Medically underserved areas and International Medical Graduates (IMGs) in the United States: challenges during the COVID-19 era

Figures & data

Table 1. Baseline demographics and patient care characteristics of IMGs in the COVID-19 pandemic

Characteristic	Response
Age, mean (SD), y	34.65 (5.15)
Professional status, No. (%) (n = 2630)
Attending physician	1493 (56.8)
Fellow in training	493 (18.7)
Resident in training	608 (23.1)
Medical school graduate	36 (1.4)
State of Residence, No. (%) (Top 5 states) (n = 2630)
New York	312 (11.9)
Pennsylvania	181 (6.9)
Ohio	120 (4.6)
Michigan	119 (4.5)
Illinois	116 (4.4)
Primary specialty, No. (%) (n = 2630)
Internal Medicine	1684 (65.7)
Pediatrics	265 (10.3)
Family Medicine	138 (5.3)
Neurology	120 (4.6)
Psychiatry	119 (4.5)
Anesthesia	57 (2.2)
Others	325 (12.7)
Board certification status, No. (%) (n = 2562)
Board Certified	1809 (70.6)
Board Eligible	475 (18.5)
Not Applicable	278 (10.8)
Practice in a Medically Underserved Area (MUA) or Health Professional Shortage Area (HPSA), No. (%) (n = 2294)	1471 (64.1)
Practice in a rural setting, No. (%) (n = 2285)	1042 (45.6)
Involved in direct patient care of COVID-19 positive or suspected patients No. (%) (n = 2275)	2025 (89)
Practicing in a ‘front line’ COVID-19 related specialty No. (%) (n = 2275)	1688 (74.2)
Administrative responsibilities for COVID-19 pandemic preparedness (Incident Commander etc) No. (%) (n = 2275)	1449 (63.7)

Table 2. Immigration characteristics of the IMGs in the COVID-19 pandemic

Charcterisitic	Response
Current VISA status, No. (%) (n = 2630)
H1b (Not requiring J1 waiver requirement)	762 (29)
H1b (Completed J1 waiver requirement)	405 (15.4)
H1b (Currently on a J1 waiver program)	459 (17.5)
J1 VISA (Training, Research)	863 (32.8)
Others	142 (5.4)
Have an approved petition for Permanent Residency (I–140), No. (%) (n = 2630)	1190 (45.2)
Have an immediate family member on a dependent VISA, No. (%) (n = 2630)	1138 (43.3)
Have a child under 21 years and not a US citizen, No. (%) (n = 2630)	272 (10.3)
Primary VISA holder of the family No. (%) (n = 2630)	2040 (77.6)
Immigration backlog based on country of origin, No. (%) n = 2247
No backlog	103 (4.6)
Some backlog (3–6 years)	311 (13.8)
Extreme backlog (50-150 years)	1833 (81.6)

Table 3. Practice and Immigration related challenges of IMGs in the COVID-19 pandemic

Characteristic	Response
Practice related challenges
Quarantined due to COVID-19 exposure. No. (%) (n = 2275)	261 (11.5)
Infected with COVID-19 virus. No. (%) (n = 2275)	28 (1.2)
Lost work days/shifts due to COVID–19 exposure or infection. No. (%) (n = 2275)	188 (8.3)
Taking a pay cut/loss of revenue due to the pandemic related issues No. (%) (n = 2045)	622 (30.4)
Number of work days lost, mean (SD), days (range 0-45 days)	0.8 (3.1)
Became unemployed due to the pandemic related issues No. (%) (n = 2057)	19 (1%)
Immigration challenges
Will your family face hardship due to your unemployment or disability? No. (%) (n = 2193)	1988 (90.6)
Is your family at risk of deportation in case of your death or disability? No. (%) (n = 1996)	1433 (71.8)
Does suspension of premium VISA processing by USCIS affect your stay or work in the US? No. (%) (n = 2259)	1470 (65.1)
Do visa restrictions limit you from providing additional coverage in places of need (like NY, Seattle, New Orleans etc) during COVID-19 pandemic?No. (%) (n = 2091)	1984 (93.1)
Are you willing to serve in COVID-19 hot spots where there is need for physicians in front lines but unable to do so because of immigration restrictions? No. (%) (n = 2212)	1854 (83.8)
Do visa work restrictions limit you from providing telemedicine services to patients? No. (%) (n = 1927)	1307 (67.8)
Did a recruiter or a hospital reach you to work at a site, city or state due to staffing shortages during the COVID-19 pandemic? No. (%) (n = 2084)	1188 (57)
Do you think a Permanent Residency status will help resolve most of the professional and personal concerns mentioned earlier? No. (%) (n = 2247)	2220 (98.8)
As an IMG, what is most concerning to you in the COVID–19 pandemic era? Mean score (range 1-4) (n = 2275)
Risk of getting infected with COVID-19 virus.	3.02
Risk of family deportation due to loss of employment or death.	2.38
Risk of losing a job due to the pandemic related issues.	2.33
Risk of facing financial hardships.	2.27

Figure 1. Sample selection of IMGs for the analysis from the survey