Reply to Barajas-Ochoa: The Imperative to Integrate International Medical Graduates into the Infectious Diseases Physician-Scientist Pathway: Expanding Opportunities and Overcoming Barriers

To the Editor—We are grateful to Dr Barajas-Ochoa for his insightful letter highlighting the pivotal role that Foreign Medical Graduates (FMGs), also known as International Medical Graduations (IMGs) could play in addressing the shortage of physician-scientists in Infectious Diseases (ID). We appreciate the opportunity to expand the discussion on this crucial issue, as raised in our recent call to action [1].

Barajas-Ochoa's observation about the substantial contributions of IMGs to the US health care system, particularly in research, resonates strongly with us. Indeed, as Barajas-Ochoa's letter points out, IMGs have historically represented a significant proportion of the workforce in academic and research settings. The decline in US physician-scientists [2–4], coupled with a similar trend within the ID field [5, 6], underscores the necessity to harness all available talent, particularly those that offer diverse perspectives such as IMGs.

Regarding the integration of IMGs into the ID physician-scientist pathway, we concur that unique barriers need to be addressed [7]. Collaborative efforts between training programs and prospective IMGs would foster a more streamlined path to research opportunities in the United States. The American Board of Internal Medicine and the American Board of Pediatrics Research Pathways [8, 9] present viable models to attract more IMGs by potentially reducing visa-related barriers and providing clearer access to National Institutes of Health (NIH) and non-NIH funding opportunities for these candidates.

Moreover, advocating for modifications in visa sponsorship and funding eligibility is essential. The H1B visa sponsorship mentioned can indeed incur additional costs. However, these costs are well worth the investment as they can strengthen and diversify a workforce that can significantly contribute to scientific research and public health in both adult and pediatric fields. Furthermore, expanding eligibility for funding opportunities, such as NIH grants, to include IMGs on J1 visas without the requirement of returning to their home country could significantly bolster the workforce.

To specifically address the funding challenge, expanding NIH training awards, including the National Research Service Award (NRSA) for Individual Predoctoral (F30, F31) and Postdoctoral (F32) Fellowships, as well as Institutional Training Grants (T32), to include IMGs is critical. Current eligibility restrictions often exclude highly qualified IMGs from these funding opportunities, limiting their ability to engage in rigorous research training. Similarly, broadening eligibility for NIH career development awards (K series), which are pivotal for early career physician-scientists, would provide IMGs with the essential support needed to develop independent research careers. By advocating for these changes, we can create a more inclusive and supportive environment that recognizes the potential contributions of IMGs and leverages their diverse perspectives to advance the field of ID.

Barajas-Ochoa's suggestion to foster collaborations during residency and fellowship to ensure IMGs have access to dedicated research electives is particularly compelling. This would not only enhance their training experience but also integrate them more seamlessly into the research community, paving the way for future innovations in ID management and prevention for both adult and pediatric populations. After fellowship, guiding IMGs through the J1 waiver process and advocating for their involvement in underserved areas without restricting them exclusively to clinical roles could further enhance their contributions to research and clinical practice.

Additionally, it is worth noting that requiring IMGs to repeat residency training to practice medicine can become a significant deterrent for those seeking fellowship training, especially on the physician-scientist track. Perhaps waivers from appropriate credentialing bodies could be explored. If implemented, such waivers could help retain highly skilled IMGs in the physician-scientist workforce, reducing barriers and encouraging their valuable contributions to both clinical practice and research.

In conclusion, recognizing and integrating IMGs into the ID physician-scientist workforce, covering both adult and pediatric specialties, is not just a necessity but provides a strategic advantage and fulfills an unmet need. Barajas-Ochoa's letter provides valuable considerations that should be acted upon to ensure the robustness of future research and health care delivery. We hope this dialogue continues and leads to substantive policy and procedural changes that will benefit the ID field and health care at large.

Notes

Acknowledgments. The authors thank the members of Infectious Diseases Society of America (IDSA) Research Committee for their invaluable support and insights that greatly enriched this correspondence, particularly Amanda Jezek, Senior Vice President, Public Policy and Government Relations, Eli Briggs, Director of Public Policy, and Sara Hoopchuk, Senior Public Policy Coordinator at IDSA. ChatGPT (OpenAI, ChatGPT-4) was used for the outline of this article. All authors have been members of the IDSA Research Committee.

Financial support. No financial support was received for this work.

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