ASA May 2003 Newsletter

In early 2002, officials at the U.S. Department of State informed the Educational Commission for Foreign Medical Graduates (ECFMG) that the current position of the Department of Health and Human Services (HHS) was that sponsorship of J-1 visa physicians was meant to be limited to Accreditation Council for Graduate Medical Education (ACGME)-accredited programs only.¹ The ECFMG serves as the J-1 visa sponsor for international medical graduates (IMGs) pursuing graduate medical training in the United States in ACGME-accredited programs and recognized subspecialties that are not independently accredited by ACGME, which are also known as “nonstandard” programs. In response to this notification, ECFMG convened with the pertinent medical organizations having an interest in this issue in order to address the position taken by HHS. The result was a new set of criteria for J-1 visa holders wishing to train in the United States in “nonstandard” programs.

ACGME is a private professional organization responsible for the accreditation of about 7,800 residency education programs in the United States.² Accreditation offers assurance that a given residency program and its sponsoring institutions meet an accepted set of educational standards set forth by specialty-specific residency review committees. It should be noted, though, that there are multiple subspecialties (cardiac, obstetric and neuroanesthesia fellowships, for example) and combined programs such as internal medicine and pediatrics that exist in absence of ACGME accreditation standards. Therefore, the position taken by the HHS that J-1 sponsorship be limited to ACGME-accredited programs would have a large impact on IMGs seeking training in the United States at non-ACGME-accredited programs as well as on the subspecialty directors and department heads of those programs.

There are approximately 1,600 medical schools outside of the United States and Canada. IMGs make up about 25 percent of medical residents in U.S. training programs.³ ECFMG provides multiple services for foreign-educated physicians including credentialing and certification so that they may enter the National Resident Matching Program (the “Match”) <www.NRMP.org>. But the designation by federal regulation (Federal Regulations 22 CFR, part 62) for ECFMG to serve as the J-1 visa sponsor for foreign national physicians is the key role the organization plays for their entry into graduate medical education in the United States.

In September 2002, ECFMG facilitated a discussion about J-1 visa sponsorship in subspecialty programs not independently accredited by ACGME that involved participants from the Department of State, ACGME, the American Hospital Association, the Association of American Medical Colleges, the American Board of Medical Specialties (ABMS), the American Medical Association and the Council of Medical Specialty Societies. The ECFMG president and manager of the Exchange Visitor Sponsorship Program and a representative from an academic medical center also participated. The discussion centered on clarifying the eligibility requirements for J-1 physicians to participate in subspecialty programs that are not independently accredited by ACGME. They agreed upon the following criteria, which will go into effect on July 1, 2003. There will be three pathways for ECFMG J-1 sponsorship: 1) A program accredited by ACGME, 2) programs within a specialty or subspecialty where the appropriate specialty board of ABMS offers a certificate and 3) programs within a subspecialty recognized by an appropriate board of ABMS as evidenced by a letter from the CEO of that board. Based on the meeting, six additional requirements, in regard to the third pathway, must also now be met: 1) the program’s institutional sponsor must be in full compliance with ACGME requirements on its most recent institutional review, 2) all accreditable programs within the institution must be in good standing with the ACGME, 3) the sponsorship institution’s graduate medical education committee must affirm in writing to ECFMG that it approves of the program after reviewing the program’s description, 4) verification must be provided by the program director that the proposed training program is directly associated with an ACGME-accredited program, 5) the program director must submit a detailed program description that has been approved by the graduate medical education committee, showing the educational objectives, the curriculum, the method of evaluation, the duration of the program and nature of supervision and 6) the applicant must submit documentation specifying a statement of need from the home country’s Ministry of Health confirming the government’s need for the specific subspecialty training and confirming that the applicant has committed to return home upon completion of training.⁴ Currently, ECFMG is working to develop procedures, guidelines and revised application instructions in order to implement these new requirements.

The bottom line for IMGs is that ECFMG can continue to sponsor J-1 visas for subspecialty training in nonaccredited programs. On the other hand, these new rules will make a J-1 visa more difficult to obtain considering the additional requirements. The new criteria will be fully implemented by July 2003, and only after that time can the full impact on international medical physicians desiring subspecialty training in the United States begin to be measured. One can only hope that there will continue to be an exchange of knowledge and skills and the promotion of good will between the United States medical community and IMGs.

References:

1. <www.ecfmg.org/2003ib/ibgrad.html>.

2. <www.acgme.org/about/role.asp>.

3. <www.visalaw.com/15mar02.html>.

4. <www.ecfmg.org/evsp/evspnews.html>.

Cain E. Dimon, M.D., is a CA-3 resident at the University of Michigan Department of Anesthesiology, Ann Arbor, Michigan.

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