December 2021

Greenwall Making a Difference Grant Team Member Discusses Challenges Facing International Medical Graduates

The COVID-19 pandemic has placed an extreme physical and mental burden on health care professionals around the world. Scholars have found that in the United States health care professionals, particularly people of color, have suffered increased levels of anxiety, stress, and burnout as a result of the pandemic.

International medical graduates (IMGs) in particular have faced heightened challenges during the pandemic related to their immigration status, argued Greenwall Making a Difference grant research team member Elizabeth Fenton, PhD, Lecturer at the University of Otago, at the 2021 American Society of Bioethics and Humanities Annual Conference.

Prof. Fenton defined IMGs as health care professionals who have received their basic medical degrees or qualifications from institutions outside of the United States or Canada. IMGs include foreign-born individuals in the United States on non-immigrant visas, immigrants who hold a medical license, and U.S. born or naturalized citizens who received their basic medical degree abroad.

In a country that faces growing shortages of physicians, Prof. Fenton reported that IMGs are ready and willing to help meet the demand. Currently, IMGs make up 25 percent of all practicing physicians in the United States, and they have shouldered a disproportionately heavy burden during the pandemic. For example, Prof. Fenton reported that, according to one study, IMGs account for nearly half of all COVID-related physician deaths.

Prof. Fenton explained that IMGs have been particularly vulnerable to pandemic-related burdens because they are overrepresented in specialties with higher risks of exposure to COVID-19 and they are more likely to work in under-resourced or rural areas.

To better understand the challenges and needs unique to IMGs, the study team conducted a series of interviews with IMGs practicing in West Virginia, healthcare administrators and leaders in West Virginia, and representatives of national and regional professional organizations.

Prof. Fenton reported that immigration-related issues were a source of significant stress for IMGs during the pandemic. For example, IMGs were concerned about contracting COVID-19 not only because of the potential health risks to themselves and their families, but also because an inability to work could impact their immigration status and that of their dependents.

Also, IMGs explained that certain visa restrictions impeded their ability to relocate and help patients in pandemic hot spots. IMGs living in the United States on work visas may only work in the hospital that employs them, which in some cases meant that they were unable to practice in the hospitals that needed them the most.

These immigration-related restrictions and stressors place an unfair burden on IMGs during the pandemic and are potentially harmful to the communities that IMGs serve, Prof. Fenton claimed. She argued that the U.S. government and society as a whole owe reciprocity to IMGs for their contribution to public health and particularly communities with high levels of health need. Prof. Fenton explained that under the principle of reciprocity, society must take steps to minimize burdens and give support to those who face a disproportionate burden while serving the public good and the welfare of the larger community.

Prof. Fenton concluded her discussion with several recommendations to increase support for IMGs. At the federal level, she advocates for friendlier immigration policies such as offering protection against deportation, extension of visa status, work flexibility, and streamlined credentialing processes. At the institutional level, she suggests developing tailored support for IMGs, explicit and public valuing of IMGs’ contributions to their institutions and communities, and advocating for supportive immigration policies. At the community level, she recommends fostering support for IMGs and immigrant communities more generally.