Training labor and treatment behavior: Evidence from physician residency programs.

Public and private investments in physician human capital support a healthcare workforce to provide future medical services nationwide. Yet, little is known about how introducing training labor influences hospitals' provision of care. We leverage all-payer data and emergency medicine (EM) and obstetrics (OBGYN) residency program debuts to estimate local access and treatment intensity effects. We find that the introduction of EM programs coincides with less treatment intensity and suggestive increases in throughput. OBGYN programs adopt the pre-existing surgical tendencies of the hospital but may also relax some capacity constraints-allowing the marginal mother to avoid a riskier nearby hospital.

Medical students' perceptions of an artificial intelligence (AI) assisted diagnosing program.

As artificial intelligence (AI) assisted diagnosing systems become accessible and user-friendly, evaluating how first-year medical students perceive such systems holds substantial importance in medical education. This study aimed to assess medical students' perceptions of an AI-assisted diagnostic tool known as 'Glass AI.' Data was collected from first year medical students enrolled in a 1.5-week Cell Physiology pre-clerkship unit. Students voluntarily participated in an activity that involved implementation of Glass AI to solve a clinical case. A questionnaire was designed using 3 domains: 1) immediate experience with Glass AI, 2) potential for Glass AI utilization in medical education, and 3) student deliberations of AI-assisted diagnostic systems for future healthcare environments. 73/202 (36.10%) of students completed the survey. 96% of the participants noted that Glass AI increased confidence in the diagnosis, 43% thought Glass AI lacked sufficient explanation, and 68% expressed risk concerns for the physician workforce. Students expressed future positive outlooks involving AI-assisted diagnosing systems in healthcare, provided strict regulations, are set to protect patient privacy and safety, address legal liability, remove system biases, and improve quality of patient care. In conclusion, first year medical students are aware that AI will play a role in their careers as students and future physicians.

Experiences and Perceptions of Racism and Sexism Among Alberta Physicians: Quantitative Results and Framework Analysis of a Cross-Sectional Survey.

BACKGROUND: The prevalence of harassment and discrimination in medicine differs by race and gender. The current evidence is limited by a lack of intersectional analysis. OBJECTIVE: To evaluate the experiences and perceptions of harassment and discrimination in medicine across physicians stratified by self-identified race and gender identity. DESIGN: Quantitative and framework analysis of results from a cross-sectional survey study. PARTICIPANTS: Practicing physicians in the province of Alberta, Canada (n=11,688). MAIN MEASURES: Participants completed an instrument adapted from the Culture Conducive to Women's Academic Success to capture the perceived culture toward self-identified racial minority physicians (Black, Indigenous, and People of Color (BIPOC)), indicated their perception of gender inequity in medicine using Likert responses to questions about common experiences, and were asked about experiences of reporting harassment or discrimination. Participants were also able to provide open text comments. KEY RESULTS: Among the 1087 respondents (9.3% response rate), 73.5% reported experiencing workplace harassment or discrimination. These experiences were least common among White cisgender men and most common among BIPOC cisgender women (52.4% and 85.4% respectively, p<0.00001). Cisgender men perceived greater gender equity than cisgender women physicians, and White cisgender men physicians perceived greatest racial equity. Participant groups reporting the greatest prevalence of harassment and discrimination experiences were the least likely to know where to report harassment, and less than a quarter of physicians (23.8%) who had reported harassment or discrimination were satisfied with the outcome. Framework analysis of open text responses identified key types of barriers to addressing racism, including denial of racism and greater concern about other forms of discrimination and harassment. CONCLUSIONS: Our results document the prevalence of harassment and discrimination by intersectional identities of race and gender. Incongruent perceptions and experiences may act as a barrier to preventing and addressing harassment and discrimination in the Canadian medical workplace.

Publicly available information about fertility benefits for trainees at medical schools in the US.

PURPOSE: Infertility affects one in four female physicians, yet current availability of fertility benefits within Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs in the United States (US) is unknown. Our objective was to examine publicly available fertility benefits information for residents and fellows. METHODS: The top 50 medical schools in the US for research were identified using US News & World Report 2022. In April 2022, we reviewed fertility benefits available to residents and fellows at these medical schools. Websites of their associated graduate medical education (GME) websites were queried for details surrounding fertility benefits. Two investigators collected data from GME and publicly available institutional websites. The primary outcome was fertility coverage and rates are reported as percentages. RESULTS: Within the top 50 medical schools, 66% of institutional websites included publicly available medical benefits, 40% included any mention of fertility benefits, and 32% had no explicit information on fertility or medical benefits. Fertility benefit coverage included infertility diagnostic workup (40%), intrauterine insemination (32%), prescription coverage (12%), and in vitro fertilization (IVF, 30%). No information on coverage for third party reproduction or LGBT family building was available on public websites. Most programs with fertility benefits were in the South (40%) or Midwest (30%). CONCLUSION: To support the reproductive autonomy of physicians in training, it is critical to ensure access to information on fertility care coverage. Given the prevalence of infertility among physicians and the impact of medical training on family planning goals, more programs should offer and publicize coverage for fertility care.

Unpopular medical specialties: exploring the concept that "the customer knows best".

BACKGROUND: Healthcare systems often face shortages of certain medical specialists due to lack of interest among medical students. We questioned a common "one solution fits all" approach to this problem which involves monetary incentives to lure students to these specialties. Instead, we used the marketing principle the "consumer knows best" to explore ways of elucidating the reasons and proposing solutions for such shortages. METHODS: A convenience sample of Israeli 6th-year medical students and interns completed questionnaires to determine why they thought three specialties (geriatrics, anesthesiology, emergency medicine) were unpopular and their ideas on increasing their appeal. RESULTS: 119 6th-year students and 84 interns completed questionnaires. Geriatrics was reported having a problematic patient population; not being interesting and challenging; and not considered prestigious by colleagues and the populace. This contrasts with emergency medicine which, although considered prestigious, has difficult working conditions both during and after residency accompanied by much pressure at work. Although, improvements in lifestyle and remuneration were thought by students and interns as possibly making these specialties more attractive, reducing the pressure at work and decreasing on-call obligations were designated by the students/interns as ways to increase emergency medicine's and anesthesiology's appeal. Half the students replied that anesthesiology would be more appealing if work was in shifts (< 16 h), while 60% replied so for emergency medicine and only 18% for geriatrics. 90% of students reported that control over lifestyle would make emergency medicine more attractive while 55% and 48% replied positively for anesthesiology and geriatrics, respectively. CONCLUSIONS: Using the concept "consumer knows best" provided additional insight into the specialty selection process. Students/interns have specialty-specific opinions as to why some specialties are unpopular. Their ideas about attracting more students to these specialties were also specialty-dependent, i.e. "one solution does not fit all". These observations render problematic a single solution aimed at ameliorating the workforce shortages of multiple specialties. Instead, these results advocate a differential approach wherein the lack of appeal of each unpopular specialty is analyzed individually and the students'/interns' (the "consumers") ideas sought resulting in solutions tailored to address each specialty's lack of attractiveness. TRIAL REGISTRATION: None.

Workforce Diversity of Interventional Radiology Physicians in North America: Reflections on the U.S. Experience.

Achieving parity in representation within the field of Interventional Radiology (IR) across women and specific subsets of minority groups has been a challenge. The lack of a strongly diverse physician workforce in gender, race, and ethnicity suggests suboptimal recruitment after, during as well prior to IR training. There is a dearth of studies which effectively characterize the national demographic trends of the evolving IR workforce. This has prevented an accurate appraisal of continuing efforts to narrow the gaps in physician workforce diversity across the field of IR. To support these needs, this article illustrates historic trends while providing contemporary data that canvasses the status of diversity within the current IR physician and IR trainee workforce. It highlights the representation of those individuals historically underrepresented in medicine as well as women. It also highlights current obstacles to achieving equity, diversity, and inclusion within the field of IR as well as existing efforts that have been employed to mitigate this gap.

The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students.

BACKGROUND: Despite substantial research on medical student mistreatment, there is scant quantitative data on microaggressions in US medical education. OBJECTIVE: To assess US medical students' experiences of microaggressions and how these experiences influenced students' mental health and medical school satisfaction. DESIGN AND PARTICIPANTS: We conducted a cross-sectional, online survey of US medical students' experiences of microaggressions. MAIN MEASURES: The primary outcome was a positive depression screen on the 2-item Patient Health Questionnaire (PHQ-2). Medical school satisfaction was a secondary outcome. We used logistic regression to model the association between respondents' reported microaggression frequency and the likelihood of a positive PHQ-2 screen. For secondary outcomes, we used the chi-squared statistic to test associations between microaggression exposure and medical school satisfaction. KEY RESULTS: Out of 759 respondents, 61% experienced at least one microaggression weekly. Gender (64.4%), race/ethnicity (60.5%), and age (40.9%) were the most commonly cited reasons for experiencing microaggressions. Increased microaggression frequency was associated with a positive depression screen in a dose-response relationship, with second, third, and fourth (highest) quartiles of microaggression frequency having odds ratios of 2.71 (95% CI: 1-7.9), 3.87 (95% CI: 1.48-11.05), and 9.38 (95% CI: 3.71-26.69), relative to the first quartile. Medical students who experienced at least one microaggression weekly were more likely to consider medical school transfer (14.5% vs 4.7%, p<0.001) and withdrawal (18.2% vs 5.7%, p<0.001) and more likely to believe microaggressions were a normal part of medical school culture (62.3% vs 32.1%) compared to students who experienced microaggressions less frequently. CONCLUSIONS: To our knowledge, this is the largest study on the experiences and influences of microaggressions among a national sample of US medical students. Our major findings were that microaggressions are frequent occurrences and that the experience of microaggressions was associated with a positive depression screening and decreased medical school satisfaction.

Modernising physician resource planning: a national interactive web platform for Canadian medical trainees.

BACKGROUND: Healthcare systems rely heavily upon human resources to ensure high-quality access to care for the general population. With significant health worker shortages predicted worldwide in the coming decades, maximizing the current workforce by means of a physician resource planning (PRP) strategy that ensures the right number, mix, and distribution of physicians to meet population needs is warranted. In Canada, there is an insufficient number of primary care providers, and disproportionately low numbers of specialist physicians in rural compared to urban regions. Currently, Canadian medical students are not effectively included in PRP strategy and lack the required information for career orientation to help rebalance the population's workforce needs. This paper present the Health Human Resource (HHR) Platform, a comprehensive web tool that includes relevant workforce data to empower medical students in choosing a discipline based on both personal interests and social accountability. RESULTS: Physician workforce data, comments from Canadian residency program directors, and career planning resources were collected by the Canadian Federation of Medical Student's (CFMS) HHR Task Force. This information was consolidated to create a national interactive platform that uses a map, comparison table, and trend graphs to illustrate over 500,000 unique data points from 37 datasets, including specific information and resources spanning 62 medical specialties from 2015 onwards. There was a 24.6% response rate for program director comments. During the first 4 months of the HHR Platform launch, there were 2434 different users, of which 985 were returning, with an average of 20.0 users per day spending on average 3 min on the platform. CONCLUSIONS: The HHR Platform constitutes a national approach to PRP informing medical students on the mix and distribution of physicians needed to meet the future healthcare demands of the Canadian population.

An Examination of the Intersection of Climate Change, the Physician Specialty Workforce, and Graduate Medical Education in the U.S.

Issue: As U.S. healthcare systems plan for future physician workforce needs, the systemic impacts of climate change, a worldwide environmental and health crisis, have not been factored in. The current focus on increasing the number of trained physicians and optimizing efficiencies in healthcare delivery may be insufficient. Graduate medical education (GME) priorities and training should be considered in order to prepare a climate-educated physician workforce. Evidence: We used a holistic lens to explore the available literature regarding the intersection of future physician workforce needs, GME program priorities, and resident education within the larger context of climate change. Our interinstitutional, transdisciplinary team brought perspectives from their own fields, including climate science, climate and health research, and medical education to provide recommendations for building a climate-educated physician workforce. Implications: Acknowledging and preparing for the effects of climate change on the physician workforce will require identification of workforce gaps, changes to GME program priorities, and education of trainees on the health and societal impacts of climate change. Alignment of GME training with workforce considerations and climate action and adaptation initiatives will be critical in ensuring the U.S. has a climate-educated physician workforce capable of addressing health and healthcare system challenges. This article offers a number of recommendations for physician workforce priorities, resident education, and system-level changes to better prepare for the health and health system impacts of climate change.

The Effect of Healthcare Provider Availability on Spine Spending.

BACKGROUND: Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that healthcare utilization and spending are driven by provider availability, which varies geographically and is a topic of healthcare policy debate. OBJECTIVE: To estimate the effect of provider availability on spine spending. DESIGN: Retrospective cohort study using relocation as a natural experiment. PARTICIPANTS: Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. MAIN MEASURES: We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of healthcare providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in provider availability separately. To account for the relative sizes of the provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. KEY RESULTS: The association between provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. CONCLUSIONS: Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect healthcare spending.

Examining Parity among Black and Hispanic Resident Physicians.

BACKGROUND: The US physician workforce does not represent the racial or ethnic diversity of the population it serves. OBJECTIVES: To assess whether the proportion of US physician trainees of Black race and Hispanic ethnicity has changed over time and then provide a conceptual projection of future trends. DESIGN: Cross-sectional, retrospective, analysis based on 11 years of publicly available data paired with recent US census population estimates. PARTICIPANTS: A total of 86,303 (2007-2008) to 103,539 (2017-2018) resident physicians in the 20 largest US Accreditation Council for Graduate Medical Education resident specialties. MAIN MEASURES: Changes in proportion of physician trainees of Black race and Hispanic ethnicity per academic year. Projected number of years it will then take, for specialties with positive changes, to reach proportions of Black race and Hispanic ethnicity comparable to that of the US population. KEY RESULTS: Among the 20 largest specialty training programs, Radiology was the only specialty with a statistically significant increase in the proportion of Black trainees, but it could take Radiology 77 years to reach levels of Black representation comparable to that of the US population. Obstetrics/Gynecology, Emergency Medicine, Internal Medicine/Pediatrics, and Orthopedic Surgery demonstrated a statistically significant increase in the proportion of Hispanic trainees, but it could take these specialties 35, 54, 61, and 93 years respectively to achieve Hispanic representation comparable to that of the US population. CONCLUSIONS: Among US residents in the 20 largest specialties, no specialty represented either the Black or Hispanic populations in proportions comparable to the overall US population. Only a small number of specialties demonstrated statistically significant increases. This conceptual projection suggests that current efforts to promote diversity are insufficient.

Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA.

BACKGROUND: Over 25 million US inhabitants are limited English proficient (LEP). It is unknown whether physicians fluent in non-English languages are training in geographic areas with the highest proportion of LEP people. Diversity of language ability in the physician workforce is an important complement to language assistance services for providing quality care to LEP patients. OBJECTIVE: To determine whether non-English language-speaking resident physicians matched in the geographic areas where language skills are needed. DESIGN: Cross-sectional study. PARTICIPANTS: Postgraduate medical training applicants to the Association of American Medical College's Electronic Residency Application Service in 2013-2014 (n = 50,766). We included data from the Graduate Medical Education Track database, mapped against American Community Survey data. INTERVENTIONS: N/A. MAIN MEASURES: We assessed the geographic alignment of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. KEY RESULTS: While 37% of resident physicians spoke at least one non-English language, in most cases the languages they spoke were not those in greatest need by the US LEP population. LEP speakers' potential exposure to non-English language-speaking residents varied. For Spanish, the language with the lowest national resident physician to Spanish LEP patient ratio, the ratio was most favorable in New York at 23.7/100,000 LEP population versus 5.1 in Los Angeles. For Tagalog, the group with the highest geographic mismatch, the ratio was 70.4 in New York but 0 in San Diego, San Jose, and Seattle. Among the top five LEP languages in the USA, Chinese-speaking resident physicians were the most geographically matched. CONCLUSIONS: We found considerable misalignment of the geographic distribution of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. Residency programs in areas of high need could consider better matching the non-English language needs of their community with the language abilities of the resident physicians they are recruiting.

How many and which physicians? A comparative study of the evolution of the supply of physicians and specialist training in Brazil and Spain.

BACKGROUND: In the face of the medical workforce shortage, several countries have promoted the opening of medical schools and the expansion of undergraduate and specialization education in medicine. Few studies have compared the characteristics and effects of expanding the supply of general practitioners and specialist physicians between countries. Brazil and Spain, two countries with distinct historical processes and socioeconomic scenarios, yet both with universal public health systems and common aspects in training and medical work, have registered a significant increase in the number of physicians and can be used to understand the challenges of strategic planning for the medical workforce. METHODS: This study provides a descriptive approach using longitudinal data from official databases in Brazil and Spain from 1998 to 2017. Among the comparable indicators, the absolute numbers of physicians, the population size, and the physician's ratio by inhabitants were used. The number of medical schools and undergraduate places in public and private institutions, the supply of residency training posts, and the number of medical specialists and medical residents per 100 000 inhabitants were also used to compare both countries. Seventeen medical specialties with the highest number of specialists and comparability between the two countries were selected for further comparison. RESULTS: Due to the opening of medical schools, the density of physicians per 1 000 inhabitants grew by 28% in Spain and 51% in Brazil between 1998 and 2017. In that period, Spain and Brazil increased the supply of annual undergraduate places by 60% and 137%, respectively. There is a predominance of private institutions providing available undergraduate places, and the supply of medical residency posts is smaller than the contingent of medical graduates/general practitioners each year. CONCLUSION: Both countries have similar specialist densities in cardiology, dermatology, and neurosurgery specialties. However, family medicine and community in Spain has 91.27 specialists per 100 000 inhabitants, while in Brazil, the density is only 2.64. The comparative study indicated the complexity of the countries' decisions on increasing the medical supply of general practitioners and specialist physicians. Research and planning policies on the medical workforce must be aligned with the actual health needs of populations and health systems.

Physician workforce in the United States of America: forecasting nationwide shortages.

BACKGROUND: Physicians play a critical role in healthcare delivery. With an aging US population, population growth, and a greater insured population following the Affordable Care Act (ACA), healthcare demand is growing at an unprecedented pace. This study is to examine current and future physician job surplus/shortage trends across the United States of America from 2017 to 2030. METHODS: Using projected changes in population size and age, the authors developed demand and supply models to forecast the physician shortage (difference between demand and supply) in each of the 50 states. Letter grades were then assigned based on projected physician shortage ratios (physician shortage per 100 000 people) to evaluate physician shortages and describe the changing physician workforce in each state. RESULTS: On the basis of current trends, the number of states receiving a grade of "D" or "F" for their physician shortage ratio will increase from 4 in 2017 to 23 by 2030, with a total national deficit of 139 160 physician jobs. By 2030, the West is forecasted to have the greatest physician shortage ratio (69 physician jobs per 100 000 people), while the Northeast will have a surplus of 50 jobs per 100 000 people. CONCLUSION: There will be physician workforce shortages throughout the country in 2030. Outcomes of this study provide a foundation to discuss effective and efficient ways to curb the worsening shortage over the coming decades and meet current and future population demands. Increased efforts to understand shortage dynamics are warranted.

The Emergency Medicine Workforce: Shortage Resolving, Future Surplus Expected.

INTRODUCTION: The emergency medicine (EM) workforce has been growing at a rapid rate, fueled by a large increase in the number of EM residency programs and growth in the number of Advanced Practice Providers (APPs). OBJECTIVES: To review current available data on patient volumes and characteristics, the overall physician workforce, the current emergency physician (EP) workforce, and to project emergency physician staffing needs into the future. METHODS: Data was obtained through review of the current medical literature, reports from certifying organizations and professional societies, Web searches for alternative sources, and published governmental data. RESULTS: We conservatively estimate the demand for emergency clinicians to grow by ∼1.8% per year. The actual demand for EPs will likely be lower, considering the higher growth rates seen by APPs, likely offsetting the need for increasing numbers of EPs. We estimate the overall supply of board-certified or board-eligible EPs to increase by at least 4% in the near-term, which includes losses due to attrition. In light of this, we conservatively estimate the supply of board-certified or eligible EPs should exceed demand by at least 2.2% per year. In the intermediate term, it is possible that the supply of board-certified or eligible EPs could exceed demand by 3% or more per year. Using 2.2% growth, we estimate that the number of board-certified or board-eligible EPs should meet the anticipated demand for EPs as early as the start of 2021. Furthermore, extrapolating current trends, we anticipate the EP workforce could be 20-30% oversupplied by 2030. CONCLUSIONS: Historically, there has been a significant shortage of EPs. We project that this shortage may resolve quickly, and there is the potential for a significant oversupply in the future.

Physician workforce planning and allocation model using agent-based modeling: A case study in Thailand.

OBJECTIVE: To address the physician workforce challenges in Thailand using Agent-Based Modeling (ABM). Physician planning and allocating have been modeled with the life cycle framework starting from medical school intakes, residency training, and career retirement. METHOD: This study proposes a systematic approach to physician planning and allocating which are modeled with a framework starting from medical school intakes, residency training, and career retirement. RESULTS: The ABM can estimate physician levels for provincial government hospitals (OPS-MOPH) and other sectors. The model can demonstrate any geographical imbalance issues at the provincial level under the existing rural recruitment program implementation. Based on the ABM simulation result, although person per physician ratios reached the target of 1800:1 at the national level in 2019, Bangkok is the only province that reached the target. For other provinces, the ratio of OPS-MOPH is far from the target. It will need 10 more years to reach the target, and a geographical imbalance will still exist. A solution of modified rural recruitment program with the limitation of hometown jobs has been proposed to reduce the geographical imbalance. With the proposed modified rural recruitment program, the model predicts that all provinces will reach the target in 2036.

The role of rural communities in the recruitment and retention of women physicians.

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.

Infectious Diseases Physicians: Improving and Protecting the Public's Health: Why Equitable Compensation Is Critical.

Infectious diseases (ID) physicians play a crucial role in public health in a variety of settings. Unfortunately, much of this work is undercompensated despite the proven efficacy of public health interventions such as hospital acquired infection prevention, antimicrobial stewardship, disease surveillance, and outbreak response. The lack of compensation makes it difficult to attract the best and the brightest to the field of ID, threatening the future of the ID workforce. Here, we examine compensation data for ID physicians compared to their value in population and public health settings and suggest policy recommendations to address the pay disparities that exist between cognitive and procedural specialties that prevent more medical students and residents from entering the field. All ID physicians should take an active role in promoting the value of the subspecialty to policymakers and influencers as well as trainees.

International Medical Graduates in Nephrology: Roles, Rules, and Future Risks.

International medical graduates (IMGs) have become an increasingly essential part of many residency and fellowship programs in the United States. IMGs, who may be of either US or non-US citizenship, contribute significantly to the physician workforce across this country, particularly in underserved areas, as well as in their home countries on their return after training. Approximately 65% of nephrology fellows are IMGs, with most of these being non-US citizens. Non-US IMG applications for nephrology fellowship have been declining, exacerbating an ongoing shortage of nephrology trainees. IMGs face visa status restrictions and immigration policy concerns, limitations on federally funded research support, and difficulty finding desirable jobs in both private practices and academia after fellowship. We review training, examination, and licensure requirements, as well as visa status rules for IMGs. We also discuss the potential negative impact of recent immigration policies limiting the entry of non-US IMGs on the medical community in general and in nephrology in particular.