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A Rising Tide: The Changing Landscape of Urology Residencies and Its Impact on Non-US Foreign Medical Graduates

2023; Lippincott Williams & Wilkins; Volume: 210; Issue: 6 Linguagem: Inglês

10.1097/ju.0000000000003742

1527-3792

Khalid Y. Alkhatib, Phillip M. Pierorazio,

Healthcare Policy and Management

You have accessJournal of UrologyEditorials1 Dec 2023A Rising Tide: The Changing Landscape of Urology Residencies and Its Impact on Non-US Foreign Medical Graduates Khalid Y. Alkhatib and Phillip M. Pierorazio Khalid Y. AlkhatibKhalid Y. Alkhatib https://orcid.org/0000-0002-6008-0503 Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics (Penn LDI), University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author and Phillip M. PierorazioPhillip M. Pierorazio Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics (Penn LDI), University of Pennsylvania, Philadelphia, Pennsylvania Online Content Editor More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003742AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail We extend our heartfelt commendation to Dr Alsyouf for the bravery he demonstrates by sharing his life story as a lens through which to view the complex hurdles foreign medical graduates (FMGs) face in securing advanced medical education and training in the US.1 Regrettably, it's evident that many who find themselves in parallel circumstances lack the appropriate platforms to articulate the obstacles they encounter, often constrained by the dread of retaliatory consequences. The author's consistent smile, particularly when questioned about the journeys undertaken to renew his J-1 visa, is a poignant part of the story—suggesting that the burden of his particular plight has been deferred, at least until the conclusion of his clinical training, a reality that remains both disconcerting and problematic. As such, we appreciate this opportunity to comment on the role of the FMGs in urologic care in the US. The landscape of urology residencies in the US has significantly evolved over the years, growing into a fiercely competitive field for students interested in becoming urologists. These changes pose considerable challenges, especially for FMGs aspiring to specialize in urology.2 Historically, urology programs had a surplus of residency slots and faced less competition, thus providing an entryway for FMGs.3,4 However, the field has evolved to become highly competitive, attracting elite candidates from within the US with extensive clinical and research experience.5 This hypercompetitive atmosphere has made it increasingly difficult for FMGs to secure US urology residencies. Successful FMG applicants are now often highly sought-after scientists and top scholars. They frequently boast extensive research backgrounds from years of work in US institutions or abroad. They represent some of the finest minds with an incredible work ethic from their home countries. In addition to such competitiveness, FMGs face exacerbated difficulties as they must navigate stringent administrative requirements, compounded by visa hurdles, and often lack institutional support.6 Despite all these difficulties, the US remains an attractive hub for foreign talent because of the elite training and the scientific opportunities, providing a strong incentive for those top-notch individuals to leave their home countries and come to the US. Compounding the academic challenges are complexities related to visa processing.6 The US offers 2 primary visa types for FMGs, J-1 and H-1B, each with their own unique challenges and delays.7 These bureaucratic roadblocks often deter program directors from admitting FMGs, a hesitancy that is further amplified by a widespread lack of recognition for foreign medical credentials.2 Those who are successful in getting into residency continue to deal with such challenging bureaucratic hurdles related to US immigration policies both during their training and later professionally.8 This current inefficient system not only hampers the timely integration of FMGs into the US health care system, but also affects their wellness, as it imposes considerable psychological and emotional strain on them.7 It would be rare to deny a US-based urology resident the ability to visit family, friends, or a support network—a point made very clear by the original work by Dr Alsyouf.1 Furthermore, the situation might put them in a vulnerable position, leading to many FMGs encountering workplace discrimination, isolation, and exploitation. There is currently a lack of focused research to understand these unique challenges.6 We already know that burnout is alarmingly prevalent among urology residents and AUA members, with rates ranging from 38% to 68.2%.9,10 The logistical and psychological barriers associated with US visa complexities further impose a unique challenge, as these bureaucratic and social stressors directly impact the wellness of FMGs. Addressing these challenges and systemic inefficiencies is crucial for improving both the quality of medical care and the well-being of all physicians in the US health care system. Therefore, we think it's crucial for fields like urology to actively participate in shaping evolving graduate medical education policies to maintain high training standards while also considering the unique challenges and contributions of FMGs. First, a better understanding of immigration policies and education regarding these challenges can help US urology programs understand the process of accepting FMGs. With misconceptions about immigration resolved, urology programs can develop a better ability to discern high-quality FMG applicants, and urology can work toward a more equitable and globally representative workforce. FMGs bring considerable value by diversifying the workforce and serving in underserved areas. Given the numerous obstacles required to become a urologist in the US, FMGs often make significant academic contributions and advance patient care, solidifying the US as an international hub of medical expertise and a significant player in the global scientific community. Once urology programs accept FMGs, health care organizations can focus on providing more support, such as accessible mental health services, additional job training, and social integration opportunities to improve FMG well-being. A balanced approach that meets health care needs both domestically and globally would not only elevate the quality of care, but also foster a more diverse and inclusive work environment. As the US health care system navigates these intricate challenges, it must consider administrative reforms, targeted support measures, and policy interventions. Only through such comprehensive efforts can we hope to build a more equitable, efficient, and effective health care system. Bringing high-quality and exceptional FMGs into urology can only “lift the tide” of quality urologic care in this country and beyond. REFERENCES 1. . Stranded in paradise: the conundrum of the foreign medical graduate and the visa sponsorship program. J Urol. 2023; 210(6):837-838. Link, Google Scholar 2. International medical graduate training in urology: are we missing an opportunity?. Urology. 2016; 95:39-46. Crossref, Medline, Google Scholar 3. Temporal trends and practice patterns in the urology work force between low and high density population areas. Urol Pract. 2017; 4(1):91-95. Link, Google Scholar 4. Recent trends in the urology workforce in the United States. Urology. 2013; 82(5):987-993. Crossref, Medline, Google Scholar 5. Geographical distribution of international medical graduates across USA urology residency programs: an analysis of trends and outcomes. Urol Pract. 2023; 10.1097/UPJ.0000000000000433. Link, Google Scholar 6. International medical graduate resident wellness: examining qualitative data from J-1 visa physician recipients. Acad Med. 2022; 97(3):420-425. Crossref, Medline, Google Scholar 7. . The implications of the current visa system for foreign medical graduates during and after graduate medical education training. J Gen Intern Med. 2019; 34(7):1337-1341. Crossref, Medline, Google Scholar 8. . Regulating high-skilled immigration: the market for medical residents. J Health Econ. 2021; 76:102436. Crossref, Medline, Google Scholar 9. American Urological Association. Census Results: U.S. Urologists, 2019-2022. https://www.auanet.org/research-and-data/aua-census/census-results Google Scholar 10. . Residency and burnout: are we so different from other training programs?. Can Urol Assoc J. 2021; 15(6 suppl 1):S31-S32. Crossref, Medline, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 210Issue 6December 2023Page: 835-836 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Khalid Y. Alkhatib Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics (Penn LDI), University of Pennsylvania, Philadelphia, Pennsylvania More articles by this author Phillip M. Pierorazio Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania Leonard Davis Institute of Health Economics (Penn LDI), University of Pennsylvania, Philadelphia, Pennsylvania Online Content Editor More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...