Physician Workforce Research Articles

Scope of Practice Intentions Among Family Medicine Residents for Integrated Care of HIV and Hepatitis C Infection in People With Opioid Use Disorder

Background and Objectives: Because deaths from opioid overdoses have increased in the United States, family physicians are needed who can provide integrated care for a patient with HIV, hepatitis C, and opioid use disorder. We sought to describe the individual and residency characteristics of graduating family medicine residents who intend to practice such integrated care. Methods: We used 2017–2021 data from the American Board of Family Medicine Initial Certification Questionnaire. Our primary outcomes were individual and residency characteristics of resident graduates who intended to provide integrated care. We used logistic regression to assess independent associations with providing integrated care. Results: The response rate was 100% with 18,479 total respondents. After exclusions, our final sample size was 10,660 (57.7%) respondents. Of those, 782 (7.3%) respondents intended to practice integrated care. Using regression analyses, we found that resident graduates who intended to provide integrated care were more likely to be male, non-Hispanic or Latinx. After residency, they were more likely to intend to practice at a federally qualified health center, Indian Health Service, or nonfederal government clinic. Conclusions: Only 7% of residency graduates reported their intention to provide integrated care for people with opioid use disorder after residency. In response to a surging opioid crisis, policymakers, residency educators, and residency funders/sponsors should increase the workforce of family physicians who can provide this integrated care.

Abstract 4136636: Analysis of Racial Disparities in the Training Path to Cardiology: Trends from 2012 to 2022

Introduction: Substantial evidence indicates that racial and ethnic diversity among the physician workforce bridges cultural gaps and improves patient care. Trends in racial diversity across the full training pipeline from undergraduate to practicing cardiologist are not yet well-characterized. Aims: We analyze racial disparities at each stage of training towards becoming a practicing cardiologist, and identify changes in these disparities between 2012 and 2022. Methods: We conducted a retrospective analysis of data specifying the racial composition of medical trainees acquired from the Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and Electronic Residency Application Service. Population data was acquired from the US Census Bureau. We computed the representation quotient (RQ) for each racial group at each stage to compare representation among the trainees or physicians to age-matched segments of the US population. Results: RQ decreases from undergraduate to active cardiologist for African Americans (0.719 to 0.314), Hispanics (0.660 to 0.359), American Indians (0.551 to 0.221), and Native Hawaiians (1.121 to 0.512). The lowest RQs of 0.133 and 0.137 were observed for American Indian active internal medicine residents and cardiology fellows, respectively. Racial disparities in medical education declined between 2012 and 2022, with RQs increasing from 0.541 to 0.735 for African American medical school matriculants and from 0.444 to 0.578 for Hispanic medical school matriculants. Similar increases were seen in the active cardiologist population for African Americans (2013 RQ: 0.227, 2022 RQ: 0.342) and Hispanics (2013 RQ: 0.283, 2022 RQ: 0.375). Conclusion: While racial diversity in the cardiology training pipeline has increased over the last decade, significant disparities persist for under-represented minorities. Addressing these barriers will help achieve a cardiology workforce reflective of the diverse population it serves.

Medical school service regions in Canada: exploring graduate retention rates across the medical education training continuum and into professional practice

ABSTRACT Purpose To create medical school service regions and examine national in-region graduate retention patterns across the medical education continuum and into professional practice as one approach to advancing social accountability in medical education. Methods Medical school service regions were created in Canada using publicly available data and mapped using Geographic Information System (GIS) software. Population size and density for each service region were calculated using census data. Retrospective data of medical graduates who completed their medical degrees between 2001–2015 (n = 19,971) were obtained from a centralized data repository and used to analyze in-region retention rates by medical specialty across the training continuum and five years into professional practice. Results Spatial inequities were observed across medical school service regions. Graduate retention patterns also varied across service region groups and medical specialties. Quebec (86.5%) and Ontario (80.4%) had above-average retention rates across the medical education continuum. Family medicine had the highest retention rates from undergraduate to postgraduate training (81.9%), while psychiatry had the highest retention rate across the training continuum and into professional practice (71.2%). The Alberta and British Columbia service region group demonstrated high retention rates across the training continuum and into professional practice and medical specialties, except for retention from undergraduate to postgraduate medical education. Conclusion This study highlights the importance of considering both medical specialty and practice location of graduates when planning and retaining the physician workforce. The observed retention patterns among graduates are a critical aspect of addressing societal needs and represent an intermediate step towards achieving health equity. Furthermore, graduate retention patterns serve as an outcome measure for schools to demonstrate their commitment to social accountability. Tracking and monitoring graduate outcomes may lead schools to actively collaborate with government agencies responsible for healthcare policy, which may ultimately improve physician workforce planning and promote more equitable healthcare access.

A cross sectional analysis of residents by race/ethnicity and specialty from 2020-2023

BackgroundMinorities are underrepresented in all areas of medical education relative to the United States general population, and minority physicians are more likely to practice in disadvantaged areas and in primary care settings. Many individual and structural factors contribute to this discrepancy. We aimed to demonstrate how resident race/ethnicity representation differs across the various resident specialties. MethodsWe used publically available data from the Association of American Medical College's Report on Residents data series and averaged the four academic years from 2019 to 2020 through 2022-2023. We then calculated the odds ratio (OR) of self-reported race/ethnicity (alone and in combination) in thirty-four specialties. ResultsAcross the four-year study period, there were, on average, 147026 unduplicated resident trainees. The average number of duplicated residents by self-identified ethnic category (alone and in combination) include: American Indian or Alaska Native (839, 0.6%), Asian (31627, 21.5%), Black or African American (7935, 5.4%), Hispanic, Latino, or of Spanish Origin (10900, 7.4%), Native Hawaiian or Other Pacific Islander (296, 0.2%), White (76289, 51.9%), Other (4879, 3.3%), Unknown (522, 0.4%), and Non-US Citizens (23914, 16.3%). Across race/ethnicity, there are differences in ORs of representation in different specialties. Key findings include high representation in Public Health and Preventative Medicine by Black and African American (OR=3.7) and Native Hawaiian (OR=2.6) residents, and Family Medicine in Native Americans (OR=1.9), Native Hawaiian (OR=1.7), Black (OR=1.5), and Hispanic (OR=1.3) residents. Psychiatry also had high ORs of representation in minority residents. ConclusionThis study illustrates relative resident ethnic representation across training specialties. Minorities ethnicities were more likely to be represented in primary care and public health domains. This has implications for creating a physician workforce suitable to serve the United States Population.

Social Accountability at Southern Illinois University School of Medicine: A Focus on Admission Policy

Given the increasing health disparities across regions and populations, social accountability is not an option but an obligation for health professions schools, including medical schools. In this short communication, the authors report the case of Southern Illinois University School of Medicine (SIU SOM), which has been an exemplary medical school for social accountability, receiving the 2013 AMEE ASPIRE Award in social accountability and the 2018 Josiah Macy Jr. Foundation Award for Institutional Excellence in Social Mission in Health Professions Education. This paper focuses on the school’s admission policies in the discussion of its social accountability. It starts with the background of central and southern Illinois, where the school is located to address the shortage of healthcare professionals in the areas. It discusses the school’s holistic admission policies and two pipeline programs—namely, MEDPREP and McNeese Physician Preparatory Pipeline Program (P4)—that are strategically designed as a long-term physician workforce development plan to address health disparities in rural areas. As of January 30, 2024, 3,233 students have earned the MD (Doctor of Medicine) degree at SIU SOM. In total, 770 alumni (33%) are practicing in primary care. Among 901 graduates practicing in Illinois, 484 (54%) are practicing in SIU SOM service area counties (i.e., central and southern Illinois). Social accountability is the core value and organizational identity of SIU SOM and the guiding principle of the school’s innovation and excellence.

Perspectives on Medical School Admission for Black Students Among Premedical Advisers at Historically Black Colleges and Universities

There remains a lack of representation of Black physicians in the physician workforce despite decades of national efforts to increase diversity. Historically Black Colleges and Universities (HBCUs) contribute to increasing representation in the workforce in the US. There is limited literature exploring the experiences of HBCU premedical students navigating the journey to medical school. To examine barriers to and facilitators of medical school matriculation among Black students by exploring the perspectives of premedical student advisers at HBCUs. In this qualitative study, HBCU advisers participated in a focus group in October 2019 or in semistructured interviews from January 2020 to March 2021. Using purposive sampling, premedical student advisers were recruited from different educational backgrounds and geographic locations and conducted 1-on-1 interviews. Data analysis was performed from March 2021 to March 2022. The main outcome was the experiences of HBCU premedical students navigating to medical school from the perspective of premedical advisers. An inductive approach to generate codes from the interviews and the focus groups was applied by reviewing transcripts and noting concepts and themes associated with advising strategies and student experiences. Among the 26 participants, 18 (69.2%) were female, 13 (50.0%) had a doctorate degree, and 8 (30.8%) had more than 10 years of experience as advisers. Participants described 3 major themes: (1) the complex institutional relationship dynamics between undergraduate HBCUs and medical schools, (2) concerns about preferential treatment for students from predominantly white undergraduate schools when accessing clinical shadowing opportunities, and (3) the "it takes a village mindset" emphasizing family and peer involvement. In this qualitative study, barriers to medical school matriculation included concerns for the preferential treatment of students from predominantly white institutions when engaging with medical schools and a lack of access to clinical opportunities for HBCU students. The findings suggest that medical schools should continue to build collaborative partnerships with HBCUs to ensure equitable access to opportunities that prepare students for medical school.

Pediatric pain physician workforce: an assessment of supply and demand.

Many youth with pain lack access to pediatric pain expertise. There is a critical shortage of pediatric pain physicians, due partly to a paucity of training programs in Pediatric Pain Medicine. Pain fellowships are Anesthesiology-based and there is no pathway to fellowship training or Pain Medicine board certification for pediatricians. This workforce assessment sought to examine the current state of Pediatric Pain Medicine in the United States and future interest in pursuing Pain Medicine among pediatricians. A multidisciplinary working group of Pain Medicine clinicians designed three surveys to examine pediatric comprehensive pain programs in the US, practice patterns of pediatricians and their motivations and opinions regarding Pain Medicine board certification, and current residents' exposure to and interest in Pediatric Pain Medicine. Wait times for initial evaluations are two months or longer for two-thirds of responding centers, and barriers to increase staff size and resources were reported, including an inadequate number of trained or available physicians. Pediatricians expressed interest in earning board certification in Pain Medicine, given the opportunity. Additionally, there is interest among pediatric residents in pursuing Pediatric Pain Medicine, and qualitative data highlight information residents perceived needing in order to pursue a career in the field. Results demonstrate the need for increased training opportunities in pediatric pain medicine. A formal pathway to Pain Medicine for Pediatricians should be developed to increase the potential workforce and to address the lack of trained pediatric pain specialists, thereby improving access to care for youth with pain.

Fostering Inclusivity in the Clinical Learning Environment.

Despite the Supreme Court's decision on race-based admissions, academic medical centers, medical societies, and accreditation bodies remain committed to recruiting a diverse workforce. Many medical schools and graduate medical education programs created initiatives to expand their census of underrepresented in medicine (UIM) as the key to addressing health care disparities. As a result, an influx of an UIM physician workforce has entered clinical learning environments, often without consideration of the inclusivity of these settings. To create inclusive, safe, and comfortable CLEs, we must first recognize the challenges faced by UIM trainees, students, and faculty and the complex ways in which discrimination manifests. Ultimately, having inclusive CLEs allows all learners, especially those from historically excluded identities, to thrive in their training and working environment, making it essential to retain the diverse workforce necessary. Using case examples, we discuss strategies of inclusivity and ways in which we can maintain clinical learning environments where learners feel safe and supported through their training.

Adequacy of the physician workforce for preparing for future society in Korea: an English translation

Adequacy of the physician workforce for preparing for future society in Korea: an English translation

Trends in gender and ethnic diversity among US psychiatry residents: A 5-year analysis.

This study aims to analyze trends in gender and ethnic diversity among incoming US psychiatry residents over the past 5 years. Physician diversity improves patient care as minority physicians often serve underserved communities and address health disparities. Increasing the representation of women and underrepresented minorities in medicine is essential for preparing a physician workforce that can effectively care for an increasingly diverse population. This study highlights the importance of efforts to enhance diversity within the field of psychiatry.

One size does not fit all for URiM applicants: a comparison of NPM program size on URiM applications.

Neonatal-perinatal medicine (NPM) lacks a racially and ethnically diverse physician workforce. Fewer trainees from groups underrepresented in medicine (URiM) are entering NPM due to declining match rates in general pediatrics, financial burdens from delaying workforce entry, and ineffective recruitment into NPM. Annual surveys from the Organization of Neonatology Training Program Directors (ONTPD) were analyzed to assess URiM recruitment trends between 2021 and 2023. Concerningly, the number of URiM candidates applying to NPM fellowship programs remains low, highlighting the need for investment in pathway programming and enhanced recruitment strategies to diversify the NPM workforce. A multifaceted approach, including promoting early interest in pediatrics, minimizing financial disincentives, collecting robust URiM trainee and workforce data, and creating inclusive, diverse educational environments will be critical to increasing URiM representation in NPM and ultimately improving health outcomes for neonates.

Racial Disparities in Surgical Oncologic Research Funding and Impact on Diverse Populations.

Racial disparities in surgical oncology research funding significantly impact minority researchers and diverse populations. This review explores historical factors contributing to the underrepresentation of minorities in academic medicine. Strategies for addressing these disparities include enhancing diversity in the physician workforce and improving funding opportunities for minority researchers, with the goal of improving patient outcomes and reducing cancer care disparities.

The importance of pathway programs in increasing diversity in dermatology: Efforts made by the American Academy of Dermatology

Our country's population continues to diversify, highlighting the need for an equally diverse physician workforce to care for patients. Unfortunately, the percentage of underrepresented minority residents in dermatology has remained relatively unchanged over the past several years. To address this disparity, the American Academy of Dermatology created the Pathways Programs to focus on early exposure to dermatology, skill-building workshops, research, and mentorship. The overarching goal is to increase the number of underrepresented minority dermatologists, which will result in improved patient care and mitigation of healthcare disparities.

Gender Differences in Planned Retirement Age Among Medical Students: Are Changes on the Horizon?

ABSTRACT Gender Differences in Planned Retirement Age Among Medical Students: Are Changes On the Horizon? Purpose Planned age of retirement has an important effect on the physician workforce. Earlier studies of practicing physicians have reported that the planned as well as actual retirement age was significantly younger for women. Also, previous reports had shown that rural physicians tended to retire earlier. This paper offers a view earlier in the physician pipeline and reports surveys of medical students and pre-medical college students concerning their retirement plans. Methods During 2015-2019, 70 college students and 41 medical students at a regional rural medical campus completed a career eulogy that included their planned retirement age. Results Combining both groups of students, women planned to retire at a mean age of 61.9 and men at 59.1, P=0.048. A longitudinal comparison of just medical students showed that prematriculation students just before starting medical school had the oldest planned age of 66.9, compared to college students (57.4 to 58.9) and medical students (64.0 to 64.6), P=0.049. There was no difference in planned retirement age in rural vs urban upbringing. Conclusions In this group of pathways students, women planned to retire almost 3 years later than men, which differs from earlier reports of physicians in practice. The men planned retirement almost 5 years earlier than in previous reports of planned retirement age. There was no difference in rural vs urban upbringing. Whether this is a generalizable finding will require similar studies in different student populations on other campuses, and our survey instrument is available for others to look deeper into the process of professional identity formation that may explain any differences in planned retirement age.

Asian representation in the United States (US) oncology workforce.

152 Background: The American Society of Clinical Oncology (ASCO) started the Diversity in Oncology initiative in 2017. Minority representation in the US oncology physician workforce was the subject of a recent series of ASCO State of the Oncology Workforce in America snapshots (1). However, Asian minority representation was not mentioned in any of these reports. Our objective was to determine the proportion of Asian workforce in various oncology specialties inclusive of physician and non-physician practitioners as well as physician trainees. Methods: We searched the web for publicly available data on Asian representation among US oncology adult (A) and pediatric (P) practitioners and trainees. Major data sources included the 2020 US Census, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and professional societies. Practitioners included hematologists/oncologists (H/O), gynecologic oncologists (GYNO), radiation oncologists (RADO), surgical oncologists (SURGO), hematopathologists (HP), oncology nurse practitioners (ONP), oncology physician assistants (OPA), and oncology nurses (ON). Trainees included fellows (F) and residents (R). For reference, we obtained similar data on US population, medical students (MS), adult internal medicine residents (AIMR), gynecology residents (GYNR), pediatric residents (PR), pathology residents (PATHR), surgery residents (SURGR), nurses (RN), nurse practitioners (NP), and physician assistants (PA). For a snapshot of the oncology workforce, data from 2020-2022 were used. Whenever available, we obtained serial data for trainees over the years. Results: A snapshot of the proportions of Asians based on their professions is shown (Table). While Asians comprise only 6.2% of the US population, between 14.7% to 32.1% of physician practitioners in various oncology subspecialties are Asian. Moreover, between 17.9% to 35.3% of oncology physician trainees and 26.7% of medical students are Asian and these proportions have remained stable from 2005 to 2022. Data are unavailable for HP, SURGO, and non-physician practitioners except for OPA (7.0%) and RN (7.2%). Conclusions: Asians comprise a large segment of the US oncology workforce. While only 1 in 20 people in the US are Asians, between 1 in 3 and 1 in 5 oncology physician practitioners and trainees are Asians. Data are limited for non-physician practitioners. Asian minority representation should be highlighted and considered as an example of success in diversity. 1. JCO Oncol Pract 2020-2022. Snapshot of Asian representation among oncology trainees and practitioners in the US. Trainees 2022 A-H/O-F 35.3% AIMR 35.9% 2022 P-H/O-F 20.0% PR 22.0% 2022 RADO-R 26.4% MS 26.7% 2022 GYNO-F 17.9% GYNR 14.9% 2022 HP-F 20.0% PATHR 26.6% 2022 SURGO-F 21.2% SURGR 19.2% Practitioners 2021 A-H/O 32.1% OPA 7.0% 2021 P-H/O 20.4% RN 7.2% 2021 RADO 25.9% HP/SURGO/ONP/ON NA 2020 GYNO 14.7% US Census 6.2%

Assessment of nurse practitioners’ capacity of using the ABC/2 formula for intracranial lesion volume measurement

BackgroundThis study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance.MethodsWe conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency.ResultsAmong the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen’s d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience.ConclusionsNurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs’ roles in other clinical diagnostic and therapeutic tasks.

Shifting the Paradigm in Workforce Diversity: Prioritizing an Inclusive Environment in Graduate Medical Education.

A diverse physician workforce is important to achieving the goal of health equity. Recruitment efforts are often the focus of graduate medical education (GME) workforce diversity efforts. However, to achieve the goal of workforce diversity, a foundation of inclusivity is essential to address the experiences of trainees whose race and ethnicity are underrepresented in medicine (UIM).Professional identity formation (PIF) describes the process through which trainees integrate their personal and professional identities as they learn to not only act but feel like they belong in their professional role. The concept of PIF provides a framework to consider how GME leaders can intentionally address inclusivity in training programs. The process of PIF is influenced by many factors including trainees' clinical and non-clinical experiences, their treatment by others, as well as the training program's structure, policy, and physical environment. The authors describe these factors influencing PIF, then through the lens of PIF, describe approaches that programs and institutions have taken to address inclusivity by investing in the workforce, disrupting the hidden curriculum, revisiting policies and procedures, and examining the physical environment.The authors encourage programs, institutions, and the greater GME community to leverage each learning environment's unique strengths and root out challenges to enhance inclusivity for UIM trainees.

Perceptions of the current and future emergency medicine workforce.

The objectives of the study were to assess emergency medicine (EM) physician perceptions of the EM job market 2 years after "The Emergency Medicine Physician Workforce: Projections for 2030" was published in Annals of Emergency Medicine and to examine how the workforce report may have influenced perceptions about job prospects. A cross-sectional survey was conducted in 2022 of EM residents, fellows, and attendings at 21 practice sites. Main outcomes were perceptions of the likelihood of currently finding any job, currently finding a desirable job, and confidence in the future EM job market. Note that 831 of 1938 physicians (42.9%) responded. A total of 92.4% reported a high likelihood of finding any job currently, 49.8% reported a high likelihood of finding a desirable job currently, and 44.4% reported future confidence. Workforce report familiarity was associated with greater likelihood of finding a desirable job. Fellows were least confident in the future. Residents with desired Midwest location were twice as confident in the future job market; those with desired West location were less confident. Attendings 20 or more years post-training were more than twice as likely to report a high likelihood of finding a desirable job and almost twice as likely to report future confidence. Attendings in leadership were nearly three times as likely to report high a likelihood of finding a desirable job and future confidence. EM trainees and attendings have favorable perceptions of the current job market but are less confident in future prospects. As the projected surplus of EM physicians appears to have had an impact, updated projections are needed for more accurate assessments of the future of the specialty.

PROMOTE: An Innovative Curriculum to Enhance the Maternity Care Workforce.

Maternal morbidity and mortality disproportionally affect marginalized populations in both rural and urban settings. While the workforce of family physicians (FPs) who provide maternity care is declining, an enhanced obstetrics (OB) curriculum during residency training can help prepare future FPs to provide competent pregnancy care, particularly in marginalized communities. We developed an innovative OB curriculum-PROMOTE: Primary care obstetrics and maternal outcomes training enhancement-in an urban underserved residency program in Pennsylvania that directly addressed barriers previously known to impact maternity care practice. We created a clinical competency assessment aligned with Accreditation Council for Graduate Medical Education requirements, and we reviewed resident feedback and logs throughout and upon completion of the track. After 3 years of implementation, 23 of 48 (48%) total residents entered and/or completed PROMOTE, compared to 17 of 45 (38%) total residents who chose the OB track in the 5 years prior to implementation. Postimplementation, 29.6% of total graduates practice inpatient obstetrics, compared to 26.6% prior to implementation. Twice annual competency evaluations were completed for all residents on the track. Our review of resident submitted feedback, logs, and competency assessments suggests that the curriculum has positively impacted their knowledge, skills, and clinical care provision. PROMOTE's curricular innovation enhances obstetrical training by addressing known facilitators and barriers to practicing family medicine obstetrics. PROMOTE was implemented in an existing family medicine residency with an obstetrics track and could be adapted by other residency programs to enhance the future maternity care workforce.

Predictors for success and failure in international medical graduates: a systematic review of observational studies

BackgroundInternational Medical Graduates (IMG) are an essential part of the international physician workforce, and exploring the predictors of success and failure for IMGs could help inform international and national physician labour workforce selection and planning. The objective of this study was to explore predictors for success for selection of IMGs into high stakes postgraduate training positions and practice and not necessarily for informing IMGs.MethodsWe searched 11 databases, including Medline, Embase and LILACS, from inception to February 2022 for studies that explored the predictors of success and failure in IMGs. We reported baseline probability, effect size in relative risk (RR), odds ratio (OR) or hazard ratio (HR) and absolute probability change for success and failure across six groups of outcomes, including success in qualifying exams, or certificate exams, successful matching into residency, retention in practice, disciplinary actions, and outcomes of IMG clinical practice.ResultsTwenty-five studies (375,549 participants) reported the association of 93 predictors of success and failure for IMGs. Female sex, English fluency, graduation recency, higher scores in USMLE step 2 and participation in a skill assessment program were associated with success in qualifying exams. Female sex, English fluency, previous internship and results of qualifying exams were associated with success in certification exams. Retention to work in Canada was associated with several factors, including male sex, graduating within the past five years, and completing residency over fellowships. In the UK, IMGs and candidates who attempted PLAB part 1, ≥ 4 times vs. first attempters, and candidates who attempted PLAB part 2, ≥ 3 times vs. first attempters were more likely to be censured in future practice. Patients treated by IMGs had significantly lower mortalities than those treated by US graduates, and patients of IMGs had lower mortalities [OR: 0.82 (95% CI: 0.62, 0.99)] than patients of US citizens who trained abroad.ConclusionsThis study informed factors associated with the success and failure of IMGs and is the first systematic review on this topic, which can inform IMG selection and future studies.Systematic review registrationPROSPERO: CRD42021252678.