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Excerpts From the AMA Policy Compendium Related to IMGs

255.974 Preservation of Opportunities for US Graduates and International Medical Graduates Already Legally Present in the US

In the event of reductions in the resident workforce, the AMA will advocate for a mechanism of resident selection which promotes the maintenance of resident physician training opportunities for all qualified graduates of United States Liaison Committee on Medical Education and American Osteopathic Association accredited institutions; and the AMA adopts the positions that it will be an advocate for IMGs already legally present in this country. (Res.324, A-97)

255.975 J-1 Exchange Visitor Program (J-1 Visa)

Policy of the AMA states: the purpose of the physician J-1 Visa Exchange Program is to ameliorate physician specialty shortages in other countries; and the AMA will work to correct the problems of inconsistency, lack of accountability, and non-compliance in the administration of the physician J-1 Visa Exchange Program identified in the December 1996 General Accounting Office publication Foreign Physicians: Exchange Visitor Program Becoming Major Route to Practicing in Underserved Areas (GAO/HEHS-97-26). (CME Rep. 2, A-97)

255.976 Speech Tests for International Medical Graduates

The AMA encourages state licensing boards to accept ECFMG certification in satisfaction of requirements for demonstrating English language competence. (CME Rep. B, A-93) 255.977 International Medical Graduates Participation in Medical Societies The AMA encourages the federation of state and county medical societies to identify qualified and interested international medical graduates to be invited, appointed and elected to committees and leadership positions within the House of Medicine. (Res. 217, A-91)

255.978 Unfair Discrimination Against International Medical Graduates

It is the policy of the AMA to take appropriate action, legal or legislative, against implementation of Section 4752(d) of the OBRA of 1990 that requires international medical graduates, in order to obtain a Medicaid UPlN number, to have held a license in one or more states continuously since 1958, or pass the Foreign Medical Graduate Examination in Medical Sciences (FMGEMS), or pass the Educational Commission for Foreign Medical Graduates (ECFMG) Examination, or be certified by ECFMG. (Res. 123, I-90)

255.979 Licensure Of International Medical Graduates

The AMA reaffirms existing policy regarding licensure by endorsement of international medical graduates and urges state licensing boards to adopt the recommendations included in these policy statements. (CME Rep. B, I-90)

255.980 Foreign Medical Graduate Examination In Medical Sciences Scores Not Sole Criteria For Residency Selection

The AMA (1) urges that Foreign Medical Graduate Examination in Medical Sciences (FMGEMS) scores not be used as the sole criteria for selecting interns and residents; and (2) recommends that residency programs consider all of the candidates' attributes and qualifications during the selection process. (Res. 143, A-90)

255.981 Graduates of Foreign Medical Schools Involvement in the AMA

The AMA encourages more involvement of graduates of foreign medical schools in its policy-making process. (Res. 144, A-89)

255.982 Equality in Licensure and Reciprocity

The AMA (1) reaffirms its policy that it is inappropriate to discriminate against any physician because of national origin or geographical location of medical education; (2) continues to recognize the right and responsibility of states and territories to determine the qualifications of individuals applying for licensure to practice medicine within their respective jurisdiction; and (3) supports the development and distribution of model legislation to encourage states to amend their Medical Practice Acts to provide that graduates of foreign medical schools shall meet the same requirements for licensure by endorsement as graduates of accredited U.S. and Canadian schools. (Res. 69, A-89)

255.983 Graduates of Non-United States Medical Schools

The AMA continues to support the policy that all physicians and medical students should be evaluated for purposes of entry into graduate medical education programs, licensure, and hospital medical staff privileges on the basis of their individual qualifications, skills, and character. (Sub. Res. 45, A-88)

255.984 FMG Participation

The AMA offers encouragement and assistance to state and county medical societies in fostering greater participation of foreign medical graduates in leadership positions at all levels of organized medicine, by providing guidelines and non-financial incentives, such as recognition for outstanding achievements by either individuals or organizations in promoting leadership among foreign medical graduates. (Sub. Res. 20, I-87)

255.985 Graduates of Foreign Health Professional Schools

(1) Any United States or alien graduate of a foreign health professional education program must, as a requirement for entry into graduate education and/or practice in the United States, demonstrate entry-level competence equivalent to that required of graduates of United States' programs. Agencies recognized to license or certify health professionals in the United States should have mechanisms to evaluate the entry-level competence of graduates of foreign health professional programs. The level of competence and the means used to assess it should be the same or equivalent to those required of graduates of U.S. accredited programs. (2) All health care facilities, including governmental facilities, should adhere to the same or equivalent licensing and credentialing requirements in their employment practices. (BOT Rep. NN, A-87)

255.986 Foreign Medical Graduates in Residency Programs

The AMA continues to support the position that those foreign medical graduates who plan to return to their country of origin have the opportunity to obtain graduate medical education in the U.S. (Res. 114, A-86)

255.987 Foreign Medical Graduates

The AMA supports continued efforts to protect the rights and privileges of all physicians duly licensed in the U.S. regardless of ethnic or educational background and opposes any legislative efforts to discriminate against duly licensed physicians on the basis of ethnic or educational background. (Res. 56, A-86)

255.988 Report of the Ad Hoc Committee on Foreign Medical Graduates

(1) The AMA reaffirms its support of current U.S. visa and immigration requirements applicable to foreign national physicians who are graduates of medical schools other than those in the United States and Canada.

(2) The AMA continues to support current regulations governing the issuance of exchange visitor visas to foreign national FMGs, including the requirements for successful completion of the FMGEMS.

(3) The AMA reaffirms its policy that the U.S. and Canada medical schools be accredited by a nongovernmental accrediting body.

(4) The AMA continues to support cooperation in the collection and analysis of information on medical schools in nations other than the U.S. and Canada.

(5) The AMA supports continued cooperation with the ECFMG and other appropriate organizations to disseminate information to prospective and current students in foreign medical schools. This information should be related to the structure and requirements of the U.S. system of medical education and patient care.

(6) The AMA continues to support working with the ECFMG and other appropriate organizations in developing effective methods to evaluate the clinical skills of FMGs.

(7) The AMA strongly supports the policy that the core clinical curriculum of a foreign medical school should be provided by that school and that U.S. hospitals should not provide substitute core clinical experience for students attending a foreign medical school.

(8) The AMA continues to support working with the Accreditation Council for Graduate Medical Education (ACGME) and the Federation of State Medical Boards (FSMB) to assure that institutions offering accredited residencies, residency program directors, and U.S. licensing authorities do not deviate from established standards when evaluating graduates of foreign medical schools.

(9) The AMA, in cooperation with the ACGME and the FSMB, supports only those modifications in established graduate medical education or licensing standards designed to enhance the quality of medical education and patient care.

(10) The AMA continues to support the activities of the ECFMG related to verification of education credentials and testing of FMGs.

(11) Special consideration should be given to the limited number of FMGs who are refugees from foreign governments that refuse to provide pertinent information usually required to establish eligibility for residency training or licensure.

(12) The AMA reaffirms its existing policy supporting the use of accreditation standards to enhance the quality of patient care and medical education. Also the AMA opposes the use of such standards for purposes of regulating physician manpower.

(13) AMA representatives to the ACGME, residency review committees and to the ECFMG should support AMA policy opposing discrimination. In particular, these AMA representatives should emphasize that AMA policy does not prohibit the appointment of qualified graduates of foreign medical schools to residency training programs.

(14) A study should be considered to determine the current status of ECFMG certified FMGs who are U.S. citizens or permanent residents and have not been able to obtain a residency or secure a license to practice medicine, and avenues to help them should be evaluated.

(15) The AMA strongly reaffirms existing policy urging U.S. licensing authorities to focus on the individual academic and personal achievements when evaluating FMGs for the purposes of licensure. More effective methods for evaluating the quality of the undergraduate medical education of FMGs should be pursued and, when available, the results should be a part of the determination of eligibility for licensure.

(16) The AMA reaffirms its support for the requirement that all medical school graduates complete at least one year of graduate medical education in an accredited U.S. program in order to qualify for full and unrestricted licensure.

(17) The AMA supports continued monitoring of the effectiveness of the Fifth Pathway program, including to the degree possible any measurable impact of the program on enrollments in Caribbean and Central American medical schools.

(18) The AMA reaffirms and supports publicizing existing policy concerning the granting of staff and clinical privileges in hospitals and other health facilities.

(19) The AMA reaffirms its support of the participation of all physicians, including graduates of foreign as well as U.S. and Canadian medical schools, in organized medicine.

(20) The AMA encourages the constituent medical societies to support qualified FMGs for nominations to AMA committees and councils.

(21) The AMA supports studying the feasibility of conducting peer-to-peer membership recruitment efforts aimed at FMGs who are not AMA members.

(22) The AMA is committed to using its existing publications to highlight policies and activities of interest to FMGs, stressing the common concerns of all physicians.

(23) The AMA supports demonstrating its interests in issues related to FMGs by publicizing its many relevant resources to all physicians, especially to nonmember FMGs.

(24) The AMA supports expansion of its efforts to prepare and disseminate information about requirements for admission to accredited residency programs, the availability of positions, and the problems of becoming licensed and entering full and unrestricted medical practice in the U.S. that face FMGs. This information should be addressed to college students, high school and college advisors, and students in foreign medical schools.

(25) The AMA continues to recognize the common aims and goals of all physicians, particularly those practicing in the U.S., and supports making every effort to include all physicians who are permanent residents of the U.S. in the mainstream of American medicine.

(26) The AMA is committed to identifying and publicizing resources within the AMA that will respond to inquiries from FMGs.

(27) The AMA is committed to providing leadership to promote the international exchange of medical knowledge as well as cultural understanding between the U.S. and other nations.

(28) The AMA urges institutions that sponsor exchange visitor programs in medical education, clinical medicine and public health to tailor programs for the individual visiting scholar that will meet the needs of the scholar, the institution, and the nation to which he will return.

(29) The AMA is committed to informing foreign national FMGs that the availability of training and practice opportunities in the U.S. is limited by the availability of fiscal and human resources to maintain the quality of medical education and patient care in the U.S. (BOT Rep. Z, A-86; Reaffirmed: Res. 312, I-93)

255.989 A Program for Exchange Visitor Physicians

(1) It is the AMA's policy to separate the issues involved in the support of alien physicians participating in exchange visitor physician programs for purposes of education, training and/or research followed by return to their native lands from the issues involving U.S. citizens who are graduates of foreign medical schools and alien physician graduates of foreign medical schools who seek permanent residence in the United States. (2) The AMA urges government and private funding of the physician exchange visitor program under the auspices of an appropriate organization that will: consider the range and type of medical education and health care needs of those foreign nations sending exchange visitor physicians; the means to evaluate the level of knowledge and needs of prospective participants in graduate medical education programs; and identify truly outstanding public health, geographic medicine, basic medical science, and clinical training programs to answer the needs of the visitor's native land. (Res. 107, I-85; Reaffirmed by CLRPD Rep. 2, I-95)

255.990 Regulation of Clinical Education Provided in U.S. Hospitals for Students in Non-LCME Accredited Schools

(CME Rep. B, I-85) Rescinded by CLRPD Rep. 2, I-95.

255.991 Education for Foreign Physicians

After reviewing the past and present status of medical education for physicians of other countries, the AMA adopts the following statement: (1) Medical education in the U.S., consistent with available resources, should recognize and respond to the unique needs of foreign physicians and the environment in which they practice.

(2) A first priority for the improvement of medical education in all countries should be directed toward the development of opportunities for medical education at all levels, undergraduate, graduate, remedial, and continuing, within the system of medical education existing in the individual foreign nation or region.

(3) U.S. physicians, when resources are available, should be encouraged to contribute to medical education conducted in other countries at the undergraduate, graduate, remedial and continuing levels.

(4) The accredited residency program directed toward practice within the U.S. is an educational modality which should be limited to foreign physicians who can be expected to apply what they have learned in the U.S. to the education or practice needs of their own country.

(5) Recognition should be afforded graduate programs, tailored to the individual needs of the foreign physicians not involving significant responsibility for the care of patients, and thus obviating the need for foreign physicians, otherwise qualified, to pass the Visa Qualifying Examination.

(6) Opportunities for exchange visitor programs of all types pertaining to the improvement of medical education should be compiled and made available to both foreign physicians and U.S. physicians who may have an interest in participating in such programs.

(7) Since continuing medical education is of universal importance, efforts to make educational materials available on an even wider basis, such as the foreign language editions of JAMA, deserve commendation. (CME Rep. C, I-85; Modified by CLRPD Rep. 2, I-95)

255.992 Discrimination Against Physicians

The AMA believes that the quality of a physician's medical education is an appropriate consideration in the recruitment and licensure of physicians and discrimination against physicians on the basis of the country in which they completed their medical education is inappropriate. (Sub. Res. 44, A-85; Reaffirmed by CLRPD Rep. 2, I-95)

255.993 Evaluation of Foreign Medical Schools

The AMA continues to support the efforts of appropriate organizations to gather information that will assist state licensing authorities in evaluating foreign medical schools. (Sub. Res. 56, A-84; Reaffirmed by CLRPD Rep. 3 - I-94)

255.994 Physician Exemption from Medical School Standards and Performance Evaluation Requirements

(1) The AMA recommends to medical licensing boards that those physicians who are foreign medical graduates currently duly licensed by any licensing jurisdiction in the U.S. should not be denied endorsement of their licenses, or denied admission to reexamination when this is required by law, solely because they are unable to provide documentation of graduation from a school meeting "equivalent standards and performance evaluation requirements" to those of programs accredited by the Liaison Committee on Medical Education. (2) The AMA encourages licensing boards, in reviewing applications for licensure endorsement, to take into account a physician's ethical standards and his or her having practiced medicine of an acceptable quality. (Sub. Res. 108, A-83; Reaffirmed: CLRPD Rep. I-93-1)

255.995 Foreign Medical Graduates

The AMA believes that (1) preferential immigration policies for foreign medical graduates should be terminated and existing immigration laws should be enforced more strictly; and (2) reduced requirements for licensure should not be applied under any circumstances to graduates of foreign medical schools. (Res. 23, A-82; Reaffirmed: CLRPD Rep. A, I-92)

255.996 Foreign Medical Schools

The AMA (1) encourages the ACGME to work with the ECFMG to study the feasibility of including a test of clinical skills and knowledge as a component of the certification process; (2) recommends that at such times as the ECFMG certificate is validated, the state medical licensing authorities should accept it as evidence of an FMG having successfully completed acceptable medical education as required for licensure, if evaluation of the educational programs of the particular foreign medical school is not possible; and (3) encourages efforts to develop a system to assist individual states in the evaluation of the educational programs of foreign medical schools. (CME Rep. D, A-82; Reaffirmed: CLRPD Rep. A, I-92)

255.997 Fifth Pathway

(1) The AMA believes that the Fifth Pathway is fulfilling its purpose of improving the education of U.S. FMGs who have completed the program and has served to help maintain standards for licensure in those jurisdictions which would have been politically pressed to lower them to accommodate these students without additional education.

(2) To reaffirm the intent of the Fifth Pathway policy, namely to provide an alternative route of entry into graduate medical education for qualified students studying abroad who are not eligible through the ECFMG route, the policy should be revised to ask the sponsoring medical schools to establish more stringent requirements for admission to and successful completion of a Fifth Pathway program.

(3) The AMA supports the principle that any existing or proposed alternative programs conducted by U.S. medical schools to facilitate entry of U.S. citizens studying in foreign medical schools into U.S. programs should assure that those who complete such programs are reasonably comparable to the school's regularly enrolled and graduated students. (CME Rep. D, A-81; Reaffirmed: CLRPD Rep. F, I-91)

255.998 Foreign Medical Graduates

The AMA supports the following principles, based on recommendations of the Ad Hoc Committee on Foreign Medical Graduates (FMGs): (1) The AMA encourages American specialty boards to adjust certification procedures to FMGs returning to their home countries. This does not suggest that FMGs should be awarded certificates on the basis of lower standards, but that requisites such as post-qualifying practice in the U.S. should be adapted to FMG diplomats returning home.

(2) The AMA supports the practice of U.S. teaching hospitals and foreign medical educational institutions entering into appropriate relationships directed toward providing clinical educational experiences for advanced medical students who have completed the equivalent of U.S. core clinical clerkships. Policies governing the accreditation of U.S. medical education programs specify that core clinical training be provided by the parent medical school; consequently, the AMA strongly objects to the practice of substituting clinical experiences provided by U.S. institutions for core clinical curriculum of foreign medical schools. Moreover, it strongly disapproves of the placement of any medical school undergraduate students in hospitals and other medical care delivery facilities which lack educational resources and experience for supervised teaching of clinical medicine.

(3) The AMA urges the ECFMG to evaluate current methods for determining the proficiency of alien FMGs in the use of English.

(4) The AMA recognizes that certain state and local medical societies have provided English language training programs to FMGs and encourages other medical societies, in areas where there are concentrations of FMGs needing such training, to consider providing it. Medical societies in areas where there are few FMGs are encouraged to recommend appropriate language programs to FMGs in need of them. (CME Rep. F, A-81; Reaffirmed: CLRPD Rep. F, I-91)

255.999 Final Report of the Ad Hoc Committee on Foreign Medical Graduate Affairs

The AMA (1) For the next three years, supports actively seeking qualified foreign medical graduates for nomination or appointment to councils of the AMA.

(2) Supports the development of a special effort to recruit FMGs to AMA membership.

(3) Encourages state medical societies to make an effort to include qualified foreign-trained physicians among their nominees for medical licensing boards.

(4) Supports considering appointing a qualified FMG as one of its representatives to the ECFMG Board of Trustees.

(5) Encourages state, county and specialty medical organizations to make a special effort to encourage membership and participation by FMGs.

(6) Continues its policy that U.S. medical schools offer admission with advanced standing, within the capabilities determined by each institution, to foreign medical students who satisfy the requirements of the institution for matriculation.

(7) Continues the policy that U.S. medical schools, within the capabilities determined by each school, sponsor one year of supervised clinical experience for foreign medical students in accordance with the criteria established for such programs by the Council on Medical Education ("Fifth Pathway"). Supports the idea of a study recently authorized by the House of Delegates to evaluate the effectiveness of these programs.

(8) Continues to provide U.S. students who are considering attendance at a foreign medical school with information enabling them to assess the difficulties and consequences associated with matriculation in a foreign medical school.

(9) Encourages medical schools to develop special programs for foreign physicians entering the United States as exchange visitors. These programs should be designed to meet the needs of the nations from which the physicians come, as well as the needs of the physicians.

(10) Commends and supports the American specialty boards for their interest in evaluating oral examinations and in developing techniques aimed at enhancing the reliability and validity of oral examinations.

(11) Commends and supports the Federation of State Boards, its several member boards and the ECFMG in their willingness to adjust their administrative procedures in processing FMG applications so that original documents do not have to be recertified in home countries when physicians apply for licenses in a second state. (BOT Rep. G, I-79; Amended and Reaffirmed: CLRPD Rep. C, A-90)

275.978 Medical Licensure

The AMA: (1) urges directors of accredited residency training programs to certify the clinical competence of graduates of foreign medical schools after completion of the first year of residency training; however, program directors must not provide certification until they are satisfied that the resident is clinically competent;

(2) encourages licensing boards to require a certificate of competence for full and unrestricted licensure;

(3) urges the Educational Commission for Foreign Medical Graduates to continue the development and careful evaluation of an examination to determine the adequacy of the clinical skills of graduates of foreign medical schools;

(4) urges licensing jurisdictions to maintain a dual route to licensure by continuing to endorse the certificate of the National Board of Medical Examiners and continuing to use the Federation Licensing Examination for licensing purposes;

(5) urges the Educational Commission for Foreign Medical Graduates to consult with the National Board of Medical Examiners concerning the possible use of Parts 1 and 2 of the National Board examination for ECFMG certification;

(6) urges licensing boards to review the details of application for initial licensure to assure that procedures are not unnecessarily cumbersome and that inappropriate information is not required. Accurate identification of documents and applicants is critical. It is recommended that boards continue to work cooperatively with the Federation of State Medical Boards to these ends;

(7) will continue to provide information to licensing boards and other health organizations in an effort to prevent the use of fraudulent credentials for entry to medical practice;

(8) urges those licensing boards that have not done so to develop regulations permitting the issuance of special purpose licenses. It is recommended that these regulations permit special purpose licensure with the minimum of educational requirements consistent with protecting the health, safety and welfare of the public;

(9) urges licensing boards, specialty boards, hospitals and their medical staffs, and other organizations that evaluate physician competence to inquire only into conditions which impair a physician's current ability to practice medicine. (Amended by: Amended BOT Rep. I-93-13; Amended by: Amended CME Rep. 10 - I-94);

(10) urges licensing boards to maintain strict confidentiality of reported information;

(11) urges that the evaluation of information collected by licensing boards be undertaken only by persons experienced in medical licensure and competent to make judgments about physician competence. It is recommended that decisions concerning medical competence and discipline be made with the participation of physician members of the board;

(12) recommends that if confidential information is improperly released by a licensing board about a physician, the board take appropriate and immediate steps to correct any adverse consequences to the physician;

(13) urges all physicians to participate in continuing medical education as a professional obligation;

(14) urges licensing boards not to require mandatory reporting of continuing medical education as part of the process of reregistering the license to practice medicine;

(15) opposes the use of written cognitive examinations of medical knowledge at the time of reregistration except when there is reason to believe that a physician's knowledge of medicine is deficient;

(16) supports working with the Federation of State Medical Boards to develop mechanisms to evaluate the competence of physicians who do not have hospital privileges and who are not subject to peer review;

(17) believes that licensing laws should relate only to requirements for admission to the practice of medicine and to assuring the continuing competence of physicians, and opposes efforts to achieve a variety of socioeconomic objectives through medical licensure regulation;

(18) urges licensing jurisdictions to pass laws and adopt regulations facilitating the movement of licensed physicians between licensing jurisdictions; licensing jurisdictions should limit physician movement only for reasons related to protecting the health, safety and welfare of the public;

(19) encourages the Federation of State Medical Boards and the individual medical licensing boards to continue to pursue the development of uniformity in the acceptance of examination scores on the Federation Licensing Examination and in other requirements for endorsement of medical licenses;

(20) urges licensing boards not to place time limits on the acceptability of National Board certification or on scores on the Federation Licensing Examination for endorsement of licenses;

(21) urges licensing boards to base endorsement on an assessment of physician competence and not on passing a written examination of cognitive ability, except in those instances when information collected by a licensing board indicates need for such an examination;

(22) urges licensing boards to accept an initial license provided by another board to a graduate of a US medical school as proof of completion of acceptable medical education;

(23) urges that documentation of graduation from a foreign medical school be maintained by boards providing an initial license, and that the documentation be provided on request to other licensing boards for review in connection with an application for licensure by endorsement; and

(24) urges licensing boards to consider the completion of specialty training and evidence of competent and honorable practice of medicine in reviewing applications for licensure by endorsement. (CME Rep. A, A-87)

305.945 Funding of Graduate Medical Education

The AMA: (1) supports the establishment of an authorization system yet to be specified (for example, a voucher system) to provide funding for the training program at the site where training occurs;

(2) supports the development of a portable authorization system for use by US medical graduates, recognizing that the MD/DO degree is only a mid-point of formal medical education;

(3) supports establishment of an authorization system which guarantees funding for US Medical Graduates and additional funding for International Medical Graduates on a competitive basis, based on limits set by the new public/private sector workforce planning group;

(4) supports the development of alternative options for support of teaching hospitals to achieve fiscal stability with reductions in Medicare Indirect Medical Education Adjustment payments and to develop alternative approaches to provide patient services previously provided by resident physicians;

(5) encourages the use of international assistance funds to provide for appropriate US training for physicians from other countries to increase the level of medical care in their home countries; and

(6) supports efforts to allow completion of training of IMG graduates already in training who might be adversely affected by an authorization system. (CME Rep. 1, I-96; Reaffirmed by CME Rep. 13, A-97)

275.983 Licensure

The AMA urges state licensing authorities or other appropriate state agencies to: (1) bar foreign medical students from taking core clinical clerkships in hospitals of their states;

(2) undertake meticulous examinations of the credentials of foreign medical graduates applying for licensure, with particular attention to the clinical education of these students;

(3) cooperate with the Federation of State Medical Boards in its efforts to secure and disseminate information on foreign medical schools;

(4) develop and enforce standards that will preclude the granting of licenses to foreign medical graduates who do not have a degree of Doctor of Medicine from a school or program that meets the standards of the LCME, or who cannot demonstrate as individuals comparable academic and personal achievements; and

(5) require successful completion of FMGEMS for entry into graduate medical education programs. (CME Rep. G, A-86)

295.995 Recommendations for Future Directions for Medical Education

The AMA supports the following recommendations relating to the future directions for medical education:

(28) The AMA recommends to state licensing authorities that they require individual applicants, to be eligible to be licensed to practice medicine, to possess the degree of Doctor of Medicine or its equivalent from a school or program that meets the standards of the LCME or accredited by the American Osteopathic Association, or to demonstrate as individuals, comparable academic and personal achievements. All applicants for full and unrestricted licensure should provide evidence of the satisfactory completion of at least one year of an accredited program of graduate medical education in the US. Satisfactory completion should be based upon an assessment of the applicant's knowledge, problem-solving ability, and clinical skills in the general field of medicine. The AMA recommends to legislatures and governmental regulatory authorities that they not impose requirements for licensure that are so specific that they restrict the responsibility of medical educators to determine the content of undergraduate and graduate medical education.

(32) Policies governing the accreditation of U.S. medical education programs specify that core clinical training be provided by the parent medical school; consequently, the AMA strongly objects to the practice of substituting clinical experiences provided by U.S. institutions for core clinical curriculum of foreign medical schools. Moreover, it strongly disapproves of the placement of any medical school undergraduate students in hospitals and other medical care delivery facilities which lack educational resources and experience for supervised teaching of clinical medicine.

(33) Methods currently being used to evaluate the readiness of graduates of foreign medical schools to enter accredited programs in graduate medical education in this country should be critically reviewed and modified as necessary. No graduate of any medical school should be admitted to or continued in a residency program if his or her participation can reasonably be expected to affect adversely the quality of patient care or to jeopardize the quality of the educational experiences of other residents or of students in educational programs within the hospital.

(34) The Educational Commission for Foreign Medical Graduates should be encouraged to study the feasibility of including in its procedures for certification of graduates of foreign medical schools a period of observation adequate for the evaluation of clinical skills and the application of knowledge to clinical problems. (CME Rep. B, A-82; Amended: CLRPD Rep. A, I-92; Amended by Res. 331, I-95)

305.981 Funding of Graduate Medical Education

The AMA believes that: (1) Graduate medical education is an essential component of the education of all physicians. The health and well-being of the American people are directly benefited by the graduate medical education of physicians. Societal contributions to the financing of graduate medical education are appropriate.

(2) The education of physicians in graduate medical education and the clinical care of patients are inextricably linked. Teaching hospitals should be fully reimbursed for the reasonable costs of residents' salaries and fringe benefits.

(3) All payors of patient care costs should support graduate medical education in the institutions in which care for their beneficiaries is delivered. Support for both direct and indirect costs must include residents assigned to ambulatory care sites that are essential components of educational programs (Reaffirmed by Sub. Res. 706, I-94).

(4) Funding from multiple sources should be available to support residency training programs.

(5) Resident physicians should not be permitted to bill directly for patient care services.

(6) In a period of fiscal constraint, first priority for Medicare funds for residents' salaries and fringe benefits should be accorded to graduates of medical schools accredited by the Liaison Committee on Medical Education or the American Osteopathic Association. Cessation of support for foreign medical graduates should be phased in over an appropriate time period.

(7) Residents should be compensated reasonably in all programs throughout the nation. Uncompensated and under-compensated positions should be discouraged.

(8) Reimbursement for patient care by all payors must be adequate to sustain the nation's teaching hospitals. Adequate indirect cost payments under Medicare should be continued. Government must consider and fund separately the care of the nation's indigent. (BOT Rep. D, I-85; Modified by CLRPD Rep. 2, I-95)

440.984 Mandatory Immunization Requirements for Foreign Students Applying for Visas

The AMA favors requiring that all foreign students, as well as their spouses and offspring, submit as a condition for obtaining a visa, acceptable medical evidence that they have either acquired immunity through previous infection with certain infectious disease agents or through appropriate immunizations against same, in keeping with statutory mandates commonly prevalent in this country. (Res. 11, A-83; Reaffirmed: CLRPD Rep. I-93-1)

540.992 Resident Physician Representation On Advisory Committee For International Medical Graduates

It is the policy of the AMA that a representative of the AMA Resident Physician Section attend all meetings of the AMA Advisory Committee on International Medical Graduates and that this representative participate in all discussions and deliberations of the Committee. (Sub. Res. 18, I-90)

The AMA favors requiring that all foreign students, as well as their spouses and offspring, submit as a condition for obtaining a visa, acceptable medical evidence that they have either acquired immunity through previous infection with certain infectious disease agents or through appropriate immunizations against same, in keeping with statutory mandates commonly prevalent in this country. (Res. 11, A-83; Reaffirmed: CLRPD Rep. I-93-1)