Evolution & History of the IMG Section
Evolution of the IMG Section
The following explanations should help in understanding the relationships that exist between IMGs and the AMA:
1989 - 1996: The Advisory Committee on International Medical Graduates
This Advisory Committee, consisting of nine AMA members appointed by the AMA Board of Trustees and one IMG resident physician recommended by the Resident Physicians Section, was first chartered in 1989 and rechartered thereafter until June 1996. Its responsibilities included assuring communication on IMG issues with state licensing boards, national ethnic medical organizations, the ECFMG, COGME, and other related groups; advising the AMA staff and Board of Trustees on IMG issues; providing regular progress reports to the Board of Trustees and the AMA House of Delegates; promoting AMA membership among IMGs; and advocating for equal opportunities and requirements for all international medical graduates either in residency training or in practice in the United States. The IMG advocacy function of this committee was transferred to the IMG Caucus Steering Committee in June 1996.
1996 - 1997: The International Medical Graduate Caucus
The IMG Caucus had been in formation for some two years, as a result of a direct charge to the IMG Advisory Committee, from the AMA Board of Trustees, to create a mechanism by which the issues and concerns of IMGs would be more adequately dealt with within the structure of the AMA. At an IMG Caucus meeting in June 1995, an IMG Caucus Steering Committee, composed of seven members, was elected from the Caucus membership and spent considerable time defining a structure that would be broadly representative and effective in an IMG advocacy role. It needed to also be in a position to assume the duties and responsibilities of the IMG Advisory Committee when its charter expired in June 1996. The transfer of duties from the IMG Advisory Committee to the IMG Caucus Steering Committee occurred on schedule in June 1996. The IMG Caucus held a plenary session in June, with over 80 IMGs attending and participating.
1997 - Present: The International Medical Graduates Section
At the IMG Caucus meeting in June 1996, a firm decision was made to petition the AMA House of Delegates for the creation of an IMG Section within the framework of the AMA. It also directed the IMG Caucus Steering Committee to appoint an IMG Section Strategy Team to implement this recommendation, and to refine a set of rules of procedure that had been proposed by the IMG Advisory Committee. An IMG Section provides IMGs with a seat in the AMA House of Delegates and a specific role in the governance and policy-making process of the AMA.
2005: AMA Bylaws Amended to Expand IMG Section
The AMA Board of Trustees supported the IMG Section Governing Council's request to amend AMA bylaws so that all IMG members of the AMA automatically become members of the IMG Section. The AMA Bylaws were further amended to provide that all IMG Section members who are AMA members be allowed to vote in the election of the IMG Section Governing Council and that, at the IMG Section Annual Meeting, only those IMG Section members who are AMA members and who are in attendance elect Governing Council members to specific offices (Chair, Vice Chair, Secretary, Delegate, Alternate Delegate, At Large Member, Resident/Fellow Member) and that this election process be reviewed three years after its final approval of the House of Delegates.
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History of the IMG Section
The International Medical Graduates (IMG) Section came into existence at the 1997 Annual Meeting, once the Bylaws were adopted. The Section came together as an Assembly for the first time at the 1997 Interim Meeting. Prior to that, IMG interests within the AMA were represented by the IMG Advisory Committee, which advised the AMA Board of Trustees on key issues that affect IMGs. Among the strategies pursued by the IMG Advisory Committee were the following:
- To create an IMG Caucus structure that would serve in an advocacy role within the AMA on IMG issues related to licensure, credentialing, obtaining residency positions, and medical practice, and to provide input to the AMA Board of Trustees and staff on other IMG issues and concerns.
- To review existing AMA policy relating to IMGs and revise or develop policy, as needed, to support IMG positions.
- To identify emerging AMA policy development needs in response to legislation, regulations and other matters that may impact the practice patterns of IMGs, and provide input to this policy as requested.
- To increase communication and liaison with state medical associations, state licensing boards, ethnic medical organizations, specialty societies, and other related groups on IMG issues.
Major accomplishments of the Committee fell into these six categories:
- State Licensure: Numerous AMA surveys identified this as the priority concern for most IMGs. Constant attention to this matter resulted in greater understanding and cooperation with state licensing authorities and procedural changes that have resulted in greater uniformity, less duplication, and more equality in the application of licensure requirements.
- Discrimination Against IMGs: The Committee urged passage of state and federal Patient Protection Act provisions calling for accountability in managed care deselection and other safeguards important to IMGs. Instances of individual discrimination were brought to the Committee's attention and they remained constant advocates for fairness and equality.
- IMG Participation in AMA: The Committee was active in supporting nominations to AMA Councils and Committees, residency review committees, etc. Numbers of IMGs in AMA leadership categories have increased in recent years. In the AMA House of Delegates, IMG representation has increased from 2.5% in the early 80's to 6.5% currently.
- Residency Positions for IMGs: The Committee long advocated fairness in residency selection and provided input to the AMA Board of Trustees on this and other key graduate medical education matters.
- The IMG Federation Infrastructure: The Advisory Committee assisted with the establishment of IMG Sections in Arizona, Colorado, Florida, Illinois, Massachusetts, Michigan, Missouri, New Jersey, Pennsylvania and Wisconsin, and IMG Committees in Georgia, New York, Ohio, Texas and Virginia, in Cook County, IL and New York (NY) boroughs and in the American Psychiatric Association (APA), American Academy of Family Practice (AAFP) and American College of Physicians/American Society of Internal Medicine (ACP-ASIM). An ethnic medical organization section is active in California with representation on the California Medical Association Board of Trustees.
- IMG Membership in the AMA: Increasing AMA membership among IMGs was a major focus of the IMG Advisory Committee, and remains so for the IMG Section leadership. A consistent belief among IMG leaders is that a growing IMG membership within the AMA will ensure that IMG issues, which in truth are physician issues, command the attention they deserve.
The IMG Section has carried forward the same agenda for change, working to build on the accomplishments of the Advisory Committee. The same three themes remain: fairness in the practice environment, equity in licensure and credentialing, and equal access to residency training.
Accomplishments of the IMG Advisory Committee
Ensured that for the first time an IMG member of the AMA would represent the AMA on the Board of the Educational Commission for Foreign Medical Graduates (ECFMG). This action was adopted at the June (Annual) 2000 meeting of the House of Delegates, and the Board of Trustees appointed Busharat Ahmad, MD to a two year term that began in January 2001. Dr. Ahmad, an ophthalmologist from Michigan, spent most of his career serving the communities of the Upper Peninsula. A long time member of the Michigan delegation to the AMA House of Delegates, Dr. Ahmad was instrumental in establishing the IMG Section, served as its first Chair in 1997-98, and was the first non U.S.-born IMG to run for the AMA Board of Trustees (1998-99).
When the National Resident Matching Program (NRMP) was planning to rescind the status of IMGs as independent applicants to the Match, the IMG Section Governing Council met with them to voice opposition on their proposal. By forcing IMG candidates to wait until the Match occurred in March, many would lose the opportunity to accept offers tendered earlier. Such a change would greatly increase the difficulty (and uncertainty) of the process for IMGs, and the NRMP dropped the proposal.
Clinical Skills Assessment (CSA)
When the ECFMG implemented the CSA, the IMG Section opposed adding a differential exam that only affected IMGs. The Section took the view that following the establishment of a uniform licensure pathway with the USMLE Step exams in 1993, the CSA represented a step backward. Although the CSA went forward, the National Board of Medical Examiners imposed a similar exam on U.S. medical graduates in 2004.
Licensure and Credentialing
The Section continues to take incremental steps toward improving licensure and credentialing concerns to practicing IMGs. At the December (Interim) 2000 Meeting the Section convinced the AMA to communicate directly to the licensure boards that the AMA Masterfile and the ECFMG are recognized as primary source verification of IMG medical education credentials. The AMA also formally agreed to support recognition by all licensure boards of the Federation of State Medical Boards’ (FSMB) Credentials Verification Service, which can save time and trouble for IMGs seeking additional licenses. Finally, the AMA agreed to ask the National Commission on Quality Assurance to accept the FSMB, ECFMG and AMA Masterfile as primary source verification of credentials for the institutions that it accredits.
The Section can be relied on to introduce unpopular, but original ideas for directions the Association should be taking. So far unsuccessfully, the Section has requested the Association consider direct elections of their leadership and eliminate the huge cost overhead of hosting a national (Interim) meeting in Hawaii.