International medical graduates in US cardiovascular care are vital to healthcare in the USA and beyond

L-R: William W Pinsky and Mandeep R Mehra

William W Pinsky and Mandeep R Mehra explain to Cardiovascular News how international medical graduates contribute to both their adopted country and their country of origin, providing benefits for all.

It should come as no surprise that international medical graduates (IMGs) are vital to US healthcare, with 25% of our active physician workforce having received their medical education outside of the USA and Canada, according to data from the American Medical Association. In the cardiovascular specialties, the proportion of IMGs—one-third of active physicians—is even more significant. In interventional cardiology, 44% of active physicians in the USA are IMGs.

Of these IMGs in cardiovascular specialties, 15% are US citizens who travelled abroad for their medical education. The IMGs in the USA who are cardiovascular physicians come from more than 130 other countries. They are drawn to the USA as a premier location for advanced training in cardiovascular care, where they not only have access to traditional training but also to a host of programmes that represent emerging knowledge, research, and techniques shaping the future of cardiovascular care.

The training opportunities afforded to IMGs in US graduate medical education (GME) programmes are the foundation for the extraordinary contributions they make to care, not only in the USA, but around the world. The Educational Commission for Foreign Medical Graduates (ECFMG) is the sole sponsor of foreign national physicians for the J-1 visa to participate in US clinical training programmes. The J-1 is the most common visa classification employed for this purpose, and therefore the ECFMG’s data provide a representative snapshot of the pipeline of foreign national IMGs who pursue US training to enter cardiovascular care. This indicates that IMGs from outside the USA are pursuing advanced US training in several fields. In 2018, the ECFMG sponsored 651 foreign national IMGs as fellows to train in nearly 40 cardiovascular specialisations within anaesthesiology, general surgery, internal medicine, paediatrics, radiology, and thoracic surgery. They engaged in training programmes located in 43 US states, with numbers growing by 23% over the past five years.

The purpose of the J-1 visa is educational and cultural exchange. In keeping with this, ECFMG-sponsored J-1 physicians are required to return home for at least two years after completion of training before they are eligible to change visa status. Although legal options have evolved that allow some of these physicians to remain in the USA, many return to their home countries, where they apply the knowledge and skills acquired in the USA. These skills are highly transferrable, ensuring a positive impact on local healthcare. It is common for IMGs who return home to become leaders in clinical and academic settings, influencing the practice and education of new generations of physicians. And, physicians who return to countries where technological resources are lacking are well positioned to advocate for the adoption of such resources.

Some IMGs remain in the USA to practice, providing vital healthcare services. But many retain strong ties to their home countries and make significant contributions to local medical education and healthcare systems. These contributions include service to home country medical schools, foundations established by US-based ethnic physician organisations, and travel to their home country to conduct medical and surgical clinics.

The role of IMGs in cardiovascular specialties in the USA mirrors their role in other medical specialties―they serve in large numbers, enrich the clinical learning environment with an international perspective, and add much needed diversity to the physician workforce. As cardiovascular physicians, we are gratified the USA continues to welcome highly qualified physicians who become leaders in cardiovascular care regardless of where they originate and where, ultimately, they practice.

William W Pinsky is president and CEO of the Educational Commission for Foreign Medical Graduates (ECFMG), board chair of the Foundation for Advancement of International Medical Education and Research (FAIMER), and an honorary professor of the University of Queensland, Brisbane, Australia.

Mandeep R Mehra is the William Harvey distinguished chair in advanced cardiovascular medicine, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, and a professor of medicine at Harvard Medical School, Boston, USA.


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