CHICAGO (July 7, 2010) — A decline in the number of international medical graduates (IMGs) is threatening patient access to quality surgical care, according to a new study in the June issue of the Journal of the American College of Surgeons.
For years, a flat supply of new U.S.-educated medical school graduates in the specialty of general surgery has created a strong need for IMGs, graduates of medical schools located outside the U.S. and Canada. The study reveals that a decline in IMGs practicing general surgery in the U.S. is creating a “crisis of urgency” as demand for general surgeons continues to grow.
Rural areas are particularly threatened by this trend. In 2005, IMGs represented 17.4 percent of all general surgeons; now they represent only 14.8 percent. Meanwhile, since 2005, the total number of rural surgeons has declined nearly 40 percent to 998, according to researchers. By 2020, the growth of the U.S. population and proportion of people older than 65 years of age will create a greater demand for healthcare resources, including surgeons. In 2020, it is estimated that the supply of general surgeons will fall short of the demand by 1,875.
“We are currently unable to fill our general surgery residencies with U.S. medical school students,” said Kyla P. Terhune, MD, a general surgical resident at Vanderbilt University School of Medicine, Nashville, Tenn. “In the 2009 residency match, if every U.S. senior medical student had been matched to a first-year position in any field, only 70 percent of available positions would have been filled. These shortages can have a lasting impact on patient access to care, particularly in trauma and critical care situations.”
While IMGs have long been relied upon to meet the growing need for general surgeons, the number of IMGs in practice is declining. This decline, along with inadequate numbers of trainees in domestic surgery programs, has created a critical gap. To help address future demands, 108 of the 126 existing medical schools (86 percent) are increasing class size, with a projected expansion of allopathic (conventional or Western medicine) graduates by 5,000 each year through 2020.
In this study, an assessment of the National Resident Matching Program’s 2009 Main Residency Match showed 22,427 total positions in all specialties offered at a postgraduate year (PGY)-1 level. However, only 15,638 senior students enrolled in U.S. allopathic medical schools submitted rank lists (the process in which applicants bid for or “rank” their preferred residency programs) for those positions. And while the number of U.S. seniors submitting rank lists in 2009 increased by 919 from 2005, the number of senior medical students submitting for general surgery spots actually decreased by 72 applicants. On a positive note, there is recent evidence that this year more seniors are interested in general surgery; even so, this country remains dependent on a dwindling pool of IMGs.
Recently, the Physician Workforce Enhancement Act of 2009 was introduced to alleviate some of these workforce shortages by providing loans to eligible hospitals to help establish residency training programs. Preference would be given to rural and small urban areas, and programs would be limited to particular specialties, including family medicine, internal medicine, general surgery, and others. This legislation makes an attempt to increase the number of residency positions, a process that may lead to more qualified general surgeons in the future. But delays in passing the legislation and residency application trends means additional general surgery residents are likely to be IMGs.
“We cannot provide for our citizens through our own medical education system,” said Dr. Terhune. “This study shows us that we must acknowledge the importance of IMGs — and the fact that we have become too reliant on them to meet the growing demand for all specialties, including general surgery.”
This cross-sectional study revealed that compared with their non-IMG counterparts, IMGs were older (52 ± 8 years versus 47 ± 8 years; p< 0.001), more likely to be male (93 percent vs. 82 percent; p< 0.001), and more likely to be further out of training (46 percent versus 28 percent ≥ 20 years out of training; p< 0.001). In terms of geographic distribution, there were 2,216 IMGs in urban cores (15 percent of general surgeons in these areas); 223 IMGs in large rural areas (12 percent of general surgeons in these areas); and 163 IMGs in small rural areas (16 percent of general surgeons in these areas).
IMGs include both U.S. citizens and non-citizens who have trained abroad. The Educational Commission for Foreign Medical Graduates requires IMGs to complete four years of education at a medical school listed in the International Medical Education Directory and to obtain passing scores on the same licensing examinations that are given to U.S. graduates.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 77,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
This shortage of surgeons, and the inability for the US to organically produce sufficient life science professionals is the obvious outcome of our failed public schooling infrastructure.
The problem is not in the students, the problem is in the process, in which one hundred year old protocols prevail, as does the absence of the scientific process to evaluate the validity of educational processes.
I suggest study of the development of Dr. Benjamin Carson, director of pediatric neurosurgery at The Johns Hopkins Hospital would open the eyes of many of the potential of those in the lowest socioeconomic levels to develop into highly effective contributors to society.
Another amazing human capital development program worthy of study and widest replication is the Hobart Shakespearean initiative which uses intensive enrichment programs based upon the classics and stage performances to develop exceptional contributors to society from fifth graders from the broken homes in the worst parts of Los Angeles.
We ignored the findings in “A Nation at Risk” , our secondary students continually perform behind those of 30 other countries in international
academic competition in the sciences.
If one desired this nation to fall to second or third tier levels in global competition, staying the course in our educational system would provide that objective.
If an organization needs a sizable number of those with high levels of scientific talent, they are forced to make one of two choices to acquire that talent: a ) to import the talent, or b ) to export the jobs.
This is unacceptable for a country which spends double the percapita amount per student on education as our G20 peers.
We are in dire need of implementing “best practice, continuous improvement” management throughout our educational system