ECFMG, FAIMER & Immigration Developments

Transcription

1 ECFMG, FAIMER & Immigration Developments Academic Internal Medicine Week 2017 March 22, 2017 William W. Pinsky, MD FAAP FACC President & CEO, ECFMG Chair, Board of Directors, FAIMER Copyright 2017 by the Educational Commission for Foreign Medical Graduates. All rights reserved. 1 Today s Discussion About ECFMG o Programs Supporting US GME and IMGs Entering US GME o Growth in International Programs About FAIMER o Education Programs o Research o Data Resources 2 1

2 Today s Discussion Recent Immigration Developments IMGs & Internal Medicine Questions 3 About Us 4 2

3 About ECFMG Established in 1956 Non profit, non governmental organization Based in Philadelphia, PA, USA 350 full time employees, ~700 total employees 5 Mission The ECFMG promotes quality health care for the public by certifying international medical graduates for entry into U.S. graduate medical education, and by participating in the evaluation and certification of other physicians and health care professionals nationally and internationally. In conjunction with its Foundation for Advancement of International Medical Education and Research (FAIMER), and other partners, it actively seeks opportunities to promote medical education through programmatic and research activities. 6 3

4 Programs Supporting US GME and IMGs Entering US GME 7 ECFMG Certification Evaluates IMGs for ACGME accredited GME 60 years of continuous operation Effective screening mechanism only 60% of IMGs who take an exam ultimately achieve ECFMG Certification 8 4

5 ECFMG Certification Review Process: ECFMG requirements for medical school USMLE Step 1, Step 2 CK, and Step 2 CS Primary source verification of diploma and transcript 9 ECFMG Certification Volume & Demographics Stable volume approximately 10,000 physicians annually In 2016, ECFMG certified 10,362 IMGs 2016 certificants graduated from 1,147 medical schools in 134 countries/territories 10 5

6 ERAS Support Services at ECFMG AAMC s web based service for applying to US residencies ECFMG = Dean s Office for IMGs o Serves 21,000+ IMGs annually o Issues Token o Collects and transmits supporting docs o Provides customer service 11 J 1 Visa Sponsorship Exchange Visitor Program = public diplomacy initiative of US Department of State (DOS) Enhance educational and cultural exchange Promote mutual understanding between US and other countries ECFMG is ONLY authorized J 1 visa sponsor of foreign national physicians in US clinical training programs 12 6

7 J 1 Visa Sponsorship Volume & Demographics Increasing volume in recent years In 2016: o 10,000+ physicians sponsored o Trained in 49 states + Puerto Rico o Top 3 specialties: Internal Medicine, Pediatrics, and Family Medicine 13 Certification Verification Service Primary source verification that IMG is ECFMGcertified Serves CVOs, HMOs, hospitals, U.S. licensing jurisdictions, and GME programs Provided to GME programs at no cost Issued nearly 90,000 reports in

8 Growth in International Programs 15 Electronic Portfolio of International Credentials (EPIC) Latest technology platform for primarysource verification (PSV) of physician credentials Brings ECFMG s world class PSV expertise to organizations AND physicians worldwide Offered at no cost to medical regulatory authorities (MRAs) and institutions 16 8

9 GEMx Global Educational Exchange in Medicine and the Health Professions Facilitates educational exchange opportunities in medicine and other health professions Supports exchanges at global and regional levels 17 Education Programs, Research, and Data Resources 18 9

10 Foundation for Advancement of International Medical Education and Research (FAIMER) Non profit foundation of ECFMG established in 2000 Strives to improve world health through education Supports ECFMG in enhancing medical education and promoting quality health care worldwide 19 FAIMER Education Programs Fellowship programs for health professions faculty worldwide o Focus on education methods, leadership and management, education scholarship and research, and project management and evaluation o More than 1,000 Fellows worldwide serving as local resources and change agents 20 10

11 FAIMER Education Programs Regional programs and education centers catalyze and sustain local curricular improvement Distance Learning in partnership with Keele University and CenMEDIC in UK Fellowships to earn master s degrees in health professions education Alignment of educational programs to create pathways for development of outstanding leaders 21 FAIMER Research Transformed modest ECFMG research efforts into award winning research program Concentrations: Characteristics and quality of international medical education programs Role and contributions of IMGs in US physician workforce Quality of care provided by IMGs 22 11

12 FAIMER Data Resources Goal: To be the single best source of data on international medical schools and their graduates Resources freely available at Developed and maintains World Directory of Medical Schools, in conjunction with WFME 23 Recent Immigration Developments 24 12

13 Recent Immigration Developments January 27 EO 13769: Protecting the Nation from Foreign Terrorist Entry into the United States February 3 TRO of EO February 22 NRMP ROL Deadline 25 Recent Immigration Developments March 3 Suspension of premium processing for H 1B petitions announced March 6 EO 13780: Protecting the Nation March 15 TRO of EO March 17 Match Day 26 13

14 Some Impacts for IMGs Inability to enter US to take USMLE Step 2 CS and Step 3 Potential influence on program director decisions in ranking applicants from identified countries Inability of matched applicants from identified countries to apply for appropriate visa status to participate in US GME 27 Some Impacts for IMGs Potential delay in visa processing for ALL foreign nationals Potential perception among IMGs that US is not a welcoming environment Potential for bleedover to physicians from other countries and longer term impact on physician workforce in primary care specialties and underserved areas 28 14

15 ECFMG Response Determined immediate impact on IMGs across services o 851 Match applicants from six countries identified in revised EO 87 outside US, definitely impacted 286 in US, probably impacted Dedicated case manager for impacted applicants 29 ECFMG Response Active consultation with immigration counsel and others in US medical education community Engagement with media 40+ responses/interviews, including: o ABCNews.com o Al Jazeera o The Atlantic o Bloomberg o Boston Globe o Chicago Tribune o CNN, CNN Money o Medscape o Modern Healthcare o NPR o New York Times o POLITICO o ProPublica o Washington Post o Vox 30 15

16 IMGs & Internal Medicine 31 Although IMGs enter many different specialties, internal medicine is by far the most common If the role of IMGs in U.S. health care diminishes, IMG dependent internal medicine programs, including subspecialty fellowships, likely will be the most affected. Pinsky, WW. Annals of Internal Medicine March 7,

17 Composition of US Physician Workforce Source: 2016 AMA Masterfile All Active Physicians n=920,189 DO 7% IMG 23% All Internists n=231,046 DO 4% IMG 36% MD 70% MD 60% 33 Composition of US Internists Source: 2016 AMA Masterfile IMG Internists N=83,214 All Internists n=231,046 DO 4% MD 60% IMG 36% non USIMG 81% USIMG 19% 34 17

18 Any disruption to this flow of international medical graduates (IMGs) will have a negative effect on patient care. Pinsky, WW. Annals of Internal Medicine March 7, IMG Internists (n=83,214), Activity Source: 2016 AMA Masterfile Office Based Practice Resident Full time hospital Research Medical Teaching Semi retired Administration Locum Tenens Other Percentage 36 18

19 IMG Internists (n=83,214), Location Source: 2016 AMA Masterfile Percentage NEW YORK CALIFORNIA FLORIDA TEXAS NEW JERSEY 37 Cautious Optimism Encouraging results from 2017 Match Overall IMG match rate increased slightly o 53% vs 52% for prior year Foreign national IMGs matched o # 45 IMGs o % 1.9% 38 19

20 Moving Forward Uncertainty for: Foreign national physicians: o Current and incoming residents/fellows J1 visa processing o Applicants for US GME programs Workforce planning 39 Moving Forward Need for research: Analysis of Match results for EO impacts Modeling of potential impacts beyond six countries identified in EO Longitudinal trends in citizenship and specialty of IMGs entering US GME 40 20

21 Moving Forward Need for: Continued education on contributions of IMGs Focus on well being of current foreign national trainees Collaboration within US medical education community 41 Questions 42 21