Evaluation of the Conrad 30 Waiver Program's Success in Attracting International Medical Graduates to Underserved Areas.
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SUBMITTER: Ramesh T
PROVIDER: S-EPMC10383001 | biostudies-literature | 2023 Jul
REPOSITORIES: biostudies-literature
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Evaluation of the Conrad 30 Waiver Program's Success in Attracting International Medical Graduates to Underserved Areas.
Ramesh Tarun T Brotherton Sarah E SE Wozniak Gregory D GD Yu Hao H
JAMA health forum 20230707 7
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Project description:BackgroundChina started a national program in 2010 to train qualified general practitioners with compulsory services program (CSP) in rural and remote areas. While the program has shown positive effects on staffing primary healthcare (PHC) in rural areas, very little is known about how well they perform. This study aims to evaluate the job performance of medical graduates from this program and the influence of program design on job performance.MethodsA cohort study was conducted with graduates from CSP and non-CSP (NCSP) from four medical universities in central and western China. Baseline and three waves of follow-up surveys were conducted from 2015-2020. The pass rate of China National Medical Licensing Examinations (NMLE) and self-reported job performance were used as measurements. Multivariable regressions were used to identify factors affecting job performance.Results2154 medical graduates were included, with 1586 CSP and 568 NCSP graduates. CSP (90.6%) and NCSP (87.5%) graduates showed no difference in passing the NMLE (P=.153). CSP graduates reported similar job performance with NCSP graduates (CSP, 63.7; NCSP, 64.2); in the multivariable regression, CSP graduates scored 0.32 and 1.36 points lower in the total sample and graduates of 2015-2017, respectively, but not significantly. Having formally funded positions improved the job performance of CSP (β coefficient=4.87, P<.05). After controlling for Qinghai which adopted a different contracting strategy, "working in hometown" showed significant influence on job performance (β coefficient = 1.48, P<.05).ConclusionCSP graduates have demonstrated as good job performance as NCSP, proving the competency to provide high-quality care for remote and rural areas. The contracted township health centers (THCs) should provide guidance for CSP graduates, especially in the first few years after graduation. The local government should provide formally funded positions on time and prioritize signing contracts with hometowns or places nearby.
| S-EPMC9818097 | biostudies-literature
Project description:To address physician shortages in the United States, Congress created the Conrad 30 visa waiver program allowing non-citizen international medical graduates to obtain visas to practice medicine in underserved areas. There is little information on whether states have effectively used the program. To fill the gap, we examined the growth and distribution of Conrad physicians between 2001 and 2020. We found that the number of states filling all of their annual allocated Conrad slots increased over the last two decades, yet one-half of the states still did not fill their allowed slots in 2020. Our analysis also revealed substantial variations across states in the number of Conrad physicians by specialty (eg, primary care physicians and psychiatrists), geography (eg, rural vs urban areas and physician shortage vs non-shortage areas). Our findings suggest that states can better use the Conrad program to meet healthcare needs across specialties and geographic areas.
| S-EPMC11364145 | biostudies-literature
Project description:IntroductionSocial connections in the host country improve International Medical Graduates' (IMGs') well-being, intercultural competence and performance at work but is an issue that has been largely overlooked in the academic literature and policy discussions. The aim of this study was to better understand the social connections that IMGs form by exploring this phenomenon in a UK context.MethodsIMGs and UK Medical Graduates (UKMGs) practising in Scotland were invited to participate. This was a qualitative study using online semi-structured interviews for data collection and reflexive thematic analysis.ResultsForty-one participants were recruited (24 IMGs and 17 UKMGs), selected with maximum variation in terms of gender, ethnicity, speciality, grade and country of primary medical qualification. Twenty-one (58%) of the participants had experience working in other parts of the UK. Five themes were identified: (i) overcoming early isolation, IMGs strove to overcome their initial social isolation which harmed their mental well-being; (ii) where connections are made, IMGs form social connections mainly at work and within their religious communities; (iii) seeds of segregation, some IMGs found themselves outside tight UK native friendship groups. Alcohol was a socially exclusive activity for some IMGs, as were other host country cultural norms. Exclusion led IMGs to form social connections with other IMGs or other 'outsider' groups; (iv) degrees of Discrimination, discrimination and racism were experienced by some IMGs. Discrimination was individual, structural and institutional, and (v) "Open (ing) the door", participants described interventions at organisational, departmental, and individual levels to improve IMGs' ability to form social connections.DiscussionThis study highlighted the challenges that IMGs face when trying to form social connections. More emphasis needs to be placed on promoting an environment where social connections, in particular between IMGs and host country natives, can flourish.
| S-EPMC11789848 | biostudies-literature
Project description:The National Health Service (NHS) was created 70 years ago to provide universal healthcare to the UK, and over the years it has relied upon international medical graduates (IMGs) to be able to meet its needs. Despite the benefits these professionals bring to the NHS, they often face barriers that hinder their well-being and performance. In this editorial, we discuss some of the most common challenges and the adverse effects these have on IMGs' lives and careers. However, we also propose practical measures to improve IMGs' experiences of working in psychiatry.
| S-EPMC8477154 | biostudies-literature
Project description:BackgroundRecruitment to residency programs in hospitals located in other than major hubs ("remotely located") is a challenge in many countries. In 2011, the Israeli Ministry of Health launched a 10-year financial incentive to encourage physicians to enroll in residency programs in such hospitals. Nearly 1 billion New Israeli Shekels (260 million US$) were invested in that program which had only limited success. As a new physician association's collective agreement is impending, we aimed to measure the effectiveness of selected incentives in attracting medical school graduates to residencies in remotely located hospitals.MethodsThis study included Israeli medical students in their final year of medical school. We used an online questionnaire with multiple-choice demographic questions and a 5-point Likert scale to gauge the effect of various incentives on their preference for residency location.ResultsBetween July and November 2022, 522 students responded (405 studied in Israeli medical schools [out of 705 students] and 117 in foreign medical schools [out of 1936 students]). Forty-two percent had at least one clerkship in a remotely located hospital, and 24% had included at least one remotely located hospital among their top five choices for internship. Only 13% reported that they prefer a residency program in those institutions. The incentive selected by students as most persuasive was government assistance in acceptance to and financial support for a fellowship abroad, followed by a financial grant and fewer on-call hours. Only 7% of the students indicated that no incentive would influence them to choose a remotely located hospital for their residency training. Medical education in a remotely located university and the choice of at least one remotely located hospital among the top five choices for internship were significantly associated with positive incentive receptivity, whereas male sex and older age were associated with negative receptivity.ConclusionThis study on the attitudes of Israeli medical school graduates toward incentives aimed at attracting them to residencies in remotely located institutions revealed that career development opportunities and assistance in obtaining fellowships might influence their choice.
| S-EPMC11346137 | biostudies-literature
Project description: Not available
| S-EPMC1283493 | biostudies-literature
Project description:International medical graduates (IMGs) are physicians who did not attend medical school in the USA or Canada. IMGs comprise nearly one-quarter of the physician workforce and play a vital role in health care. Here, we aimed to identify the prevalence of IMGs in integrated programs and evaluate factors that influence their success in the residency match.MethodsThe annual match reports from 2010 to 2020 were retrieved and summarized. Electronic surveys for program directors and program coordinators were distributed to US integrated plastic surgery programs. Each program's website was appraised for information regarding the eligibility of IMGs. Websites were also used to identify the number of IMG residents.ResultsThe number of applicants who matched into integrated programs ranged from 69 to 180 per year, of which US applicants comprised 61-165. US IMGs filled one to three positions per year, whereas non-US IMGs filled two to seven. Although 48% of programs have matched non-citizen IMGs and 79% have not encountered difficulties during the visa process, 67% of coordinators reported that the onboarding process is more challenging for IMGs. There are no IMGs in 52% of programs, and most institutions offer information on their website regarding visa sponsorship.ConclusionIMGs make up less than 10% of filled positions per cycle. Although most programs accept IMGs, a small number matriculate. This may be explained by the competitiveness of integrated programs and the volume of IMG applications. Further research is needed to identify contributing factors of low IMG representation in plastic surgery programs.
| S-EPMC10419534 | biostudies-literature
Project description:IntroductionIncreasingly medical students pursue medical education abroad. Graduates from International Medical Programs (IMPs) practice globally, yet how to prepare students for an unknown international environment is complex. Following IMP graduates throughout their early careers, this study offers insights into gaps in current undergraduate education.MethodsIn this international, longitudinal, mixed-methods study, 188 graduates from seven IMPs completed baseline surveys on career choice and job preparedness. Forty-two participants completed follow-up until three years after graduation. Nine graduates participated in semi-structured interviews on individual experiences and the evolution of their perspectives. The multiphase, sequential design allowed data collected at baseline to inform further data collection instruments.ResultsTwo typical student profiles emerged. The first depicts a student who, despite the challenges of studying abroad, pursues a medical degree 'anyhow', with a common aim of practicing in their home country. The other deliberately selects an IMP while envisaging an international career. Two years after graduation, the majority (> 70%) of our participants were practicing in a country other than their country of training. They reported challenges around licensing, the job application process and health system familiarization. Participants' experiences point towards potential curriculum adaptations to facilitate cross-border transitions, including career guidance, networking and entrance exam preparation.DiscussionIMP graduates lack support in practical aspects of career orientation and international exposure. Most IMPs essentially prepare their graduates for a career elsewhere. Gaps and challenges that IMP graduates experience in this cross-border career transition entail a responsibility for preparation and guidance that is currently lacking in IMP curricula.
| S-EPMC9582102 | biostudies-literature
Project description:ContextMany health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective.MethodsThe realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement.ResultsSixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment.ConclusionsOrganisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.
| S-EPMC5113661 | biostudies-literature
Project description:BACKGROUND: International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase. OBJECTIVE: To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States. DESIGN: Longitudinal analysis of the American Medical Association Physicians' Professional Data (AMA-PPD) database using the 1978-2004 files and a comparative analysis of the characteristics of a random sample of 1,000 IMGs and a random sample of 1,000 USMGs using the 2004 file. MEASUREMENTS: Historical trends and characteristics of IMGs in the United States. RESULTS: Over the last 26 years, the number of IMGs in the United States grew by 4,873 per year reaching a total of 215,576 in 2004, about 2.4 times its size in 1978. The proportion of IMGs increased 0.12% per year, from 22.2% in 1978 to 25.6% in 2004. In 2004, compared with USMGs, IMGs were older, less likely to be board certified [Odds ratio (OR), 0.68; 95% CI, 0.53 to 0.86], less likely to work in group practice (OR, 0.60; 95% CI, 0.37 to 0.98), more likely to have Internal Medicine as practice specialty (OR, 2.10; 95% CI, 1.62 to 2.71) and more likely to be residents (OR, 1.52; 95% CI, 1.07 to 2.16). CONCLUSIONS: Over the last quarter century, the IMGs provided a significant and steady supply for the United States physician workforce that continues to grow. Policymakers should consider the consequences for both the United States and source countries.
| S-EPMC1824721 | biostudies-other