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International Medical Graduates―Vital to Cardiovascular Care Here and Abroad

Updated: May 7

William W. Pinsky, MD, FAAP, FACC

It’s been 40 years since I completed my fellowship in Pediatric Cardiology. In the course of my career, I have been privileged to view cardiovascular care, and health care more generally, from a variety of roles―clinical, academic, regulatory, and administrative. I have had the opportunity to serve in hospitals and health systems around the country that vary widely in size and resources. My experience also includes roles with organizations like the Educational Commission for Foreign Medical Graduates (ECFMG®), which are concerned with the education, training, and assessment of physicians, nationally and internationally.


While much has changed during my career, the important role played by international medical graduates (IMGs) in the cardiovascular disciplines has been a constant. They are leaders in our field, our teachers and mentors, and our colleagues and students. In each of these roles, they are sources of knowledge, inspiration, and support. They also are our healthcare providers.


As providers, IMGs are vital to US health care. Twenty-five percent of our nation’s physicians received their medical education outside of the United States and Canada, according to data from the American Medical Association. Even more significant, about one-third of active physicians in the cardiovascular specialties, and 22% of Congenital Cardiac surgeons, are IMGs.


Some IMGs in cardiovascular care in the United States are US citizens who earned their medical credentials abroad. The vast majority, about 85%, come from more than 130 other countries. They are drawn to the United States as one of the world’s premiere locations for advanced training in cardiovascular care. In the United States, they have access not only to training in traditional aspects of our specialties, but also to a host of advanced programs, which represent the emerging knowledge, research, and techniques that are shaping the future of the cardiovascular disciplines.


ECFMG is the sole sponsor of foreign national physicians for the J-1 visa to participate in US clinical training programs. Since the J-1 is the most common visa classification employed for this purpose, ECFMG’s data provide a representative snapshot of the pipeline of foreign national IMGs who pursue US training to enter cardiovascular care.


In 2018, ECFMG sponsored 651 foreign national IMGs to train in nearly 40 cardiovascular specializations within Anesthesiology, Surgery, Internal Medicine, Pediatrics, Radiology, and Thoracic Surgery. These individuals were engaged in training programs located in 43 US states. The number of foreign national IMGs training in these cardiovascular specializations in J-1 visa status has grown by 23% over the past five years.


The purpose of the J-1 visa is to expose individuals from around the world to the culture and institutions of the United States and to foster a better understanding between nations through educational and cultural exchange. ECFMG-sponsored J-1 physicians are required to return home for at least two years after completing their training. Although there are legal options that allow some of these physicians to remain in the United States, many return to their home countries, where they apply the knowledge and skills acquired in their US training programs. 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. Additionally, the physicians who return to countries where technological resources are lacking are well-positioned to advocate for the adoption of such resources.


The IMGs who remain here to practice provide healthcare throughout the nation. IMGs are a significant percentage of the physician workforce, and our access to care depends upon their continued contributions. This is especially true in underserved areas, both rural and urban, where IMGs practice in large numbers and become integral to our communities. In addition to providing highly-skilled care, these physicians from around the world bring much-needed diversity to our health care system and enrich our learning and practice environments with their international perspectives.


For those of us who work with them, international physicians elevate our knowledge and practice. For the sake of our field and the patients we serve, we are fortunate that the United States continues to attract the best and brightest from around the world.


William W. Pinsky, MD, FAAP, FACC, 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, Australia. He is a pediatric cardiologist who graduated from Saint Louis University School of Medicine and trained at Baylor College of Medicine and at Texas Children’s Hospital in Houston. Dr. Pinsky has served on the Boards of the Accreditation Council for Graduate Medical Education, the Accreditation Council for Continuing Medical Education, and the Alliance of Independent Academic Medical Centers where he also served as President.


This article was originally published in the September 2019 Issue of CCT.

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