
School of Medicine
University of Texas Medical Branch
Huey Mays, M.D., M.B.A., M.P.H.
Galveston, Texas
Stockton, New Jersey
Paul C. Brucker, M.D
Eric E. Whitaker, M.D., M.P.H.
President
Internal Medicine Resident
Thomas Jefferson University
University of California at San Francisco
Philadelphia, Pennsylvania
San Francisco, California
Sergio A. Bustamante, M.D.
Gloria Holland, Ph.D.
Director, Pediatric Medical Education
Special Assistant to the Chief
Childrens Regional Hospital at
Academic Affairs Officer
Cooper Hospital
Department of Veterans Affairs
Camden, New Jersey
Mists
John W. Brown
Sophia Cox
Adjudication Officer
Adjudication Officer
U.S. Immigration and Naturalization
U.S. Immigration and Naturalization
Service
Service
4
1 0