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InternatIonal medIcal graduates In amerIcan medIcIne: Contemporary challenges and opportunities

In most countries, high medicine prices are a consequence of high prices charged by manufacturers and/or high add-ons in the supply chain, such as wholesale and retail margins and government-imposed duties and taxes. Both of these factors, acting either singly or in combination, can substantially increase the final price of medicines to patients in both the public and private sectors. In the limited number of low- and middle-income countries for which data are available, private sector wholesale mark-ups range from 2% to 380%, whereas retail mark-ups range from 10% to 552% (4). In countries where value added tax (VAT) is. | INTERNATIONAL MEDICAL GRADUATES IN AMERICAN MEDICINE Contemporary challenges and opportunities A position paper by the AMA-IMG Section Governing Council January 2010 AMA AMERICAN MED I c A L ASSOCIATION Table of contents Page Acknowledgements.1 Foreword.2 Introduction.3 Profile of IMGs.4 Historical context of medical education and migration.7 History of the ECFMG.10 Controversies in physician work force recommendations.12 Council on Graduate Medical Education.12 Pew Health Professions Commission.12 A consensus statement.12 The Institute of Medicine.13 Managed care.13 Reduce GME funding.13 Physician work force recommendation implications.14 IMG contributions.15 Gap filling or safety net role.15 IMGs in primary care.17 IMGs in academic medicine and research.19 2009 Nobel Prize scientists.20 Trends among IMG faculty at U.S. medical schools 1981-2000.20 Immigration.20 Graduate medical education.22 Selecting residency programs. 22 ECFMG certification.22 Applying to graduate medical education programs.22 National Resident Matching Program.23 Obtaining a residency position in the United States.26 International medical schools.27 Observerships.27 Immigration and visas.29 Temporary worker H-1B visa.30 Immigrant visas.30 Significant dates in U.S. immigration policy affecting IMGs.30 USIMGs . 31 Dynamics of migration Brain drain.33 Conclusion.35 Recommendations.36 International medical graduates in American medicine I Contemporary challenges and opportunities January 2010 Table of contents continued Page IMGs in organized medicine.37 2009-2010 AMA-IMG Section Governing Council.37 State medical societies with IMG sections.37 References.38 Additional recommended resources.41 Appendix A Index of tables and graphs.42 International medical graduates in American medicine II Contemporary challenges and opportunities January .