Friday, July 06, 2007

Could More Cells of Jihadi Physcians be in America's future?...I see a Trend....

We will need to recruit more International Medical Graduates(IMG) aka Alien Physicians because our Population is growing.  The NEJM following articles discuss the particulars of this topic.  I hope we will not get Jihadi Cells of Physicians!.....
The Coming Shortage of Physicians in the United States from New England Journal of Medicine
  • Those proposing the theory of a physician surplus often point to the grand total number of physicians entering the workforce annually. This number includes approximately 5,700 International Medical Graduates (IMGs). What this figure masks, however, is the fact that without these IMG's the United States would suffer an even worse shortage than MGT of America predicted. The truth is that the number of U.S. medical graduates has declined steadily as a percentage per 100,000 population. From 1981 to 1999 the numbers of U.S. medical graduates per 100,000 population dropped 16%. They are predicted to drop another 16% by 2020 if nothing changes.
The Case for More U.S. Medical Students from New England Journal of Medicine
  • Second, since the number of first-year residency positions (just under 22,000) is more than 30 percent higher than the number of students who graduate annually from U.S. allopathic medical schools, (approximately 16,000), U.S. hospitals hire approximately 5000 graduates of foreign medical schools each year to fill these positions. This shortfall in the supply of U.S. medical students stands in dramatic contrast to the fact that U.S. medical schools annually turn away thousands of applicants with high grade-point averages.
The solution to this shortage will be to recruit more foreign educated Physicians as the NEJM explains and advertises in this article Immigration Knowledge Essential to Recruiting IMGs 
For many years, the United States was a closed shop for most foreign-born physicians. Today, however, as many as 30% of all physicians in some specialties are international medical graduates (IMGs) and the majority of these physicians are foreign-born.
Because most of these physicians must pass through the immigration system in order to work in the U.S., it is important for recruiters to understand the basics of immigration law as it applies to physicians. Fundamental immigration terms and concepts include:

Requirements Needed to Practice

IMGs need the following in order to practice medicine in the United States: 1) A degree from a foreign medical school. 2) An Educational Commission on Foreign Medical Graduates (ECFMG) certificate showing the physician has knowledge equivalent to that gained in a U.S. medical school. To obtain an ECFMG certificate, IMGs must pass the United States Medical Licensing Exam Parts 1 & 2, pass an English language exam, and pass the Clinical Skills Assessment (CSA) exam.
Because many IMGs are reluctant or unable to take the CSA exam, the number of IMGs applying to U.S. residencies is declining. Indeed, the National Residency Matching Program reports that the number of IMGs applying for the match declined 21% from 1999 to 2000. If this trend continues, the number of IMGs entering the United States could decline.

The H-1B Visa

The term "H-1B" is becoming a household word as Congress debates whether or not to increase the annual cap on this temporary work visa, which now stands at 115,000 per year. The H-1B is an employer-sponsored visa that allows foreign professionals to work in the U.S. for up to six years. At the end of that time, IMGs must leave the U.S. for one year, unless they have obtained permanent residence (a green card) or have obtained another type of work visa. An increasing number of IMGs enter the U.S. on H-1B visas in order to enter their residency programs, with the residency programs acting as the "employer."

Permanent Residence (the Green Card)

There are several avenues IMGs can take to obtain a green card. A standard approach is called "Labor Certification" through "Reduction in Recruitment." This is the process in which the employer must actively recruit for the job for six months and must advertise for the position in a major national publication such as the New England Journal of Medicine or Journal of the American Medical Association. While the time to complete labor certification has decreased, INS processing is still slow, so obtaining a green card can take years.
This is an important point to consider if you are attempting to obtain a green card for an IMG currently on an H-1B.
Will the IMG's H-1B expire before a green card can be obtained? If so, you may wish to pursue a faster method of obtaining a green card.
One expedited method for obtaining a green card is through a "National Interest Waiver," which does not require employers to go through the labor certification process. Instead, they must show that their communities historically have had a difficult time recruiting physicians. Generally, employers must be in a Health Professional Shortage Area (HPSA) or a Medically Underserved Area (MUA) to obtain a National Interest Waiver on behalf of an IMG. Congress and the President recently restored the ability of certain physicians to obtain National Interest Waivers.
In addition, an IMG might qualify for a green card through a U.S. relative, through the visa lottery, or other possible channels.

J Waivers

Many IMGs still come to the U.S. to train on Exchange Visitor or "J visas." This type of visa requires the holder to return to their home country for two years before being able to practice medicine in the U.S. However, an exception to this rule may be obtained if a U.S. government agency such as the Agriculture Department will sponsor the IMG for a waiver (approximately 5,000 IMGs are sponsored annually for J waivers). Employers must be located in HPSAs or MUAs to obtain waivers for J visa holders. In addition, over 40 states participate in the "Conrad 20" program, in which each state's Department of Health may sponsor 20 J waivers a year for IMGs, provided their employers are located in HPSAs or MUAs.

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