Recruiting International Medical Graduates an Essential Part of Addressing Pennsylvania’s Physician Workforce Shortage

The nation, including the state of Pennsylvania, is facing a potential physician shortage in certain geographic locations and with various populations.

On April 20, 2015, a report on the Pennsylvania physician workforce from the Pennsylvania Joint State Government Commission was released. The report identified a number of causes of the shortage such as aging physicians nearing retirement, longer lifespans, increased health care utilization, and a growing insured population.

It’s a challenging issue but one that must be addressed in order to meet the needs of Pennsylvania residents. Six recommendations were made in the report, including the following:

Ensure that Pennsylvania fully utilizes the tools available to recruit international medical graduates.

In addition to increasing the number of physicians in the workforce, international medical graduates (IMGs) add diversity to the medical profession and the communities in which they serve, the report concludes. IMGs are eligible for licensure in the U.S. after passing an examination and completing an approved residency program in the U.S.

Tools Available to Recruit IMGs
The U.S. Department of State has established a special visa program called the exchange visitor non-immigrant visa (J-1), for non-citizen IMGs approved to participate in work and study-based exchange visitor programs, including residency programs.

Normally, the J-1 visa program requires IMGs who have completed their residencies to return to their home countries and practice medicine for two years prior to re-entering the U.S. However, the report’s recommendation references two J-1 visa waivers of the two-year requirement:

  • Conrad State 30 ProgramRequires participating IMGs to agree to practice a minimum of 40 clinical hours in direct patient care per week, for a term of three years. Service sites must be located in areas designated as Health Professional Shortage Areas (HPSAs), Medically Underserved Areas (MUAs) or Medically Underserved Populations (MUPs). Sites must also serve patients with Medicare, Medicaid, and those who are uninsured or underinsured. Each state participating in the Conrad State 30 program is limited to 30 waivers per year.
  • Appalachian Regional Commission (ARC)—Program has similar requirements to Conrad State 30 and is available to IMGs who agree to practice in underserved areas in the Appalachian region. Fifty-two of Pennsylvania’s 67 counties lie within this region, says ARC. There is no annual limit to the number of waivers available through ARC.

Increased financial support to Pennsylvania’s Department of Health (DOH) is also recommended in the report. This will ensure that the available resources exist in order to evaluate applications and fill visa slots as well as to track participants in the program.

More PAMED Resources:

  • News release on the physician workforce report
  • Video update on PAMED’s advocacy efforts for medical student loan forgiveness
  • How Pennsylvania’s Health Care Scholars Academy  is addressing the state’s physician shortage issue

A Discussion of the Workforce Shortage Report with Deepak Mehrotra, MD, MBA

Deepak Mehrotra, MD, MBA, is a PAMED member and anesthesiologist from Philadelphia. He also participates in PAMED’s IMG section.

Q. Can you comment about your own experience as an IMG? Were there any programs or support systems that were helpful to you?

A. I came in the mid 70’s when there were no support systems. I had to figure out how to support my living expenses while I applied for a residency position. I came at a time (late April) when the matching was over and all the remaining slots were filled. I had no way to work in a medical setting (e.g. observerships) while waiting to apply for next year’s residency positions.

Q. The report references waiver programs like the Conrad State 30 program. Can you talk about the value of programs like this?

A. Waiver programs have been a win/win for both IMGs and the U.S. underserved population. IMG residents are eager and willing to take such jobs that pay them decent wages and help them work towards a permanent visa.

Q. You are involved with the education and training of residents in Pennsylvania. Another recommendation from the Physician Workforce Report is to increase the number of residency positions in the state. Can you comment on how this recommendation would positively impact your students and help your fellow physicians in Pennsylvania?

A. The number of residency slots fall short of the numbers needed to take full advantage of the non-U.S. born IMGs who are willing to take primary care residencies in hospitals/programs that may not be considered by the U.S. graduates. Increasing residency positions in primary care fields will help this labor pool and workforce that can be trained to address the expected physician shortage (approximate shortage of 90,000 physicians by 2020 due to aging population and more insured Americans). There needs to be an initial training period to polish these IMG’s language/communication skills and cultural competencies. This will also help the U.S. physicians’ burnout and suicides by taking some load off the primary care physicians.

PAMED Note: Read more about our efforts to maintain physician-led, team-based care in Pennsylvania and find out how to add your voice to our advocacy.