Challenges for International Medical Graduates before and during the COVID-19 pandemic

Dr Elizabeth Fenton1

1University of Otago, Dunedin, New Zealand, 2Davidson College, , United States, 3NORC at the University of Chicago, , United States, 4Charleston Area Medical Center; West Virginia University School of Medicine, , United States

The COVID-19 pandemic has exposed numerous weaknesses in health care systems worldwide. One is ongoing health workforce shortages and dependence on international medical graduates (IMGs), in many OECD countries, and corresponding losses of expertise from IMGs’ countries of origin, frequently low- and middle-income countries. These shortages and dependencies raise concerns of justice in relation to access to health care. Less well explored are the experiences of IMGs themselves, who are often working under challenging conditions, compounded by immigration policies and pandemic-related travel restrictions. The purpose of this presentation is to:


(1)          Summarize findings from a Greenwall Foundation-funded empirical study of IMGs working in one of the poorest and most unhealthy U.S. states (International Medical Graduates at the Crossroads: Ethics of Immigration Policy and Health Care in Underserved Areas).

(2)          Discuss the challenges IMGs face, including immigration insecurity, potential job losses threatening immigration status, and visa restrictions limiting movement to areas of greatest need in a public health emergency. These challenges create harms for both IMGs and communities who depend on them to access health care.

(3)          Draw out implications of the study data for other jurisdictions reliant on IMGs to address health workforce shortages, including Australia and New Zealand.

(4)          Present proposed guidance from the study for IMGs, health institutions, and policy makers. This guidance is grounded in the broader ethical conclusion of the study that IMGs are owed such support in return for their contribution to governments’ moral obligation to ensure equitable provision of and access to health care.

Non-presenting authors: Dr. Kata Chillag(2); Dr. Maysoun Freij (3); Dr. Christian Sirbu (4).


Dr. Elizabeth Fenton is a lecturer in the Bioethics Centre at the University of Otago. Her research interests are in public health ethics, global health, and health policy.

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