IMG's and U.S. immigration policies

1933-1948 - European IMGs immigrate as refugees in relatively small numbers.


1948 - Exchange visitor program lets IMGs train in U.S. Many stay.


1956 - AMA and others create IMG-certification system; the ECFMG.


1965 - Easily obtainable visas in some specialties attract Third World IMGs.


1971 - IMGs get quicker job clearances for permanent residency status.


1976 - Congress raises immigration barriers against IMGs.


1980 - Federal study recommends IMG limits.


1985 - Federal legislation proposed to cut off GME funding for IMGs. Fails.


1990s - Steep rise in incoming IMGs attributed to breakup of Soviet Union, changes in licensing exam and new immigration laws.


A profile of the IMG population would be:


IMGs make up approximately 23% of the U.S. physician population and 24% of resident physicians.


The heaviest concentration of IMGs is in New Jersey (44% of doctors); New York (41%); West Virginia (34.8%); and Illinois (34.3%).


Almost half of all IMGs (48%) train in primary care specialties vs. 33% of U.S. graduates.


The largest national group is from India (19.5% of total).


Of the 154,576 total IMG population, 130,741 (85%) are in patient care, 7.635 (5%) are in medical teaching, administration or research, and the remainder are not classified, are inactive, or have an unknown address.


Of the 22,230 IMGs who are in residency training or are clinical fellows, more than 4,000 are American citizens, 8,200 are immigrants and are permanent residents, and 8,900 are in the U.S. on an exchange visitor visa and plan to return to their country of origin unless the INS grants them a waiver because they are needed to provide care to the American public. Therefore, some 55% of all IMGs in graduate medical education programs are U.S. citizens or lawful immigrants.


The total physician population increased by 350,386 between 1970 and 1994 or 104.9% while IMGs accounted for over one-fourth (27.8%) of this increase by gaining 97,359 physicians.


In this 24-year period, non-IMGs grew by 91.4% while IMGs increased by 170.2%.


In 1980, IMGs accounted for 20.9% of the total physician count of 467,679 while that percent climbed to 22.6% of the total count of 684,414 physicians in 1994.


Where IMGs come from:


India - 19.5% .


Pakistan - 11.9%


Philippines - 8.8%


Ex-USSR - 3.1%


Egypt - 2.6%


Dominican Republic - 2.5%


Syria - 2.5%.


United Kingdom - 2.4%


Germany - 2.3%


Mexico - 1.8%


In terms of specialty, IMG participation is as follows:


Internal Medicine - 20.9% (32,242).


General/Family Practice - 9.8% (15,065).


Pediatrics - 9.3% (14,352).


Psychiatry - 7.0% (10,767).


Anesthesiology - 5.7% (8,826).


General Surgery - 5.2% (7,987).


Obstetrics/Gynecology - 4.6% (7,138).


Pathology - 3.5% (5,439).


Cardiovascular Diseases - 3.3% (5,024)




AMA and IMGs:


An Ad Hoc Committee on Foreign Medical Graduate Affairs was appointed by the AMA Board of Trustees and rendered a final report with recommendations for action which was adopted by the House of Delegates at the 1979 Interim Meeting. It was a report that requested "support," "encouragement," and "commendation" but had little in the way of direct action requests.


Another Ad Hoc Committee on Foreign Medical Graduates was appointed in 1985 and submitted a final report to the House of Delegates at the 1986 Annual Meeting. Although containing some 29 definitive recommendations, it too had little effect other than to incorporate the recommendations into the Association's policy base.


A very strong effort was made in 1987 for the establishment by the House of Delegates of an IMG Section. This proposal was defeated at 1987 the Annual Meeting by a vote of 215 to 145. There was considerable disappointment with this decision within the IMG community.


The AMA Board of Trustees, in October 1989, approved a recommendation from the Executive Vice President to create an International Medical Graduate Advisory Committee. In June 1989, the IMG Services Unit was established. The IMG Committee was rechartered in 1991, 1993, and 1994, with a 1996 sunset provision.


Another effort was made in 1993 to receive approval from the House of Delegates for the establishment of an IMG Section, and it too was defeated at the 1993 Annual Meeting. This was not a well organized effort and the outcome was predictable.


In rechartering the IMG Committee in 1994 for a two year period, the Board of Trustees charged the Committee to create a structure that would more effectively allow for consideration of IMG issues within the framework of the AMA. The IMG Committee responded to this charge by creating a broadly based, participatory IMG Caucus.


In June 1996, the IMG Caucus Steering Committee assumed the IMG advocacy function and the IMG Advisory Committee's charter expired. The AMA Board of Trustees agreed to provide funding to the IMG Caucus Steering Committee for a period of one year.


The IMG Caucus, meeting at the 1996 Annual Meeting, decided to once again seek the formation of an IMG Section within the framework of the AMA. This time there was a favorable response and an IMG Section was authorized. It will become a reality in June 1997.


At the 1997 Annual Meeting, the AMA House of Delegates adopted the IMG Section bylaws, formally establishing the IMG Section.


The IMG Section met as an Assembly for the first time at the 1997 Interim Meeting.


IMG membership within the AMA:


AMA membership among IMGs has shown slow but consistent growth, with IMGs representing approximately 17% of the total AMA membership.


Between 1970 and 1994, the number of IMG members increased by some 161%, in comparison with an 88% increase in the U.S. medical graduate population.


Since 1993, IMG membership has increased gradually from 44,449 to 44,683 in 1995, an increase of 0.5%. In 1995, 31% of the active physician IMG population were AMA members.


Of the 22,230 IMG resident physicians, 5,768 are AMA members. This represents a 26% market share.


IMGs are more inclined to become AMA members directly rather than through their state or county medical societies. Over 17,000 IMGs, or 39%, are AMA direct members.

Text Lifted from American Medical Association