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Comparison of Academic Productivity between American and International Medical Graduate Vascular Surgeons
Khaled I Alnahhal, Ranjana Lingutla, Suhas Penukonda, Ali Irshad, Payam Salehi
Tufts Medical Center, Boston, MA

Introduction: The demand for vascular surgeons stands to far exceed the current supply. International medical graduates (IMGs) are not only vital to meeting the country’s growing healthcare needs, but help to advance clinical research and medical education. Nearly 17% of vascular surgeons in the United States are IMGs, yet little is known about their relative contributions to academic vascular surgery. Our study aims to compare the research productivity and academic profiles of IMG academic vascular surgeons to that of their American medical graduate (AMG) counterparts.
Methods: A cross-sectional study was performed on all AMG and IMG academic vascular surgeons who are currently practicing in U.S.-based hospitals with vascular residency/fellowship programs. In addition to the baseline surgeon characteristics, academic profiles (academic ranks, additional degrees, and leadership positions) and research output (number of publications, citations, Hirsch (H) index, top 3 journals’ impact factors, and number of publications where they were first or senior author) were collected. Comparative statistical analyses were conducted to determine if there were any significant differences between the AMG and IMG groups.
Results: A total of 908 academic vascular surgeons were included, 759 (83.6%) were AMGs, while 149 (16.4%) were IMG surgeons. The median year of graduation was comparable between the two groups (AMGs: 2008 vs. IMGs: 2011; P = .0519), but AMGs had a significantly higher proportion of female surgeons (23.6% vs. 10.7%; P = .0003). The academic ranks, additional degrees, and leadership positions were comparable between the two groups (P > .05 in all) (Table I). While the median number of publications and H indices were similar between the two groups (AMGs: 14 publications vs. IMGs: 19; P = .842) and (AMGs: 6 vs. IMGs: 6; P = .4982), IMG surgeons were significantly more likely to have first or senior-authorship papers (47.1% vs. 37.5%; P < .001) (Table II). Additionally, a greater number of faculty IMG surgeons were observed in departments where the vascular chair was held by an IMG (31.1% vs. 14.0%; P < .0001). Though IMGs had strong leadership representation in national societies their presence was significantly lower in the selected ones in the past 21 years (25.4% vs. 10.7%; P <.001).
Conclusions: IMG academic vascular surgeons demonstrate a comparable academic profile to that of their AMG counterparts. Although both IMGs and AMGs demonstrated high research outputs, IMGs had a significantly greater percentage of papers with first or senior authorship.

Table I. Basic characteristics of vascular surgeons stratified by their AMG/IMG status.
AMG(n =759)IMG(n =149)P value
Year of graduation, median2008 (1998 - 2015)2011 (2002 - 2016).0519
Male580 (76.4%)133 (89.3%).0003
Female179 (23.6%)16 (10.7%)
Type of Vascular training
Independent693 (91.3%)138 (92.6%).599
Integrated66 (8.7%)11 (7.4%)
Additional degree
Masters70 (9.2%)16 (10.7%).5635
PhD24 (3.2%)9 (6.0%).0861
Masters & PhD2 (0.3%)2 (1.3%).0691
Academic rank
Clinical Instructor42 (6.1%)6 (4.4%).4391
Assistant Professor293 (42.7%)61 (44.9%).6353
Associate Professor156 (22.7%)38 (27.9%).1889
Professor196 (28.5%)31 (22.8%).1715
Leadership positions
Chief of Vascular89 (11.7%)16 (10.7%).7281
Chief of Surgery26 (3.4%)1 (0.7%).0703
Assocait/program director of integrated residency program27 (3.6%)5 (3.4%).9029
Assocait/program director of integrated vascular fellowship38 (5.0%)8 (5.4%).8536
(co-) Director of a center66 (8.7%)14 (9.4%).7828
More than one position47 (6.2%)8 (5.4%).7001
Abbreviations: AMG, American medical graduate; IMG, international medical graduate.

Table II. Academic profile of the vascular surgeons stratified by their AMG/IMG status.
AMG(n =759)IMG(n =149)P value
Number of publications, median14 (4-60)19 (4-51.5).842
Percentage of publications where the surgeon is first or senior author37.5%47.1%<.001
Number of citations, median150 (13-1351)119 (11.5-705).2806
H index, median6 (2-19)6 (2-13).4982
Mean impact factor of top 3 journals (with highest factors)
> 5379 (49.9%)78 (52.4%).5899
5 – 10138 (18.2%)23 (15.4%).4244
> 10174 (22.9%)33 (22.2%).8362
Type of publication, mean
Conference paper5.85.8.7917
Book/book chapter1.31.8.2562
Abbreviations: AMG, American medical graduate; IMG, international medical graduate; H, Hirsch.

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