When a 7.8 magnitude earthquake struck Turkey and Syria in February, killing nearly 60,000 people and causing damage to an area roughly the size of Germany, its effects reverberated around the world, including in U.S. health care system. That is because hundreds of international medical graduates (IMG) from Turkey were matched with residency and fellowship programs or in practice.
Many had to deal with not only the anguish of losing family members and friends, but also financial difficulty from providing support to relatives, as well as the mental distress of being unable to provide immediate hands-on assistance to affected areas.
The effects on IMGs from Turkey were so significant, in fact, that many policymakers, including the AMA House of Delegates, began taking a fresh look at the challenges facing foreign IMGs.
Not all stressors are obvious
“Immigration status is being increasingly recognized as a social determinant of health,” according to a resolution introduced at the 2023 AMA Annual Meeting by the AMA International Medical Graduates Section (AMA-IMGS) urging support for IMGs from Turkey. The attending social, psychological and financial stresses, it noted, can all significantly affect work performance.
“Many people don't realize what IMGs are going through,” said Ricardo Correa, MD. He directs the endocrinology, diabetes and metabolism fellowship and is director for health equity and inclusion initiatives at the Endocrine and Metabolism Institute of the Cleveland Clinic. A Panama native, Dr. Correa is also immediate past chair of the AMA-IMGS Governing Council and a member of the AMA Council on Medical Education.
“For example, we had an event a few years ago where three IMGs in New York died by suicide only about a month apart,” said Dr. Correa, who also is clinical professor of medicine at the Lerner College of Medicine of Case Western Reserve University. “IMGs desperately want to keep their jobs and their immigration status, and this puts them at risk of abuse by their programs.”
Foreign IMGs also face unique licensure challenges. The COVID-19 pandemic and the war in Ukraine are recent examples of events that interrupted the process of primary source verification, which confirms that an individual has a valid license, certification or registration to practice medicine.
The Educational Commission for Foreign Medical Graduates (ECFMG), which is a member of Intealth and provides independent certification of IMGs’ qualifications before they enter U.S. residency programs. Unfortunately, not all state medical licensing boards and other credentialing entities accept ECFMG certification as proof of primary source verification.
Policy is catching up
The plight of IMGs is all the more dramatic in light of the roles they play in the U.S. health care system.
“It’s a little-known fact that IMGs make up the majority of physicians practicing in rural America,” Dr. Correa said, adding that IMGs are also overrepresented in specialties that do not frequently bill by the procedure, such as endocrinology, nephrology, rheumatology and infectious disease. “Without IMGs, millions of Americans would suffer.”
To better support IMGs during times of crisis abroad, the House of Delegates adopted policy to support “the development and implementation of channels of communication for immigrant physicians to share their personal and professional journey when facing severe destruction, humanitarian crises or personal losses in their country of origin, contributing therefore to improving the understanding of the difficulties faced by immigrant physicians.”
Delegates also directed the AMA to “affirm its support and advocate for immigrant physicians and trainees working in the United States when their country of origin faces major humanitarian crises, regardless of their country’s political alignment, to promote an understanding of the challenges specific to immigrant physicians.”
In addition, acknowledging the necessity and validity of ECFMG source verification, delegates amended existing AMA policy to “encourage state medical licensing boards, the Federation of State Medical Boards, and other credentialing entities to accept certification by the ECFMG (a member of Intealth) as proof of primary source verification of an IMG’s international medical education credentials.”
Visit AMA Advocacy in Action to find out what’s at stake in clearing IMGs' route to practice and other advocacy priorities the AMA is actively working on.
