Fewer Foreign Doctors Seek U.S. Graduate Programs Since Implementation of New Test
The number of international medical school graduates who seek certification for U.S. graduate medical education programs has "plummeted" since the institution of a clinical skills assessment (CSA) test, according to a study in today's issue of the Journal of the American Medical Association, the AP/Philadelphia Inquirer reports (Buchanan, AP/Philadelphia Inquirer, 9/4). In the study, researchers from the Educational Commission for Foreign Medical Graduates, which certifies IMG candidates for U.S. GME programs, examined a group of IMG candidates in databases "reporting on all individuals beginning the certification process" between 1995 and 2001. The CSA, added to the certification process in July 1998, includes 10 patient encounters in which IMG candidates interact with standardized patients to obtain a relevant medical history, conduct a "focused" physical exam, communicate in spoken English and compose a "patient note" that serves as a "written record of the encounter." The study found the number of IMG candidates who took the first part of the ECFMG certification examination dropped by 45.5% -- from 36,983 in 1995 to 16,828 in 2001 -- and the number who registered to take the second part of the exam dropped by 38.1% -- from 31,751 in 1995 to 12,122 in 2001. In addition, the study found that the number of ECFMG certificates issued each year decreased from a range of 9,000 to 12,000 between 1995 and 1998 to fewer than 6,000 between 1999 and 2001.
According to researchers, "It is possible that the addition of the skills [test] to the required examinations introduced several factors" that may have contributed to the decrease in the number of IMGs who seek ECFMG certification (Whelan et al., JAMA, 9/4). Researchers said that IMG candidates "may be dissuaded by the prospect of having their English evaluated" in the CSA, the AP/Inquirer reports. They also cited the $1,200 cost of the CSA and the expense of travel to Philadelphia, the only location that offers the test. American College of International Physicians President Alex Yado said, "Foreign doctors cannot afford that." A similar CSA proposed for U.S. medical students has "prompted objections" from the American Medical Association and other groups concerned about the cost and effectiveness of the test (AP/Philadelphia Inquirer, 9/4). The study is available online.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.