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New Visa Limits for Foreign Medical Graduates: Crisis in Subspecialty Care in USA

Department of Cardiac Surgery Children's Hospital, Harvard Medical School Boston, Massachusetts, USA

In June 1999, new regulations affecting Education Council for Foreign Medical Graduates (ECFMG) sponsorship of visas for foreign medical graduates (FMGs) wishing to come to the United States (US) were published in the Federal Register. The new rules specified that in future ECFMG could only sponsor trainees who were accepted by an Accreditation Council for Graduate Medical Education (ACGME)-accredited program. Furthermore, the duration of ECFMG sponsorship is limited to the length of training accredited by ACGME. These new regulations are a particular imposition for subspecialty programs which are not ACGME-accredited like congenital cardiac surgery or thoracic transplantation, and for those FMGs wishing to train in these cutting-edge areas. This article will examine why these regulations both for the US as well as for other countries make little sense and should be revoked.

	QUALITY OF CARE

 
The first priority of any government health policy must be to optimize the quality of care provided to that government's constituents. A subspecialty such as congenital cardiac surgery is personnel-intensive requiring a large number of highly trained intensive care nursing staff as well as physicians. Residents spend limited time on a congenital rotation as part of their basic training in cardiothoracic surgical training, and during that time acquire a basic understanding of the terminology and concepts of the specialty. Fellows have usually completed some or all of their general cardiothoracic training and are acquiring more advanced concepts and operating skills. The ability of fellows to provide a skilled level of assistance in the operating room as well as managing the many surgical aspects of intensive care management are essential for optimal outcome for patients with complex congenital cardiac problems. An example of the level of expertise required is the current management of a cardiac arrest in a postoperative patient. While in the past simple cardiopulmonary resuscitation techniques . . . [Full Text of this Article]

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