New Policies affecting some International Medical Graduate (IMG) Faculty
Dr. Luca Cicalese, and colleagues, were invited to speak on issues related to new policies affecting some International Medical Graduate (IMG) Faculty. Dr. Cicalese stated there has been an increased pressure to implement a mandatory requirement
for American Board Certification and unrestricted licensure at UTMB. We would like to point out possible limitations and detrimental effects of such proposed changes.
It was stated that most doctors in the US have an unrestricted license, however, some of them do not qualify for unrestricted licensure in selected States due to the different requirements of the respective Medical Boards. It is important to note
that these are not underqualified doctors, but International Medical Graduates (IMG) who have been granted a different type of license to allow them to work in the US Academic Institutions because of their specific expertise and skills. Some
of these come to the US to address a gap in positions that could not be filled by American Doctors. These doctors have worked for years in the US, become US citizen and have been teaching medicine and science to countless American Medical
Students, residents (in ACGME accredited programs), and fellows. A few faculty at UTMB have been recruited for their skills and value to establish new programs. Some had unrestricted license in other US State before joining UTMB and
some are tenured professors. These have all worked with great value for the Institution and the community for many years. They are professionally esteemed by their peers, and they constitute an asset for UTMB and for Texas. To allow them to
work in our State, the Texas Medical Board (TMB) allows an indefinite renewal of their license (faculty temporary license-FTL) since, with the current statute cannot grant them an unrestricted license. These highly skilled Doctors ultimately
came to UTMB to help fulfilling the institutional mission when others were not available. These Doctors renounced to other jobs and careers opportunities to join and/or to remain at UTMB. These faculty were hired knowing their license situation.
For these reasons, UTMB has promised these doctors to continue to renew their FTL, and tenured professors were granted, in writing, a “permanent extension” for FTL renewal.
In August 2021 a new IHOP 05.05.08 (1) was introduced stating that faculty who were hired prior to June 1, 2021, will have to have unrestricted license by this current extension. Moreover, faculty who were granted a “permanent extension”
on FTL renewal, must achieve unrestricted licensure by September 2022. This new IHOP segregates arbitrarily who was hired after June 1, 2021, requiring them to have unrestricted licensure in one year versus those hired after that date that
will have 3 years of time. In other words, if one was hired in May 2021 they will have to be licensed by May 2022. Moreover, it eliminates, for two tenured professors, a previously granted “permeant extension” with no justification
and without providing any reasonable or realistic time frame to resolve the issue.
On December 6th, 2021, a proposed amendment of the bylaws was presented (2), and it is currently under review. This document appears to focus only on the introduction of changes relevant to the board certification that are highlighted
in the original document to focus the attention of that part. However, it also attempts to introduce renewal of the FTL for a maximum of 3 years without drawing attention to it since it was not originally highlighted. This time limit for FTL
renewal was not present in the bylaws of the medical staff up to now or when these doctors were hired at UTMB.
American Board Certification
It was stated, similarly to the license issue, there are doctors in the US that cannot obtain American Board Certification. Some Boards will not allow certification if specialty training was completed outside the US, or they require some unrealistically
onerous pathways. Some require unrestricted licensure to give certification, therefore linking the license issue to the board as well. Some subspecialties do not have an American Board Certification at all. These doctors are experienced professors
who have been practicing in their specialty for years while teaching American residents and fellows.
Some faculty at UTMB are affected by this situation as they have been recruited for their skills and value to establish new programs or because American candidates were not available or suitable. They brought precious skills and a diverse experience
to UTMB and the US. All have completed a “foreign equivalent” training and are Board Certified in another Country. All were accepted to work at UTMB with these credentials. They have all completed a subspecialty fellowship in prestigious
US Institutions or at UTMB. They have all worked with great value for the Institution for many years and are professionally esteemed by their peers. They constitute an asset for UTMB and for Texas.
Scientific publications on this topic show that there is no supportive evidence for American Board Certification as a valid quality metric. Of note, the American Medical Association (AMA), resolution H-275.926 paragraph 3 (5), opposes discrimination
against physicians based on lack of American board Certification or when measuring quality of care or determining eligibility for credentialing or ascertaining competence to practice medicine etc. Therefore, the proposed changes at UTMB contrasts
with the official position of the AMA and is not based on solid evidence.
There are examples in other Institutions in the US of non-American Board-Certified Doctors who become Chairman of Departments or hold higher positions, clearly demonstrating that this requirement is not mandatory.
Possible issues and resolutions were proposed/discussed along with strategies for moving forward.