Bibliometric Analysis of International Medical Graduates and Professorship Promotion in Neurosurgery

Abstract

International medical graduates (IMGs) comprise ∼25% of physicians in the United States. Differences in promotion rates from assistant to associate to full professorship based on medical school location have been understudied. We aim to stratify odds of professional advancement by 3 categories: IMG with U.S. residency, IMG with international residency, and U.S. medical with U.S. residency training. We created and queried a database after exclusions of 1334 neurosurgeons including multiple demographic factors: academic productivity and promotion rates. Stratified logistic regression modeled odds of promotion including the variables: decades out of training, Scopus h-index, gender, and training location. Odds ratios (ORs) and 95% confidence intervals (CIs) for each variable were calculated. Significant predictors of increased associate versus assistant professorship included decades out of training (OR= 2.519 [95% CI: 2.07-3.093], P < 0.0001) and Scopus h-index (OR= 1.085 [95% CI: 1.064-1.108], P < 0.0001) while international medical school with U.S. residency (OR= 0.471 [95% CI: 0.231-0.914], P= 0.0352) was associated with decreased promotion. Significant predictors of associate versus full professorship were decades out of training (OR= 2.781 [95% CI: 2.268-3.444], P < 0.0001) and Scopus h-index (OR= 1.064 [95% CI: 1.049-1.080], P < 0.0001). Attending medical school or residency internationally was not associated with odds of full professorship. Time out of residency and Scopus h-index were associated with higher academic rank regardless of career level. Attending medical school internationally with U.S. residency was associated with lower odds of associate professorship promotion over 10 years. There was no relationship between IMG and full professorship promotion. IMGs who attended residency internationally did not have lower promotion rates. These findings suggest it may be harder for IMGs to earn promotion from assistant to associate professor in neurosurgery.