To the Editor:
International medical graduates (IMGs) are a heterogeneous group of physicians who have received their medical education outside the United States; they constitute about 25% of the U.S. physician workforce. 1 We believe there are several reasons to proactively support IMG recruitment to U.S. residency programs. For example, IMGs play a critical role in delivering health care to underserved populations while bringing experience, humility, and industriousness to their workplaces. Furthermore, IMGs contribute to diversity and cultural competence in the U.S. physician workforce, which are requirements for the ever-diversifying demographic nationally. Also, the public health crisis caused by COVID-19 has led to an anticipated increase in the need for health services. Finally, COVID-19 has highlighted the disparities in health care outcomes for communities of color. 2
Due to COVID-19, the Association of American Medical Colleges proposed the use of virtual interviews during the 2020–2021 Match cycle. Virtual interviewing is a new concept for residency programs, and the outcomes of this approach are unknown at present. Now that programs have begun this year’s recruitment season, it is important to assist IMGs who interview virtually and to highlight other unique ways in which the recruitment of IMGs can be supported.
Given the current situation, there are a few changes that we assume most training programs are aware of, such as the suspension of the Step 2 Clinical Skills exam of the United States Medical Licensing Examination. Also, the Educational Commission for Foreign Medical Graduates (ECFMG) has recently determined alternate pathways that can help IMGs acquire ECFMG certification. Similarly, due to restrictions on international travel, many IMGs will not be able to receive the U.S. Clinical Experience (USCE). The USCE familiarizes IMGs with the U.S. health care system. Considering recent limitations, residency programs should think about creative ways to promote this process by offering opportunities for remote mentorship and inviting the matched IMG applicants to have the USCE before the beginning of their training.
Other factors to consider include planning for an anticipated increase in the number of applications received by programs. This may happen because there are various unknowns associated with virtual interviewing, so some applicants may apply to more programs. Expanding the pool of application reviewers could prevent any inadvertent deprioritization of IMG applications. Also, time zone differences between the United States and other countries should be considered while planning the virtual interview. Some IMG applicants from low- and middle-resourced countries may struggle with unstable Internet availability, and alternate ways for communication should be explored in such cases. Last, as programs brainstorm ways to advertise opportunities for “open houses” to U.S. medical graduates, avenues for engaging IMG applicants, such as IMG Listservs of medical organizations, should also be considered.
1. Murphy B. How IMGs have changed the face of American medicine. American Medical Association. https://www.ama-assn.org/education/international-medical-education/how-imgs-have-changed-face-american-medicine
. Published October 19, 2020. Accessed February 2, 2021.
2. Laurencin CT, McClinton A. The COVID-19 pandemic: A call to action to identify and address racial and ethnic disparities. J Racial Ethn Health Disparities. 2020;7:398–402.