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Kodumudi V, Cohen JM, Feng H. Training and Practice Characteristics of International Medical Graduates in Dermatology. JAMA Dermatol. 2022;158(4):452–454. doi:10.1001/jamadermatol.2022.0136
Although international medical graduates (IMGs) make up nearly a quarter of active physicians in the United States,1 they constitute less than 5% of practicing dermatologists.2 Given the paucity of data on where IMG dermatologists received their residency training and where they practice, we performed a cross-sectional analysis of these characteristics.
In this cross-sectional study, we analyzed training and practice data of IMGs, defined as physicians who graduated from medical schools outside the United States, Puerto Rico, and Canada.1 Our analysis is representative of practicing IMGs in dermatology as of June 2021. We used several online sources to determine training and practice characteristics. We used Medicare clinician data3 from the Centers for Medicare & Medicaid Services to identify IMGs based on medical school location. For practice characteristics, the rural-urban status of county of practice was determined by using US Department of Agriculture 2013 Rural-Urban Continuum Codes. Medically underserved areas were identified by using Health Resources and Services Administration data. County demographic information and race and ethnicity categories were obtained from the US Census Bureau. Analyses were performed using Stata, release 17.0 (StataCorp LLC). This study used publicly available online data sets and did not qualify as human participant research; therefore, University of Connecticut Health Center institutional review board approval was not required. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.
We identified 558 dermatology IMGs, which corresponds to 94.4% of the 591 total reported by the American Association of Medical Colleges in 2019.2 Of these 558 dermatology IMGs, 297 (53.2%) were men, 261 (46.8%) were women, and the mean (SD) age was 56.3 (11.8) years. A breakdown of IMGs by race and ethnicity could not be determined from our data. More IMGs received their training from medical schools in Asia (221 [39.6%]) than any other global region (Table 1). A greater proportion of IMGs are aged 55 years or older compared with all practicing dermatologists (53.2% vs 44.3%).2 According to National Resident Matching Program data, the percentage of matched dermatology residents from 2003 through 2020 who were IMGs was less than that of all dermatologists who were IMGs (2.7% vs 4.7%).2,4 Similar percentages of IMGs and non-IMGs worked in private practice (64.7% vs 65.8%) and academic hospital groups (15.8% vs 15.5%). A similar percentage of IMGs worked in nonmetropolitan areas when compared with non-IMGs (3.8% vs 6.0%). Compared with non-IMGs, a greater proportion of IMGs practiced in counties where the mean (SD) proportion of non-Hispanic White residents is lower (47.8% [18.7%] vs 58.3% [19.7%]) and the mean county proportions of non-Hispanic Asian (12.4% [5.5%] vs 7.0% [7.2%]) and Hispanic (25.3% [14.3%] vs 18.3% [15.7%]) residents are higher (Table 2).
The main observation from this cross-sectional study is that dermatology IMGs are older than non-IMGs, which is also seen in primary care and general surgery.1,5 Some IMGs who may have practiced in other countries are required to complete another residency in the United States, thus contributing to their entering US practice at an older age. In addition, a smaller percentage of IMGs were matched with and entered into the specialty between 2003 and 2020, which further contributed to an older age distribution.
The proportion of IMGs practicing in nonmetropolitan areas was similar to that of non-IMGs. This finding contrasts with the practice patterns of IMGs in primary care but is similar to those of IMGs in general surgery.1,5 Although dermatology IMGs were not more likely to practice in nonmetropolitan areas, we found that they did practice in counties with greater proportions of residents of races and ethnicities other than White. The reasons for this observation are unknown.
Limitations of this study include potentially incorrect publicly available data and the possibility that some IMGs do not bill Medicare. Nonetheless, our data help to better elucidate the characteristics of IMGs in dermatology. Since the changes in immigration laws in the 1960s and 1970s, the percentage of IMGs practicing in the United States has increased dramatically, and these physicians play an important role in health care today.6 The field of dermatology can benefit from additional research into the current practice patterns of its own IMG workforce.
Accepted for Publication: January 12, 2022.
Published Online: March 16, 2022. doi:10.1001/jamadermatol.2022.0136
Corresponding Author: Hao Feng, MD, MHS, Department of Dermatology, University of Connecticut Health Center, 21 South Rd, Second Floor, Farmington, CT 06032 (firstname.lastname@example.org).
Author Contributions: Mr Kodumudi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Cohen, Feng.
Acquisition, analysis, or interpretation of data: Kodumudi, Feng.
Drafting of the manuscript: Kodumudi, Feng.
Critical revision of the manuscript for important intellectual content: Cohen, Feng.
Statistical analysis: Kodumudi.
Administrative, technical, or material support: Feng.
Conflict of Interest Disclosures: Dr Feng reported being a paid consultant for Cytrellis Inc and Soliton Inc. No other disclosures were reported.