Border barriers ease for international medical graduates

This year, 20% of IMGs missed their residency start date, compared with 38% last year, according to the Educational Commission for Foreign Medical Graduates.

By Myrle Croasdale — Posted Nov. 15, 2004

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Tighter U.S. border controls are continuing to have unintended consequences on medical education. Some resident physicians from overseas are arriving late or not at all, but the situation has improved this year, according to the Educational Commission for Foreign Medical Graduates.

Catheryn Cotten, director of the International Office at Duke University, which handles visa issues for Duke's international students and staff, said security checks are going more smoothly this year.

"In general the [U.S.] Dept. of State is working hard to shorten the security clearance time," Cotten said.

Last year, it took anywhere from 60 to 90 days or longer, she said, but the wait now is generally 30 days, though some continue to take longer.

The State Dept. heightened its use of security checks on visa applicants after Sept. 11, 2001.

Preliminary data from the ECFMG shows that 80% of IMGs with J-1 visas started first-year training on time this academic year, compared with 62% last year.

The ECFMG tracks IMGs coming for their first year of residency on only J-1 visas. Physicians with other visas, such as the H-1B, are not tracked by the ECFMG, nor are those beyond their first year of training.

Edward Ashworth, assistant director at Duke's International Office, said three of Duke's IMGs were delayed this year, compared with 10 last time around. But for the department short a doctor, the impact is enormous, he said.

"The other residents have to carry more during their already intense schedules, without knowing when the missing doctor will arrive," he said.

Once they arrive, they aren't free from worry, either. This fall, one of Duke's IMGs went home to Pakistan for a week-long vacation and ended up being gone three weeks because of the lengthy security clearance process.

Omar Atiq, MD, president of the Assn. of Pakistani Physicians of North America, said the organization had been contacted by at least a dozen Pakistani medical graduates facing delays or outright denials.

"It's still a big problem," Dr. Atiq said. "We have a lot of physicians who have contracts to start residencies, they've passed all the tests, come here for interviews, despite all of this, now they can't get in."

While the situation has improved, some program directors say this is in part because they've become more selective when interviewing IMGs. Thomas O. Dickey III, MD, program director for psychiatry at West Virginia University, lost a first-year resident, Aftab Khan, MD, when he got married in India and was not allowed to return. The program ended up short a resident for almost six months.

"After all the problems we experienced two years ago with late arrivals or never arriving and then Aftab's problem, we will interview a few physicians with J-1 visa needs, but they will have to be exceptionally strong candidates," Dr. Dickey said.

The ECFMG's preliminary data show an increase of 180 first-year, J-1 physicians for 2004-05, or 1,313 of these doctors, compared with 1,133 in 2003-04.

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