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The Alternative Career Pathways for International Medical Graduates in Health and Wellness Sector

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International Medical Graduates in the United States

Abstract

International medical graduates (IMGs) are critical part of the healthcare system of the United States and Canada. However, they encounter a myriad of barriers to integrating professionally both as practicing physicians and as non-physicians in various alternative careers suitable to their knowledge and skills. There are some common barriers for both pathways such as financial barriers, local work experience, and communication and language difficulties. For alternative careers, however, the IMGs face some unique issues that include a lack of information on potential alternative careers and ways to obtain them, not recognizing their transferable skills by themselves and employers, and a lack of professional guidance, support, and bridging programs. There are different types of potential alternative careers those may be clinical or non-clinical, may or may not require licensure, and often ask for further training that may be minimal such as in-job training to extensive training such as a master’s degree or PhD.

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References

  1. National Center for Biotechnology Information: MeSH term. Foreign Medical Graduates. 1970. https://www.ncbi.nlm.nih.gov/mesh/68005550. Accessed 27 Feb 2020.

  2. Motala MI, Van Wyk JM. Experiences of Foreign Medical Graduates (FMGs), international medical graduates (IMGs) and overseas trained graduates (OTGs) on entering developing or middle-income countries like South Africa: a scoping review. Hum Resour Health. 2019;17:7. https://doi.org/10.1186/s12960-019-0343-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Educational Commission for Foreign Medical Graduates (ECFMG). Definition of an IMG. 2019. https://www.ecfmg.org/certification/definition-img.html. Accessed 27 Feb 2020.

  4. Sumalinog R, Zacharias A, Rana A. Backgrounder: International Medical Graduates (IMGs) and the Canadian Health Care System: A Joint Project of the Committee on Health Policy and the Committee of Medical Education. Canadian Federation of Medical Students. 2015. http://www.old.cfms.org/attachments/article/1370/BACKGROUNDER%20-%20IMGs%20AND%20THE%20CANADIAN%20HEALTHCARE%20SYSTEM.pdf. Accessed 27 Feb 2020.

  5. National Resident Matching Program, results and data: 2019 main residency match®. Washington, DC: National Resident Matching Program; 2019. http://www.nrmp.org/main-residency-match-data/. Accessed 27 Feb 2020.

  6. Ranasinghe PD. International medical graduates in the US physician workforce. J Am Osteopath Assoc. 2015;115:236–41.

    Article  Google Scholar 

  7. AMA-IMG Section Governing Council. International medical graduates in American medicine: contemporary challenges and opportunities. American Medical Association: Chicago; 2013.

    Google Scholar 

  8. MedClerkships: USCE & Residency Consultation. Top 20 US states IMGs practice medicine. 2015. https://medclerkships.com/top-states-img-practice-medicine/. Accessed 27 Feb 2020.

  9. Canadian Institute for Health Information. Physicians in Canada, 2016: summary report. Ottawa: CIHI; 2017.

    Google Scholar 

  10. The New York Times. Why America needs Foreign Medical Graduates. 2017. https://www.nytimes.com/2017/10/06/upshot/america-is-surprisingly-reliant-on-foreign-medical-graduates.html. Accessed 27 Feb 2020.

  11. Organization For Economic Co-Operation and Development (OECE). OECD Stat: health workforce migration: foreign trained doctors by country of origin. 2020. https://stats.oecd.org/Index.aspx?QueryId=68336. Accessed 27 Feb 2020.

  12. General Medical Council. GMC data explorer: list of registered medical practitioners. 2020. www.gmc-uk.org/doctors/register/search_stats.asp. Accessed 27 Feb 2020.

  13. 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 Fam Pract. 2019;20:47. https://doi.org/10.1186/s12875-019-0933-8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yen W, Hodwitz K, Thakkar N, et al. The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario. Can Med Educ J. 2016;7:19–30.

    Article  Google Scholar 

  15. Peters J. Highly trained and educated, some foreign-born doctors still can’t practice medicine in the US. Public Radio International (PRI): The World. 2018. https://www.pri.org/stories/2018-03-26/highly-trained-and-educated-some-foreign-born-doctors-still-can-t-practice. Accessed Feb 27 2020.

  16. Paul R. A preliminary report of an environmental scan of human resource practices. Employment Opportunities and Alternate Careers for Internationally Educated Health Professionals in Ontario.

    Google Scholar 

  17. McDonald JT, Worswick C. The determinants of the migration decisions of immigrant and non-immigrant physicians in Canada. Hamilton: Program for Research on Social and Economic Dimensions of an Aging Population. 2010. https://socialsciences.mcmaster.ca/sedap/p/sedap282.pdf. Accessed 27 Feb 2020.

  18. Bailey M. STAT. After earning an MD, she’s headed back to school – to become a nurse. 2016. https://www.statnews.com/2016/11/28/residency-failed-to-match/comment-page-3/. Accessed 27 Feb 2020.

  19. Educational Commission for Foreign Medical Graduates (ECFMG). IMGs continue to show gains in 2019 match: growth in primary-care specialties offers enhanced opportunities. 2019. https://www.ecfmg.org/news/2019/03/15/imgs-continue-to-show-gains-in-2019-match/. Accessed 27 Feb 2020.

  20. Alberta International Medical Graduate Association (AIMGA). Career Transition Program for IMGs an exploration of alternative pathways into healthcare. Final report. January 2020.

    Google Scholar 

  21. Canadian Resident Matching Service. CaRMS forum data presentation. Presented at CaRMS Forum 2019, Niagara Falls, 2019. https://www.carms.ca/pdfs/2019-CaRMS-Forum.pdf. Accessed 27 Feb 2020.

  22. Educational Commission for Foreign Medical Graduates. 2008 Annual report. Philadelphia: Educational Commission for Foreign Medical Graduates; 2009.

    Google Scholar 

  23. Boulet J, Swanson DB, Cooper RA, Norcini JJ, McKinley DW. A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004. Acad Med. 2006;81(10 suppl):S116–9.

    Article  Google Scholar 

  24. Boulet J, Norcini JJ, Whelan GP, Hallock JA, Seeling SS. The international medical graduate pipeline; recent trends in ECFMG certification and residency training. Health Aff (Millwood). 2006;25:469–77.

    Article  Google Scholar 

  25. Jolly P, Boulet J, Garrison G, Signer MM. International Medical Graduates: participation in U.S. graduate medical education by graduates of international medical schools. Acad Med. 2011;86(5):559–64.

    Article  Google Scholar 

  26. Thomson G, Cohl K. IMG selection: Independent review of access to postgraduate programs by international medical graduates in Ontario. Volume 1: findings and recommendations. September 2011.

    Google Scholar 

  27. Ko DT, Austin PC, Chan BT, Tu JV. Quality of care of international and Canadian medical graduates in acute myocardial infarction. Arch Intern Med. 2005;165(4):458–63.

    Article  Google Scholar 

  28. Desbiens NA, Vidaillet HJ. Discrimination against international medical graduates in the United States residency program selection process. BMC Med Educ. 2010;10:5. https://doi.org/10.1186/1472-6920-10-5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nasir LS. Evidence of discrimination against international medical graduates applying to family practice residency programs. Fam Med. 1994;26(10):625–9.

    CAS  PubMed  Google Scholar 

  30. Moore RA, Rhodenbaugh EJ. The unkindest cut of all: are international medical school graduates subjected to discrimination by general surgery residency programs? Curr Surg. 2002;59(2):228–36.

    Article  Google Scholar 

  31. Woods SE, Harju A, Rao S, Koo J, Kini D. Perceived biases and prejudices experienced by international medical graduates in the US Post-Graduate Medical Education System, Medical Education. 2006. Online, 11:1, 4595. https://doi.org/10.3402/meo.v11i.4595

  32. Kuczkowski KM. (Not) “Born in the USA”: foreign medical school graduates in the American healthcare system. Sao Paulo Med J [Internet]. 2005;123(3):154–155.

    Google Scholar 

  33. Balon R, Mufti R, Williams M, Riba M. Possible discrimination in recruitment of psychiatry residents? Am J Psychiatry. 1997;154(11):1608–9.

    Article  CAS  Google Scholar 

  34. Hanson CW 3rd, Durbin CG Jr, Maccioli GA, et al. The anesthesiologist in critical care medicine: past, present, and future. Anesthesiology. 2001;95(3):781–8.

    Article  Google Scholar 

  35. Atchabahian A. Are “international” medical graduate students second-class anesthesiologists? Anesthesiology. 2002;97(1):278.

    Article  Google Scholar 

  36. Minnesota Department of Health. International Medical Graduate. Assistance Program: Report to the Minnesota Legislature. 2016. https://www.health.state.mn.us/facilities/ruralhealth/img/docs/2018imgleg.pdf. Accessed 27 Feb 2020.

  37. Nedelman M. 2017. Why refugee doctors become taxi drivers. CNN Health. https://edition.cnn.com/2017/08/09/health/refugee-doctors-medical-training/index.html. Accessed 27 Feb 2020.

  38. Association of American Medical Colleges. 2012. A Snapshot of the new and developing medical schools in the US and Canada.pdf [Internet]. https://store.aamc.org/a-snapshot-of-the-new-and-developing-medical-schools-in-the-u-s-and-canada-pdf.html. Accessed 27 Feb 2020.

  39. Association of American Medical Colleges. Physician supply and demand through 2025: key findings. 2015. https://www.aamc.org/download/153160/data/physician_shortages_to_worsen_without_increases_in_residency_tr.pdf. Accessed 27 Feb 2020.

  40. Traverso G, McMahon GT. Residency training and international medical graduates: coming to America no more. JAMA. 2012;308(21):2193–4.

    Article  CAS  Google Scholar 

  41. Young S. The problem of unmatched Canadian Medical Graduates: where are we now? UBCMJ. 2019;10(2):53–4. https://med-fom-ubcmj.sites.olt.ubc.ca/files/2019/03/Letter-3.pdf. Accessed 27 Feb 2020.

  42. ARMC. Undergraduate Medical Education and Student Affairs Committees. The role of MD programs in transitioning students to residency (position paper). Unpublished.

    Google Scholar 

  43. College of Physicians and Surgeons of Alberta. Apply for independent practice. 2020. http://www.cpsa.ca/registration/apply-for-independent-practice/. Accessed 27 Feb 2020.

  44. Kamimura A, Samhouri MS, Myers K, et al. Physician migration: experience of international medical graduates in the USA. Int Migration Integration. 2017;18:463–81.

    Article  Google Scholar 

  45. Miller RS, Dunn MR, Richter TH, Whitcomb ME. Employment-seeking experiences of resident physicians completing training during 1996. JAMA. 1998;280:777.

    Article  CAS  Google Scholar 

  46. Med Applications: Medical Coaching by Doctors. CaRMS as an International Medical Graduate (IMG) – part 1. 2020. https://medapplications.com/carms-international-medical-graduate-part-1/. Accessed 27 Feb 2020.

  47. FMG Portal. 2018 Trends for non-U.S. IMGs in the match. 2018. https://fmgportal.com/2018-trends-for-non-u-s-imgs-in-the-match/. Accessed 27 Feb 2020.

  48. Liang M, Curtin LS, Signer MM, Savoia MC. Understanding the interview and ranking Behaviors of unmatched international medical students and graduates in the 2013 Main residency match. J Grad Med Educ. 2015;7:610–6. https://doi.org/10.4300/JGME-D-14-00742.1.

    Article  PubMed  PubMed Central  Google Scholar 

  49. De Silva, R. B. (2014). Theorizing the barriers and facilitators to relicensing and resettling of Albertan international medical graduates (order no. 1569459). Available from ProQuest Dissertations & Theses Global. (1626727091).

    Google Scholar 

  50. MedClerkships: USCE & Residency Consultation. How hard is it for International Medical Graduates to match into surgery residency. 2016. https://medclerkships.com/how-hard-is-it-for-international-medical-graduates-to-match-into-a-surgery-residency/. Accessed 27 Feb 2020.

  51. Peters C. The bridging education and licensure of international medical doctors in Ontario: a call for commitment, consistency, and transparency. 2013. http://hdl.handle.net/1807/31896. Accessed 27 Feb 2020.

  52. Mylonakis E, Mega A, Schiffman FJ. What do program directors in internal medicine think about international medical graduates? Results of a pilot study. Acad Med. 1999;74:452.

    Article  CAS  Google Scholar 

  53. Zulla R, Baerlocher M, Verma S. International medical graduates (IMGs) needs assessment study: comparison between current IMG trainees and program directors. BMC Med Educ. 2008;8(1):42. https://doi.org/10.1186/1472-6920-8-42.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Part HM, Markert RJ. Predicting the first-year performance of international medical graduates in an internal medicine residency. Acad Med. 1993;68:856–8.

    Article  CAS  Google Scholar 

  55. Bates J, Andrew R. Untangling the roots of some IMGs’ poor academic performance. Acad Med. 2001;76(1):43–6.

    Article  CAS  Google Scholar 

  56. University of Calgary. PGME Clinical Teacher Resources: special considerations and unique cases. 2020. https://www.ucalgary.ca/pgme-clinical-teachers/special-cases. Accessed Feb 2020.

  57. Lim Consulting Associates. Foreign qualifications recognition and alternative careers. The Best Practices and Thematic Task Team of the Foreign Qualifications Recognition Working Group. Report: 2013. https://novascotia.ca/lae/RplLabourMobility/documents/AlternativeCareersResearchReport.pdf. Accessed 27 Feb 2020.

  58. World Education Services. Who is successful in the Canadian market labour? Predictors of Career Success for Skilled Immigrants. 2019. p. 7. https://knowledge.wes.org/canada-report-who-is-succeeding-in-the-canadian-labour-market.html. Accessed 27 Feb 2020.

  59. Neiterman E, Salmonsson L, Bourgeault IL. Navigating otherness and belonging: a comparative case study of IMGs’ professional integration in Canada and Sweden. Ephemera: theory and politics in. Organization. 2015;15(4):773–95.

    Google Scholar 

  60. Bourgeault IL. Health care brain waste needs a long-term policy solution. 2007. http://www.embassynews.ca. Accessed 27 Feb 2020.

  61. Bourgeault IL, Neiterman E, LeBrun J, Viers K, Winkup J. Brain gain, drain & waste: the experiences of internationally educated health professionals in Canada. Ottawa: University of Ottawa; 2010.http://www.threesource.ca/documents/February2011/brain_drain.pdf. Accessed 27 Feb 2020.

  62. Batalova J,Fix M, Bachmeier JD. Untapped talent: the costs of brain waste among highly skilled immigrants in the United States. Migration Policy Institute. 2016. https://www.migrationpolicy.org/research/untapped-talent-costs-brain-waste-among-highly-skilled-immigrants-united-states. Accessed 27 Feb 2020.

  63. Royal Bank of Canada. Immigrant labour market outcomes in Canada: The benefits of addressing wage and employment gaps. 2011. http://www.rbc.com/newsroom/pdf/1219-2011-immigration.pdf. Accessed 27 Feb 2020.

  64. Beran et al. Ego identity development in physicians: a cross-cultural comparison using a mixed method approach. 2012. http://www.biomedcentral.com/1756-0500/5/249. Accessed 27 Feb 2020.

  65. Fowkes V, Cawley JF, Herlihy N, Cuadrado RR. Evaluating the potential of international medical graduates as physician assistants in primary care. Acad Med. 1996;71(8):886–92.

    Article  CAS  Google Scholar 

  66. Jones IW. Should international medical graduates work as physician assistants? J Am Acad PAs. 2015;28(7):8–10.

    Google Scholar 

  67. Blain M, Fortin S, Alvarez F. Professional journeys of international medical graduates in Quebec: recognition, uphill battles, or career change. Int Migration Integration. 2017;18:223–47. https://doi.org/10.1007/s12134-016-0475-z.

    Article  Google Scholar 

  68. Seak Inc. The biggest mistakes physicians make in transitioning to a non-clinical career and how to avoid them. 2019. https://seak.com/the-biggest-mistakes-physicians-make-in-transitioning-to-a-non-clinical-career-and-how-to-avoid-them/. Accessed 27 Feb 2020.

  69. Flowers M, Olenick M. Transitioning from physician to nurse practitioner. J Multidiscip Healthc. 2014;7:51–4. https://doi.org/10.2147/JMDH.S56948.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Zegarra M. 7 Things to know before studying diagnostic medical sonographer technology. Florida National University: Academic resources. 2019. https://www.fnu.edu/7-studying-diagnostic-medical-sonographer-technology/. Accessed 27 Feb 2020.

  71. Creticos PA, Schultz JM, Beeler A, Ball E. The integration of immigrants in the workplace. Institute for Work and the Economy. 2006. https://zdoc.site/the-integration-of-immigrants-in-the-workplace-institute-for.html. Accessed 27 Feb 2020.

  72. Barker C. Barriers to employment and overcoming economic integration challenges for foreign-born workers in Maine. Maine: University of Maine; Spring 5, 2018.

    Google Scholar 

  73. Dickstein C, Dorrer J, Love E, Chong T. Building Maine’s economy: how Maine can embrace immigrants and strengthen the workforce. Coastal Enterprises; 2016. https://www.ceimaine.org/wpcontent/uploads/2016/03/CEI-Immigration-Report-2016-WEB-PAGES.pdf. Accessed 27 Feb 2020.

  74. Grossman D, Jorda ML. Transitioning foreign-educated physicians to nurses: the new Americans in nursing accelerated program. J Nurs Educ. 2008;47(12):544–51.

    Article  Google Scholar 

  75. Neiterman E, Bourgeault IL, Covell CL. What do we know and not know about the professional integration of international medical graduates (IMGs) in Canada? Healthcare Policy. 2017;12(4):18–32.

    PubMed  PubMed Central  Google Scholar 

  76. Bhimji A. International medical graduates: the Medicentres experience. HealthcarePapers. 2010;10(2):46–9.

    Article  Google Scholar 

  77. Howard LW, Garman KA, McCann RE. Another go at the experiment. Public Health Rep. 1995;110(6):668–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Anderson AL, Gilliss C. Nurse practitioners, certified nurse midwives, and physician assistants in California. West J Med. June 1998;168(5):437–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  79. Smith MW, Fowkes VK. Unlicensed foreign medical graduates in California: social and demographic characteristics and Progress toward licensure. Med Care. 1983;21(12):1168–86.

    Article  CAS  Google Scholar 

  80. Nyandat J. Doctors: discover these 8 alternative career paths. MIMS Today. 2016. https://today.mims.com/doctors%2D%2Ddiscover-these-8-alternative-career-paths-. Accessed 27 Feb 2020.

  81. Ace Surgical Assistants. Ideal training for Foreign Medical Graduates. 2019. https://www.acesatraining.com/custom-solutions/foreign-medical-graduates/. Accessed 27 Feb 2020.

  82. California Institute of Behavioural Neurosciences and Psychology. Learn Course Online. 2020. https://www.cibnp.com/. Accessed 27 Feb 2020.

  83. Certified Clinical Research Professionals Society (CCRPS). Clinical research training. 2020. https://ccrps.org/. Accessed 27 Feb 2020.

  84. Bhuiyan SU. Ryerson University’s internationally trained medical doctors bridging program: preliminary results from a pilot program. Ryerson University and University of Toronto. J Prof Contin Online Educ. 2018. https://journals.library.ualberta.ca/jpcoe/index.php/jpcoe/article/download/35/16. Accessed 27 Feb 2020.

  85. University of San Diego. Accelerate your career. Earn your Master’s Degree in Health Care Informatics – Online or On Campus. 2019. https://onlinedegrees.sandiego.edu/programs/master-of-science-in-health-care-informatics/. Accessed 27 Feb 2020.

  86. Skills for Change. The Health Informatics Bridging Program at Skills for Change provides internationally trained newcomers with a background in healthcare or the IT sector, the knowledge, and experience they need for a rewarding career in the field of Health Informatics. 2019. https://skillsforchange.org/healthinformatics/. Accessed 27 Feb 2020.

  87. Canadian College of Naturopathic Medicine (CCNM). CCNM is accepting applications for the two-year bridge delivery program for international medical graduates (IMGs). 2019. https://www.ccnm.edu/future-students/international-medical-graduates. Accessed 27 Feb 2020.

  88. JVSTORONTO. ISAGE: international skills applied for geriatrics. 2019. https://www.jvstoronto.org/find-a-job/newcomer-employment-services/. Accessed 27 Feb 2020.

  89. Bridge to Registration and employment in Mental Health. 2019. https://brem.bridgingprograms.org/index.php/about-brem/. Accessed 27 Feb 2020.

  90. Collège Boréal. Bridging Program – Health System Navigator for internationally educated Francophone professionals. 2019. http://www.collegeboreal.ca/student-services/newcomers/. Accessed 27 Feb 2020.

  91. The Michener Institute of Education at UHN. Ultrasound scanning evaluation (BPUS800). 2019. https://michener.ca/program/bpus/. Accessed 27 Feb 2020.

  92. Wick KH. International medical graduates as physician assistants. JAAPA. 2015;28(7):43–6. https://doi.org/10.1097/01.JAA.0000466891.23457.b0.

    Article  PubMed  Google Scholar 

  93. Learning Enrichment Foundation. Alternative careers in health promotion and education for International Medical Graduates (IMGs) Program. 2019. http://lefca.org/training/IMGs.shtml. Accessed 27 Feb 2020.

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Authors and Affiliations

  1. Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Nashit Chowdhury & Turin Tanvir Chowdhury

  2. Alberta International Medical Graduates Association (AIMGA), Calgary, AB, Canada

    Mark Ekpekurede & Deidre Lake

  3. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Turin Tanvir Chowdhury

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  1. Nashit Chowdhury
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Correspondence to Turin Tanvir Chowdhury .

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Editors and Affiliations

  1. California Institute of Behavioral Neurosciences and Psychology, Fairfield, CA, USA

    Hassaan Tohid

  2. University of California, San Francisco, CA, USA

    Howard Maibach

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Chowdhury, N., Ekpekurede, M., Lake, D., Chowdhury, T.T. (2021). The Alternative Career Pathways for International Medical Graduates in Health and Wellness Sector. In: Tohid, H., Maibach, H. (eds) International Medical Graduates in the United States. Springer, Cham. https://doi.org/10.1007/978-3-030-62249-7_18

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