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In 2005, the FAIMER Research Committee was successful in formulating both short- and long-term research goals. Broad objectives, and associated focus areas, were developed to direct research efforts toward projects that will help to identify, track, and assess the educational experiences and migration patterns of international medical graduates (IMGs). By targeting our research efforts in certain key areas, we will be better able to understand the complex issues related to the supply of, and need for, physicians in various regions around the world. Based on the Committee's recommendations, FAIMER research activities are now categorized into three broad domains:
International Migration of Physicians: Recently, the international migration of physicians has been the focus of numerous research endeavors, both within the U.S. and elsewhere. More >>
United States (U.S.) Physician Workforce Issues: In the U.S., there is growing concern over the number and source of physicians. A recent article by Cooper (Annals of Internal Medicine, 2004), provides evidence to suggest that there is a need to expand the future supply of doctors. More >>
International Health Professions Education: FAIMER strives to be the single best source of data on international medical schools and their graduates. To this end, much work has been done to create, assemble, and maintain high quality data repositories. More >>
With these areas in mind, we will continue to design and conduct studies focused on international health professions education, including the quality of medical schools and their graduates, and international accreditation, licensure, and certification processes. Consistent with previous efforts, these investigations have been and will be conducted, often in collaboration with other institutes and researchers, to help inform policy makers in government, academia, and various other interested organizations.
International Migration of Physicians
Recently, the international migration of physicians has been the focus of numerous research endeavors, both within the U.S. and elsewhere. From a population health perspective, any global imbalance in professional workforces must certainly be addressed; to do this, a quantification of the problem, including gathering data to better appreciate its underlying causes, must first be undertaken.
FAIMER has been actively involved in research aimed at enumerating and understanding the push and pull factors that drive the international migration of physicians. In Africa, Institute Fellows have been collecting detailed information on their medical schools, including enrollment and graduation rates. Going forward, in conjunction with various surveys of international medical graduates, we plan to gather detailed information on why physicians leave particular countries, where they plan to go, and what, if any, incentives might work to retain them where they are needed. Collaboratively, we have also been involved with other groups and individuals who are interested in the global migration of healthcare workers and how this affects local patient care, physician training, and workforce policies and projections. A recent article in the Journal of the American Medical Association (Mullan, 2005), outlining the metrics of physician "brain drain", was supported, in part, by data supplied through FAIMER. As with previous years, many external organizations and interested investigators have approached FAIMER to discuss potential collaborative research projects; these include, among others, the World Health Organization (WHO), the Association of American Medical Colleges (AAMC), the American Medical Association (AMA), Health and Human Services (HHS), Centers for Workforce Studies, Health Research Centers, and several international Medical Councils and Colleges of Medicine.
United States Physician Workforce Issues
In the U.S., there is growing concern over the number and source of physicians. A recent article by Cooper (Annals of Internal Medicine, 2004), provides evidence to suggest that there is a need to expand the future supply of doctors. While this can be accomplished by expanding U.S. medical school enrollment, it will take several years for any increases to yield qualified practitioners. As a result, internationally trained physicians will maintain a role in U.S. healthcare services for some time to come. With this in mind, there continues to be a great deal of attention devoted to studying the qualifications and practice patterns of graduates who did not attend medical schools in the United States. These individuals currently make up over 25% of the practicing physician workforce in the United States. Within this group of IMGs, there is particular interest in studying those medical students who were U.S. citizens at the time of entry to medical school (USIMGs). This cohort, including many individuals who attended medical schools in the Caribbean, is growing, not only in terms of enrollment, but also with respect to placement in U.S. Graduate Medical Education (GME) programs and subsequent service in the U.S. healthcare system.
From a research perspective, we recently completed a longitudinal study summarizing the historical role that IMGs play in the U.S. healthcare system. Since all IMGs must be certified by the Educational Commission for Foreign Medical Graduates to be eligible to enter accredited GME programs, demographic and examination performance data is available to FAIMER. These data have been analyzed to note changes in the characteristics and qualities of physicians who wish to pursue advanced training opportunities in the U.S.. Over the past 25 years, approximately 190,000 ECFMG certificates were issued to IMGs, with nearly 20% being awarded to graduates from medical schools located in India. Currently, IMGs fill approximately 6,000 postgraduate year 1 GME positions annually. Because many of these physicians stay in the U.S. following their graduate training, knowing more about their characteristics, including their intended specializations and likely practice locations, will only help with future physician workforce planning.
To explore U.S. physician workforce issues in more detail, FAIMER has partnered with various organizations and individuals, including the Association of American Medical Colleges (AAMC), the National Board of Medical Examiners (NBME), the American Medical Association (AMA), and Dr. Richard Cooper from the Leonard Davis Institute of Health Economics at the University of Pennsylvania. By pooling the available expertise and relevant data sources, FAIMER will be better able to fulfill its research goals related to the U.S. physician workforce.
International Health Professions Education
FAIMER strives to be the single best source of data on international medical schools and their graduates. To this end, much work has been done to create, assemble, and maintain high quality data repositories. Starting with data made available by ECFMG, we have expanded individual IMG records to include GME experience (GMETrack, AAMC) as well as U.S.-based physician practice information (AMA Masterfile, AMA). These datasets, most of which are updated annually as a result of negotiated data sharing agreements, provide information on practicing physicians, including residents and fellows, and can be linked to ECFMG applicant and certification records, as well as performance data (e.g., basic science, clinical knowledge, clinical skills) from the required certification and licensure examinations. Where current and historical data exist, both longitudinal and cross-sectional studies of selected cohorts are feasible.
Although detailed information is available for IMGs who come to the United States, the same cannot be said for physician migration elsewhere. Therefore, efforts are underway to develop corresponding information resources for physicians in other countries. For example, ECFMG maintains a large data bank of medical school student transcripts that can be used to harvest information on curriculum, training experiences, and international educational methodologies. Once data sources are identified, the experiences gained in developing our U.S. physician resources can be used to verify, integrate, and combine the resources on physicians in other countries in ways that promote an understanding of the global physician community. The long-term goal of this project is to develop an international physician workforce data repository that can be shared among interested researchers.
To validate the information gathered from international medical schools, surveys are periodically mailed to Ministries of Health, Education, or Medical Councils. In addition to collecting information used to validate the Ministry's recognition of international medical schools, respondents are asked to report on admission requirements, accreditation processes, and medical licensure. The results of these surveys are used to further refine and design instruments for the collection of data on international accreditation bodies, including standards used to approve medical programs and criteria employed to certify and license physicians. In the past year, AAMC and FAIMER successfully partnered to conduct a study to learn more about the structure and quality of international medical schools where US citizens often go for their medical training. By combining information from medical school transcripts and individual student surveys, and contrasting this with AAMC survey data on U.S. medical students, a detailed picture of the curricula and health professions education training programs at international schools could be drawn. These summary data, in combination with other sources, can be used to better understand the educational processes used outside the U.S. and how they may influence the career choices and clinical abilities of international medical students and graduates. As a public service, FAIMER has and will continue to provide much of this information, and related links, on its website.