United States International Medical Graduates (IMG) are critical members of healthcare in fighting the Coronavirus pandemic. The United States medical system is in turmoil over physician shortage. An IMG is a medical doctor that is a US Citizen, resides in the United States, and obtained their medical education in a foreign country. This term is not to be confused with a Foreign Medical Graduate who is a medical doctor that is not a US Citizen, obtained their medical education in a foreign country, and does not reside in the United States.

US-based IMGs can help in decreasing the physician shortage nationwide if provided a similar standard as mid-level practitioners. It is time to establish a new healthcare system giving privileges to US-based international graduates with legal residence status to practice medicine. IMGs sacrifice and dedicate close to a decade of their lives to their medical education.

In comparison, mid-level providers such as Physician Assistants, Advanced Practice Registered Nurses, and Nurse Practitioners are permitted to practice in primary care with completion of one board examination certification with only one year of clinical clerkships. However, IMGs are required complete 6-8 years of medical school education and required to take 4 exams (Step1, CK, Cs and Step 3) in order to start residency.

While midlevel providers are not required to complete residency training to obtain an license. It is crucial to emphasize that not all IMGs have the opportunity to take these examinations due to the fees and cost of preparation. USMLE Step 1 and Step 2CK are roughly $965, Step 2CS is $1200, Step 3 is $895. The cost of preparation for each examination varies between $2,500-$10,000. IMGs who are not from middle-class families struggle tremendously with the reality that the fees associated with these examinations are out of their reach. While PA, ANP, and NP only take one examination and are not burdened with financial responsibilities as international medical graduates.

Mid-level providers are only required to complete their examinations before allotted autonomy to practice independently with and in some states without MD supervision. Meanwhile, IMGs who are just as competent, if not more, are discriminated against and can only obtain positions that demean their medical education. IMGs are currently employed in positions that do not utilize their education or contribute to the physician shortage we are currently experiencing. Many IMGs are not employed or are unable to find work in their field. IMGs that are employed often work as medical assistants, receptionists, Uber drivers, janitors, gas station clerks, and restaurant servers to make ends meet. This is a serious concern. Mid-level providers are taking care of America while IMGs who are just as competent, but having a foreign education, are scrubbing dishes and floors.

Midlevel providers are not required to complete a residency while IMGs finish 72-84 weeks of clinical clerkships and study an additional two years when compared to mid-level providers. However, they are not held to the same standard and are discriminated against by the healthcare system. There are qualified IMGs working in positions unrelated to the healthcare field with no license and a valid medical degree accredited and recognized by the ECFMG.

Every other country except the United States permits it's graduates to practice as a general practitioner in primary care. This is a request for a call to equal opportunity for IMGs who are United States citizens or legal residence. They are just as qualified as mid-level providers to provide primary care. This is a call to provide an unrestricted license for them to practice medicine. A call to satisfy the physician shortage and allot IMGs the same standard provided to mid-level providers. This petition is a request to reform federal regulations and help fill in the gaps for the physician shortage. We call for the creation of a new primary care field in which IMGs have the opportunity to practice as

General Practitioners despite the USMLE examinations.

We call for the following suggested implementations:

Permit IMGs to practice as a house physician/general physician and implement a nationwide license specifically designated to this field; Permit US-based IMGs with equal opportunities to practice medicine with an unrestricted license as a midlevel providerPermit IMGs an unrestricted license with ability to collaborate with a board-certified MD and protocol in place to practice independently; Allow the opportunity for IMGs to write one of following board examinations “The International Foundations of Medicine” (IFMO) regulated by the National Board of Medical Examiners (NBME) of the United States of American AND/OR the required USMLE step 1 or 2 examinations OR with ECFMG certification to obtain the GP license. Permit US-IMG post examination to gain entry into a mandatory one-year training program that allows graduates training as a prelim/intern without restriction on exam scores or graduation years. Restrict ACGME residency training programs in their ability to discriminate IMGs on number of attempts of USMLE examinations, or graduations years, allowing equal opportunities to all applicants of the match program.

US-based International Medical Graduates are highly qualified to work as Midlevel providers. The federal government needs to hear the request of international graduates to end the discrimination and provide healthcare to countless individuals during this pandemic. By providing equal opportunities to IMGs with a similar scope of practice as midlevel providers, we can help eliminate the physician shortage in the United States.