The ACGME and Global Health: Enhancing Physician Competence Through Education and Training Amid Global Health Workforce Mobility Challenges
North America, like much of the world, faces significant health care worker shortages, where the maldistribution of the physician workforce is challenging access to care. Countries that have traditionally faced a workforce supply shortage are increasingly seeking externally sourced solutions to fill the gap.
Reflecting on this theme, key issues in the migration of physicians were addressed during an interactive session, “Enhancing Physician Competence: Education and Training Amid Global Health Workforce Mobility Challenges,” at the 2025 ACGME Annual Educational Conference, held in February in Nashville, Tennessee.
Leaders from Intealth and the Medical Council of Canada (MCC) shared scenarios from the US and Canada respectively, highlighting the significant physician workforce needs of both countries.
Intealth Chief Executive Officer (CEO) Eric Holmboe, MD, MACP, FRCP elaborated on the increasing geographic maldistribution of the physician workforce in the US, which has led to individual states exploring alternate regulatory pathways for international physicians to practice.
MCC CEO Viren N. Naik, MD, MEd, MBA, FRCPC shared that to provide for the Canadian population, the number of medical schools would need to triple or quadruple.
Among the many key issues circling this complex topic, attendees of the session raised specific points about the ethics of recruiting an externally sourced physician workforce, and the assessment of these physicians’ competence for local licensure. Opinions shared in the discussions demonstrated that solutions will remain a challenge.
Balancing Critical Needs with Ethical Recruitment
With the critical workforce shortages in their respective countries laid out in stark terms by Drs. Holmboe and Naik, the presentation shifted to ethical recruitment of foreign-educated and -trained physicians.
ACGME Global Services Executive Vice President (and ACGME Chief Financial and Administrative Officer) John Ogunkeye, MS posed this question to his fellow speakers and session attendees: In seeking to address workforce challenges for each country, what are the US’s and Canada’s responsibilities to global health equity?
Session attendees offered various insights concerning moral responsibilities for “donor” and “recipient” countries, as well as individual physicians making the choice for mobility; some suggested an interdependence between “donor” and “recipient” countries has developed.
For instance, several participants raised that countries and systems as economically and socially diverse as India and Ireland tend to “overtrain” at the medical school/undergraduate medical education level, but offer limited local pathways for graduate medical education (GME). This, in turn, leads new physicians to go abroad in pursuit of their specialty education and training.
On the other hand, international medical graduates who complete their GME outside their home countries may face barriers to practice if they choose to return to less-resourced settings to establish their post-GME careers.
Other attendees pointed out that ethical recruitment needs to be considered at the in-country level as well, especially for large and diverse countries such as the US, where rural and urban centers face significant physician workforce shortages, recalling the imbalance the speakers addressed earlier in the presentation.
Assessment is Vital
Alternate pathways for foreign-educated and -trained physicians may streamline the process by which these physicians can enter unsupervised practice and help rectify the physician workforce shortages in the US and Canada.
Canada has already adopted pathways to licensure other than repeating residency or fellowship education and training. In doing so, Dr. Naik described, the country has increased its physician workforce, noting as one example that 70 percent of Saskatchewan’s physician workforce comprises foreign-educated and -trained physicians.
However, for such pathways to be successful, proper assessment is essential to ensuring that those entering the workforce are able to practice independently. Key factors include cultural integration and recency of practice experience, in addition to exam results and time in supervised practice. Dr. Holmboe stressed the importance of acculturation, which takes time and effort.
To demonstrate difficulties related to these critical assessments, attendees viewed a short video of a medical consultant, and were asked to score the interaction. A wide-ranging set of assessment scores came in, many discrepant from the video’s conclusion, which punctuated the presenters’ point about the variability and criticality of these assessments.
In response, Dr. Holmboe challenged the dimensionality of a one-off assessment score model and instead emphasized the importance of coaching and narrative feedback to assist with acculturalization. In addition, he advocated for better training of assessors.
In a timely development, this educational session took place the day after the ACGME, Intealth, and the MCC signed a Memorandum of Understanding (MOU) on the development of assessment training (read more about the MOU and the signing event).
This series, The ACGME and Global Health, seeks to engage the global medical and health care communities in conversations on challenges facing global health that transcends borders. The goal of this content series is to provoke discussion about issues that concern the global GME community, enabling critical conversation that engages with stakeholders across borders, disciplines, and perspectives. This post includes input from ACGME and other public health leaders from recent interviews and presentations.
ACGME Global Services, a department of the ACGME, was created to advance the ACGME Mission by working with global entities to enhance the quality of resident and fellow physicians’ education. We invite comments by email (global@acgme.org) and through X, LinkedIn, and Instagram (with the hashtag #ACGMEGlobalServices). We also seek external voices for future posts in The ACGME and Global Health series; email us if you would be interested in potentially participating.