“Impact of the Current Landscape on GME Nationwide”

Transcript

• 03:33Okay. Let's try this one.
• 03:34Can you hear online?
• 03:38Yes.
• 03:39Okay.
• 03:41Well, it always it always
• 03:43helps when you click the
• 03:44audio button on the on
• 03:45the Zoom.
• 03:47In any case,
• 03:49the slides were good, so
• 03:50I hope you understand what
• 03:51I was talking about earlier.
• 03:52Again, congratulations
• 03:53to the eighteen GIM faculty
• 03:55who were identified by the
• 03:57graduating students as impactful.
• 04:00That's a big number.
• 04:01So I will now pass
• 04:03the microphone over to your
• 04:04vice chief for education, Jeanette
• 04:06Tetreault. Jeanette.
• 04:09Thank you.
• 04:10One other announcement I just
• 04:12wanted to mention.
• 04:14If you have
• 04:16a presentation
• 04:17coming up for a spring
• 04:18meeting that you would like
• 04:19to practice,
• 04:21for SGIM or other spring
• 04:23meetings,
• 04:24please let us know. We're
• 04:25gonna make space for that.
• 04:26You can it's okay to
• 04:28email you, Michelle, with that
• 04:29information.
• 04:30So, just wanted to put
• 04:32that out there. So I'm
• 04:33delighted to introduce doctor Mba,
• 04:36who is our,
• 04:38graduate medical education director for
• 04:40collaborative excellence here at Yale
• 04:42and our associate,
• 04:44designated institutional
• 04:45official
• 04:46really, really,
• 04:48changed the landscape of our
• 04:50GME training with being thoughtful
• 04:52around recruitment, retention,
• 04:55and sustainability,
• 04:57for our house staff and
• 04:59faculty as well.
• 05:00So, doctor Imba trained in
• 05:02Nigeria and then completed a
• 05:04medicine residency in the UK,
• 05:07before coming to the US
• 05:09to do, an additional residency
• 05:11at Cook County Hospital where
• 05:12he served as chief medical
• 05:13resident and then spent, time
• 05:15on faculty,
• 05:18as the, associate chair of
• 05:19medicine for faculty development in
• 05:21the department of medicine.
• 05:23We were lucky enough to
• 05:24recruit him in twenty twenty
• 05:26three,
• 05:27here and he has really,
• 05:28really,
• 05:30made profound
• 05:31impact in the way we
• 05:32think about,
• 05:34measuring and,
• 05:37you know, following our faculty
• 05:39and what they're doing here
• 05:41at Yale School of Medicine
• 05:42and how we how we
• 05:43retain them. He has won
• 05:44numerous awards. The most recent
• 05:46was the ace at the
• 05:47ACP,
• 05:48national meeting where he received,
• 05:51an award for diversity, equity,
• 05:52and inclusion.
• 05:54So in the interest of
• 05:55time, I'm going to ask
• 05:56him to come on up.
• 05:58I asked him to come
• 05:59and talk about the impact
• 06:00of the kinda current landscape,
• 06:03both politically and and just
• 06:05in general
• 06:06on GME training nationwide. So
• 06:08doctor Imba, thank you so
• 06:10much.
• 06:13Thank you very much for
• 06:14the introduction.
• 06:16And,
• 06:18just one more announcement. If
• 06:20you haven't voted for the
• 06:21SGIM
• 06:22president, is this still open?
• 06:24Oh, sorry. It is still
• 06:26open.
• 06:28Oh,
• 06:29that was closed yesterday. Closed
• 06:31yesterday. Oh. So, hopefully, you
• 06:33got your vote. Yes. I
• 06:34did hope. Yeah. It's fine.
• 06:35Well, I tried factoring.
• 06:40Good luck.
• 06:46You should be all set,
• 06:47I think. But,
• 06:49Yeah.
• 06:50Everything we like. Yeah. Okay.
• 06:52Ace. Cool. Good.
• 06:57Okay.
• 06:58Okay. Thank you. So if
• 07:00you so I'm gonna talk
• 07:01about the impact of the,
• 07:03current landscape on the g
• 07:05m on GME nationwide, and
• 07:06it's going to be from
• 07:08a lens,
• 07:09mostly from a lens of
• 07:10the collaborative
• 07:11excellence space, inclusion space, belonging
• 07:14space, and,
• 07:16impact on international medical graduates.
• 07:22Oh,
• 07:23this one.
• 07:26Oops.
• 07:30Okay.
• 07:31So
• 07:32this presentation does not present
• 07:35legal advice.
• 07:37I have no financial,
• 07:38conflicts of interest,
• 07:40and the views are are
• 07:41mine mostly.
• 07:43And so
• 07:45I think to talk about
• 07:47the impact,
• 07:49on GME, I think really
• 07:51the in the timeline should
• 07:52start from the SCOTUS decision,
• 07:55which was in, June o
• 07:57three twenty three.
• 07:59Then in in January,
• 08:01we had the DEI executive
• 08:03orders.
• 08:05Then in April, we had
• 08:06the executive orders aimed at
• 08:08accreditation bodies.
• 08:10Then in June, we had
• 08:11travel bans.
• 08:13Then in July, we had
• 08:14the DOJ guidance on illegal
• 08:17immigration.
• 08:18And then in September, we
• 08:20had the executive order on
• 08:21h one b visas. And
• 08:23then the in August, we
• 08:24had the new proposals for
• 08:25the j one status,
• 08:27to be modified.
• 08:30And all along, we've had
• 08:31federal funding via federal funding
• 08:34cuts via multiple ongoing modalities.
• 08:38In January of twenty
• 08:40December of the twenty five,
• 08:42we had the extension of
• 08:43the travel ban to hit
• 08:44now seventy five or seventy
• 08:45six countries.
• 08:47And I'll end with the
• 08:48impact on the current match
• 08:49which we just concluded.
• 08:52And, obviously, to note that
• 08:53the ink is not dry
• 08:54yet on this timeline because,
• 08:56anything can happen.
• 08:59So let's start with the
• 09:00SCOTUS decision.
• 09:01The SCOTUS decision was
• 09:04June twenty three and, basically,
• 09:08terminated
• 09:10affirmative actions,
• 09:12ability to consider race as
• 09:13one of multiple factuals, factors
• 09:16for admission.
• 09:17And just to read to
• 09:19quote chief justice Roberts, many
• 09:20universities have for too long
• 09:22concluded wrongly that the touchstone
• 09:24of an individual's identity
• 09:26is not challenges bested, skills
• 09:28built, or lessons learned, but
• 09:30the color of their skin.
• 09:31Our constitutional history does not
• 09:33tolerate that choice.
• 09:35He did note that nothing
• 09:36in his opinion should be
• 09:37construed as prohibiting universities from
• 09:39considering an applicant's discussion of
• 09:41how race affected or affects
• 09:43his or her life. And
• 09:44so this was limited to
• 09:46college admissions. This was not
• 09:47really in the GME space.
• 09:49Specifically, there was no comment
• 09:50on this,
• 09:52decision on outreach, affinity groups,
• 09:54scholarship, or retention programs.
• 09:58So
• 09:59what has been the impact
• 10:00on this in terms of
• 10:01admission? So for the first
• 10:02the first set of data
• 10:03we have for medical school
• 10:05matriculants from twenty twenty four
• 10:07to twenty twenty five shows
• 10:09at, on the table,
• 10:11If you go to the
• 10:12right of your screen,
• 10:15the the
• 10:16the before the last
• 10:18column, the last two columns
• 10:19is twenty twenty three to
• 10:20twenty four and twenty four
• 10:21to twenty five. And what
• 10:22you see is the percentage
• 10:24change within the year following
• 10:26the decision
• 10:28with a twenty two percent
• 10:29drop in in matriculants for
• 10:31American Indians
• 10:33and eleven
• 10:34twelve percent drop for black
• 10:36Americans,
• 10:37about eleven for Hispanics, and
• 10:39about four percent for, native
• 10:41Hawaiians,
• 10:42with about,
• 10:45eight percent increase in,
• 10:47in Asian Americans.
• 10:49And so
• 10:51this is yes. Go ahead.
• 10:55Increase of percent of other
• 10:57race and ethnicity. What do
• 10:58you know what that represent?
• 11:00So that usually that's represents
• 11:02a combination of,
• 11:05categories like,
• 11:07Mina, which is a new
• 11:08category, which I'll talk about,
• 11:10Middle Eastern and North Africans.
• 11:12And I I will show
• 11:14for the first time, the
• 11:15NRMP
• 11:16has actually recorded the percentage,
• 11:18and I'll show you that
• 11:19in some slides. And some
• 11:20will be, just unidentified races,
• 11:23mixed races.
• 11:25It's it's hard to get
• 11:26into
• 11:28deep layers when it says
• 11:29other or or late races
• 11:31like that.
• 11:32And so this significant reduction,
• 11:35if you look at it
• 11:36this way, is concurrent with
• 11:38actually an increase
• 11:39in applicants
• 11:41in for Hispanic or or
• 11:43black
• 11:45applicants, increase in applicants, reduction
• 11:47in
• 11:48matriculants.
• 11:49And for Asian American Indians,
• 11:51you have a significant drop
• 11:52in applicant applicants and in
• 11:54matriculants
• 11:55as well. So this is
• 11:56twenty twenty four. So just
• 11:58think of it like matriculation
• 12:00sets the tone for the
• 12:01future. Right? For the health,
• 12:03physician workforce in this case.
• 12:05So at that same point
• 12:07in time,
• 12:08twenty twenty four, across all
• 12:10trainees in GME,
• 12:12this was the breakdown.
• 12:14Right?
• 12:14And what you can see
• 12:16is that for the Hispanic
• 12:17or Latino, Black or African
• 12:19Americans, American Indians, Hawaiian native
• 12:22or Pacific Islanders,
• 12:24their numbers were actually back
• 12:25to pre pandemic,
• 12:28levels in terms of,
• 12:31race or ethnicity of enrolled
• 12:32students.
• 12:33Of all the enrolled students
• 12:35in the United States, one
• 12:36point four percent are you
• 12:38non US and non green
• 12:40card holders.
• 12:41So we have several of
• 12:42those at Yale.
• 12:44Now
• 12:46so that's twenty twenty four.
• 12:47But now we have two
• 12:48years of data because we
• 12:49have twenty twenty five.
• 12:51So this, very colorful but
• 12:53I can walk you through
• 12:54it. Green on top is
• 12:55twenty twenty four to twenty
• 12:57five and twenty twenty five
• 12:58to twenty six matriculants.
• 13:00And you can see in
• 13:02red the groups that the
• 13:05the URM groups
• 13:07have not had any significant
• 13:09increase. And if you look
• 13:11at black,
• 13:12African American over the last
• 13:13several years, you can see
• 13:14there's been a significant drop.
• 13:16Also a drop in Hispanics
• 13:17since twenty twenty three. Again,
• 13:19this is for medical school.
• 13:21And at the bottom, you
• 13:22can see that the total
• 13:23URM,
• 13:24component
• 13:25across matriculants
• 13:27has actually dropped almost by
• 13:29four point five percent, something
• 13:31like that. So these are
• 13:32this is the pipeline that's
• 13:34eventually going to lead into,
• 13:36physicians and GME trainees and,
• 13:38attendings, etcetera.
• 13:40This is another way to
• 13:41look at it,
• 13:42if if you prefer graphs.
• 13:44And so, basically,
• 13:46all the
• 13:48all of these
• 13:51all these
• 13:52the four colors represent the
• 13:54URM the traditional URM groups
• 13:56that that we
• 13:57talk about.
• 13:59Now
• 14:02as of so that was
• 14:03medical school.
• 14:04That same year of all
• 14:07the MD residents in training
• 14:08in twenty twenty four, you
• 14:10can see the breakdown,
• 14:14and you find that
• 14:16basically,
• 14:17the matriculants
• 14:19and the
• 14:20almost matches
• 14:22the UIM groups in training.
• 14:23Nine percent for Latinos,
• 14:25seven percent for black African
• 14:27American, and the combination adds
• 14:29up to, you know, something
• 14:30like sixteen percent or or
• 14:32so.
• 14:33But interesting to start to
• 14:34note that in twenty twenty
• 14:36four, before a lot of
• 14:37the executive orders,
• 14:39twenty four percent of all
• 14:40active residents or IMGs. And
• 14:42that that actual number comes
• 14:44to thirty nine thousand out
• 14:45of a hundred and sixty
• 14:47two thousand trainees in twenty
• 14:49twenty four.
• 14:51And then
• 14:52visa holders,
• 14:53non US citizens and non
• 14:54green card holders constitute about
• 14:56seventeen percent.
• 15:00So that's,
• 15:01in a way, what we
• 15:03can project from the scotus
• 15:04effect in terms of
• 15:06applicants,
• 15:07matriculants
• 15:08and then GME training.
• 15:11So then,
• 15:12let's now talk about so
• 15:13that was the first impact.
• 15:15Let's talk about the DEI
• 15:17executive orders in January twenty
• 15:19twenty five.
• 15:21So the first order,
• 15:23executive order was the ending
• 15:25racial and wasteful government DI
• 15:27program. So this is general
• 15:29this is the order that
• 15:30kind of terminated all DI
• 15:32activities in federal agencies
• 15:34under whatever name that they
• 15:35may appear.
• 15:37And this was on January
• 15:38twentieth.
• 15:40And on January twenty first
• 15:41was the ending illegal discrimination
• 15:43and restoring merit based opportunities.
• 15:46This directed the attorney generals
• 15:48and federal agencies to look
• 15:50at the private sectors to
• 15:53find those that
• 15:55were conducting,
• 15:56egregious
• 15:58DEI programs and illegal DEI
• 16:00programs without actually defining what
• 16:02constituted
• 16:03illegal DEI programs at that
• 16:04point in time.
• 16:08This,
• 16:09this, I believe,
• 16:12this order was challenged and
• 16:14the government, I believe, dropped
• 16:16the defense of this order
• 16:18recently,
• 16:19but not the DOJ guidance
• 16:21which we'll get to.
• 16:23So what impact has all
• 16:25of this had? So executive
• 16:26orders are not laws. They,
• 16:29but they can lead to
• 16:30a chilling effect. They can
• 16:32lead to a cascade,
• 16:34of compliance.
• 16:38So this is updated as
• 16:40of March twenty twenty six.
• 16:42This is from the Chronicle
• 16:43of Higher Education.
• 16:44And this is a map
• 16:45showing where anti DI legislation
• 16:47has been proposed, either introduced,
• 16:50final approval, or signed into
• 16:52law.
• 16:53And just just to summarize,
• 16:55since twenty twenty three, a
• 16:57hundred and fifty one, bills
• 16:59have been introduced, thirty four
• 17:00have had legislative
• 17:02approval,
• 17:03and thirty have become,
• 17:05law.
• 17:06And what does the law
• 17:08what what does the legislation
• 17:11represent? So this map shows
• 17:13you, like, for these states,
• 17:15you cannot have DEI offices
• 17:17and staff.
• 17:18For these states, you cannot
• 17:19have mandatory DEI training.
• 17:23You cannot have diversity statements,
• 17:25and you cannot have identity
• 17:27based preferences
• 17:28for hiring.
• 17:29So in effect, even though
• 17:31one of the executive orders
• 17:33was challenged and the government
• 17:35has dropped
• 17:36it has dropped its defense
• 17:37of the of the challenge,
• 17:39but nonetheless, numerous states have
• 17:41passed anti DEI legislation
• 17:44and all federal agencies have
• 17:45ended their DEI programs
• 17:47like the VA,
• 17:49c CDC, NIH.
• 17:52And numerous private academic centers
• 17:54and university systems have also
• 17:56dismantled their DEI programs.
• 17:59For example,
• 18:01this is just not an
• 18:02ex for example, these schools
• 18:04have abolished or
• 18:06or suspended their DEI programs,
• 18:10and there are many others.
• 18:11And, of course, I'm sure
• 18:12there are many more to
• 18:13come.
• 18:14To put this in perspective,
• 18:17in general,
• 18:20approximately actually, exactly, there are
• 18:22one hundred and fifty nine
• 18:23MD granting schools and there
• 18:24are forty one dual granting
• 18:26schools in the United States.
• 18:27And roughly, there are about
• 18:28two hundred and thirty academic
• 18:30medical centers affiliated with training
• 18:32or course.
• 18:33And so
• 18:35what has been the impact
• 18:36of the executive orders?
• 18:39Does anyone know this,
• 18:41organization?
• 18:43So do no harm is,
• 18:45to protect health care from
• 18:46the disastrous consequences of identity
• 18:49politics.
• 18:50And of September,
• 18:52twenty twenty five,
• 18:54they
• 18:56had quoted that they had
• 18:57whittled down DEI activities
• 18:59down to
• 19:00sixty six medical schools of
• 19:02out of the close to
• 19:03two hundred,
• 19:05including those that have rebranded.
• 19:07And for Yale,
• 19:08Yale is on the list
• 19:10as collaborative excellence
• 19:12clearly stating that that
• 19:14is
• 19:16represents what the DEI office
• 19:18was. In fact, the names
• 19:19of our our leaders are
• 19:20there in both categories.
• 19:23Now in September that year,
• 19:25this organization also established
• 19:27the Center for Accountability
• 19:29in Medicine,
• 19:31and they came up with
• 19:32a medical school excellence index.
• 19:35And all the medical schools
• 19:36have a so you have
• 19:37the QR code if you're
• 19:38interested. You wanna look at
• 19:40all the schools. But I
• 19:41just pulled up our, Yale
• 19:42School of Medicine, and you
• 19:43can see that, there's an
• 19:45a to f ranking that
• 19:46based on this,
• 19:48medical school excellence index that
• 19:49we have a c. And,
• 19:50of course, the more
• 19:53if you have a pass
• 19:54or fail,
• 19:55you're, you know, you're going
• 19:56and you go towards the
• 19:57f. If you have
• 19:59any
• 20:00I did
• 20:01possible DI office, you go
• 20:03towards the f. And if
• 20:04you have honor systems and
• 20:05grading, you go towards the
• 20:06AOA, you go towards the
• 20:08a.
• 20:11So
• 20:11so all of that so
• 20:13this is just to show
• 20:14that the the kind of
• 20:15the
• 20:16the movement or the landscape
• 20:17or or or the forces
• 20:19that are impacting
• 20:22inclusion and belonging, I think,
• 20:24in in medicine and GME.
• 20:27So then we move along
• 20:28to April twenty twenty five
• 20:30when some executive orders targeted
• 20:32the accreditation bodies. And, of
• 20:34course, you we're all aware
• 20:35that the LCME
• 20:37in May dropped its requirement
• 20:39element three point three, which
• 20:41was of which,
• 20:42mandated
• 20:43diverse faculty, diverse trainees, etcetera.
• 20:47And
• 20:49just recently, I think in
• 20:50February, the LCME has also
• 20:52withdrawn requirements to teach cultural
• 20:54competence in medical school.
• 20:56The WMC no longer has
• 20:57a chief diversity officer.
• 20:59And then finally,
• 21:01the ACGME, which is the
• 21:02accreditation body for GME,
• 21:05has retired its diversity, equity,
• 21:07and inclusion
• 21:08specific accreditation,
• 21:10and anyone that had citations
• 21:11were dropped instantly
• 21:13and actually closed this department
• 21:14of DEI completely.
• 21:17So there's no accreditation
• 21:20cover or incentive
• 21:21or motivation
• 21:23to
• 21:24be inclusive, expansive, and etcetera.
• 21:29So now let's go to
• 21:30the travel bans.
• 21:36This list of, I think,
• 21:37twenty countries have a full
• 21:39ban
• 21:40suspended for immigrant and all
• 21:42nonimmigrant
• 21:43visas. Right?
• 21:45So you may think of
• 21:46it as, okay. Our trainees
• 21:48are not coming from these
• 21:49countries
• 21:50of etcetera.
• 21:51But that means that anyone
• 21:53who is in the United
• 21:54States professional
• 21:56in any help any professional
• 21:58capacity, for instance, who is
• 21:59from these countries
• 22:01and who who came here
• 22:02ahead of their spouse or
• 22:04their significant other or their
• 22:06children or their parents
• 22:08cannot
• 22:10go home
• 22:11and cannot
• 22:12be joined
• 22:14by
• 22:15their family.
• 22:16Open ended. I mean, so
• 22:18think about the the the
• 22:19the the the emotional
• 22:21aspects, the mental drain, the
• 22:23the
• 22:24the stress that this,
• 22:26impacts on it. So
• 22:28then
• 22:30there's a second group with
• 22:32the partial ban,
• 22:33which includes,
• 22:36for immigrant, b one visas,
• 22:38f m, and most importantly
• 22:40for us in the GME
• 22:41space, j visas. Right?
• 22:44And if you look at
• 22:45that list,
• 22:47not because I'm from Nigeria,
• 22:48but Nigeria is one of
• 22:50the biggest suppliers
• 22:51of trainees,
• 22:53and I'll show you a
• 22:53list later on. And so
• 22:55you can imagine
• 22:58and I I'm sure that's
• 22:59not the case here, but
• 23:00I'm sure across the country,
• 23:02program directors
• 23:03were
• 23:04navigating their rank list accordingly.
• 23:07Right?
• 23:08A program that usually takes
• 23:10maybe three or four Nigerians
• 23:12would not
• 23:14take that risk anymore because
• 23:15they they may not get
• 23:16the j one visa. There
• 23:17are no exemptions at the
• 23:18government level.
• 23:21So again and all these
• 23:22partial bans also impact spouses
• 23:24and families, etcetera.
• 23:26I'm sure Mark has residents
• 23:27that haven't been home for
• 23:28four or five years and
• 23:30missed major family events.
• 23:33So then let's talk about
• 23:34the so so the impact.
• 23:36So we talked about j
• 23:37one. So the j one
• 23:38is a very important for
• 23:39GME.
• 23:41In twenty twenty four, there
• 23:42were about sixteen thousand physicians
• 23:44in the US
• 23:45GME on j one visas.
• 23:47Right? And you can see
• 23:48the list of countries
• 23:50where Nigeria is the sixth.
• 23:51So Nigeria usually supplies about
• 23:53four hundred and fifty
• 23:55to five hundred physicians annually.
• 23:57And you can see so
• 23:58Nigeria is the only one
• 23:59on that top ten list
• 24:00that has been affected
• 24:02by the ban, the partial
• 24:04ban.
• 24:05Now where do these j
• 24:06one physicians go?
• 24:09They actually
• 24:10New York has the highest
• 24:12number,
• 24:13and but you can see
• 24:14Connecticut is in the top
• 24:15ten as well.
• 24:17And, of course, understanding that
• 24:19this j one
• 24:20physicians after they complete training
• 24:23form the significant number of
• 24:25physicians in underserved areas because
• 24:28of their j one waivers.
• 24:29So an impact again in
• 24:31rural health care.
• 24:34What specialties
• 24:36really
• 24:37depend on j one visas
• 24:39for GME trainees? And you
• 24:40can see that we are
• 24:42the majority
• 24:43internal medicine
• 24:44by far.
• 24:46And then we have pediatrics,
• 24:47family medicine, neurology.
• 24:52Now later on,
• 24:54in January came, an increased
• 24:57ban. This was what we're
• 24:59leading up to the match.
• 25:00But this time, a ban
• 25:01on immigrant visas. So in
• 25:03addition to those,
• 25:05forty countries I listed, we
• 25:07are now up to about
• 25:08seventy six countries
• 25:10that have a ban or
• 25:12pause that if people trainees
• 25:14here have spouses or significant
• 25:16orders there,
• 25:18there's no hope of them
• 25:19coming.
• 25:21My neighbor actually
• 25:22was from
• 25:24is from Iran, and my
• 25:25neighbor's mom actually had an
• 25:27interview
• 25:28scheduled for
• 25:30the end of January
• 25:31in
• 25:32in in in Turkey to
• 25:34get the green card, and
• 25:35now that's completely
• 25:37suspended.
• 25:42Okay.
• 25:43So I'm sorry. It's all
• 25:44a little bit doom and
• 25:45gloom, but
• 25:46but it's just to illustrate
• 25:47the impact, it's having.
• 25:49So then in July, we
• 25:50had the finally, the DOJ
• 25:53gave guidance. Yes, Andre.
• 25:55Once people were here on
• 25:57the j one,
• 25:58you're saying they're allowed to
• 26:00stay as long as they
• 26:01Correct. Yes.
• 26:02If you're on a j
• 26:03one, I'll get to h
• 26:04one. But if you're on
• 26:04a j one,
• 26:06you can stay.
• 26:08But the new j ones,
• 26:10like, if you match and
• 26:11you have a new j
• 26:12one coming from your country,
• 26:14if you're under the ban,
• 26:15that's a no that's a
• 26:17no go.
• 26:18And if they're here and
• 26:19they finish their training, are
• 26:20they able to serve in
• 26:21those rural areas under that
• 26:23j one that would Yes.
• 26:24Correct. They can stay if
• 26:25they're in here.
• 26:27But the less that come
• 26:29in,
• 26:31eventually, it just adds to
• 26:33the shortage.
• 26:34I mean, it's easy to
• 26:35see without a significant change
• 26:38right from matriculation
• 26:39and GME training.
• 26:41So now a lot of
• 26:42these countries are so so
• 26:44now Brazil,
• 26:45we have a lot of
• 26:46professionals from Brazil, especially in
• 26:48Connecticut, actually. There's a large
• 26:49Brazilian population.
• 26:51Brazil is now under this.
• 26:52Russia is now under this.
• 26:54Right?
• 26:55So it has been expanded,
• 26:56for immigrant visas.
• 27:01Okay.
• 27:02So the DOJ so what
• 27:04what what was that illegal
• 27:06DI activity? Even though the
• 27:08government's is no longer defending
• 27:09the executive order, but the
• 27:11DOJ guidance still stands.
• 27:13And what it is, the
• 27:14DOJ has defined four categories
• 27:16of what they would consider
• 27:18unlawful discrimination.
• 27:20One is preferential treatment,
• 27:22granting opportunities
• 27:23based on race, gender,
• 27:25in any way that disadvantages
• 27:27others.
• 27:28So we have the swim
• 27:30group here. We have several
• 27:31groups in across universities.
• 27:34Also, use of proxies.
• 27:36And if you read through
• 27:38it, it says,
• 27:39use of, for instance,
• 27:42schools
• 27:43or geographical areas or ZIP
• 27:45codes,
• 27:46it with with the intention
• 27:48of being a proxy. So,
• 27:49I mean, that would be
• 27:50a legal threshold to cross,
• 27:52but, potentially,
• 27:54you could be it could
• 27:55be said, why are you
• 27:56going to that district for
• 27:58outreach? Or why are you
• 27:59going to Puerto Rico for
• 28:01outreach? Right?
• 28:03For an example.
• 28:05Segregation,
• 28:06having activities or resources like,
• 28:09several
• 28:10undergraduate programs, and I don't
• 28:11I'm not sure if Yale
• 28:12does have, but some some
• 28:14undergraduate programs actually have residences
• 28:17where people live and study,
• 28:19based on on certain characteristics.
• 28:22And then, any kind of
• 28:24DEI training program that creates
• 28:26a hostile environment for any
• 28:28individual
• 28:29within the,
• 28:31in the audience.
• 28:32So then this had me
• 28:34thinking, what about the HBCU
• 28:37schools?
• 28:38Right? These are schools that
• 28:41are officially, the whole mission
• 28:42is based upon an identity
• 28:44or a culture. So
• 28:48They are referred to as
• 28:49minority serving institutions,
• 28:51right? And there are two
• 28:52broad categories. There's the mission
• 28:54based, which is the HBCUs,
• 28:57the tribally controlled colleges,
• 28:59and they are then they
• 29:00are enrollment based. So mission
• 29:03based, this is your mission.
• 29:05Enrollment based means that we
• 29:07tend to recruit and retain
• 29:08a significant number of minorities
• 29:10in our university or colleges
• 29:13so much so that in
• 29:13the past, you could be
• 29:15called a
• 29:17a a Hispanic Hispanic center
• 29:18of excellence if you had
• 29:19more than about, I think,
• 29:21nine or eight percent of
• 29:22your enrollees over the last
• 29:24several years
• 29:25identify as Hispanic.
• 29:27So all of those those
• 29:29are enrollment based.
• 29:31And what's happened is that
• 29:32the Department of Education
• 29:35ended discretionary funding to the
• 29:37enrollment based programs that predominantly
• 29:40support
• 29:41community colleges or colleges that
• 29:43have high Hispanic populations or
• 29:45black populations.
• 29:47They ended a lot of
• 29:48discretionary funding.
• 29:49But instead,
• 29:51they channeled five hundred million
• 29:54to the mission based school.
• 29:55So it's kind of
• 29:57I think it's just kind
• 29:58of
• 30:00zero sum game. In the
• 30:01end, net zero,
• 30:03because you're not you're withdrawing
• 30:05support from not all minorities
• 30:07can get into or can
• 30:09be served by mission based,
• 30:11institutions.
• 30:14So now let's go to
• 30:15the h one b visas
• 30:16and the j one status
• 30:18approval.
• 30:19So we'll start with the
• 30:20j one.
• 30:21Just a brief introduction. So
• 30:23the j one visa is
• 30:24a training visa,
• 30:26and it means that you
• 30:27go train and you're going
• 30:28to go back home to
• 30:29your home country or you're
• 30:31going to go to an
• 30:33underserved area in the United
• 30:35States for a period of
• 30:37three years, convert to a
• 30:38h one b visa, and
• 30:40end up with a green
• 30:41card.
• 30:42The bulk of,
• 30:44trainees,
• 30:45international medical graduates come from
• 30:48come in on a j
• 30:49one b visa.
• 30:50So traditionally,
• 30:52on a j one visa.
• 30:53Traditionally, the j one visa
• 30:55is,
• 30:57is the duration of status,
• 30:59which means in general, you
• 31:01come in,
• 31:03and it usually lasts up
• 31:04to seven years. So let's
• 31:05say you're coming as a
• 31:06intern, you do your residency,
• 31:07you do your chief residency,
• 31:08and you do a two
• 31:09year rheumatology
• 31:10program. As long as you
• 31:12are in training status,
• 31:14your visa would follow you.
• 31:16Right? So that was status
• 31:17duration.
• 31:19The proposal in August is
• 31:20to switch that status duration
• 31:23to a fixed four year
• 31:24period.
• 31:26The idea being that the
• 31:27four years to get an
• 31:28undergraduate degree. So they fixed
• 31:29the j one to four
• 31:30years. And any extension of
• 31:32that would need to be
• 31:33filed by individuals directly to
• 31:35USCIS,
• 31:36which will include biometrics
• 31:38and proof of financial resources,
• 31:40etcetera.
• 31:41So if this goes through,
• 31:44going into
• 31:47neurosurgery,
• 31:48doing a fellowship,
• 31:50going into a five year
• 31:51program,
• 31:52combined med piece and chief
• 31:53residency, it makes it just
• 31:55changes the whole pipeline.
• 31:58Currently, the grace period when
• 31:59you finish, you have up
• 32:00to sixty days be it
• 32:01to do your board exams
• 32:02to wrap up your things.
• 32:03The proposal is to drop
• 32:04that to thirty days.
• 32:06So they invited public comments,
• 32:08and this they had over
• 32:09twenty two thousand comments.
• 32:11The final rule publication is
• 32:13unknown. So currently, it's the
• 32:14status quo.
• 32:16This is still
• 32:17pending final release. And just
• 32:19as a reminder,
• 32:21there are approximately sixteen thousand
• 32:23physicians
• 32:24in GME training on j
• 32:25one b visas.
• 32:26Part of the proposal because
• 32:27people asked what will happen
• 32:29to people who are currently
• 32:30in the j one status.
• 32:32And they said that
• 32:34they they would end when
• 32:36their current if it goes
• 32:37through, when their current status
• 32:39ends
• 32:41or four years,
• 32:43whichever is sooner.
• 32:45Right? So
• 32:46it would have an impact
• 32:48retrospectively.
• 32:49The proposal could, not it
• 32:50would. It could have an
• 32:51impact retrospectively.
• 32:53And
• 32:56just to give you context,
• 32:57in the last ten years,
• 32:59the United States
• 33:01j one visa sponsorship has
• 33:03increased by sixty seven percent
• 33:06to meet the demands. And
• 33:08and, of course, we know
• 33:08that the j one physicians
• 33:10go into the rural areas,
• 33:12so that's the impact. So
• 33:13that's the j one. Luckily,
• 33:15the it it no final
• 33:16decision has been made.
• 33:19And in terms of Mark,
• 33:20are you I mean, I
• 33:21guess it's too soon. Are
• 33:21you aware of any other
• 33:23program director
• 33:26that anyone that has succeeded
• 33:27with
• 33:28the,
• 33:29exemption to the j one
• 33:32bans? Like, I mean, maybe
• 33:33too soon to like, if
• 33:34someone match someone from Nigeria,
• 33:37for instance.
• 33:39I don't know. You know,
• 33:40I I can tell you
• 33:42to your point. We we
• 33:43only had a small number
• 33:45of international medical graduates who
• 33:46residing outside the country.
• 33:49Correct. Yes. Yeah. Yeah. Alright.
• 33:51Jeez. Actually, all the ones
• 33:52who matched with us. I
• 33:53intend yes. Not sure. I
• 33:55I don't think that's the
• 33:55case with other programs, though.
• 33:57It's Yeah. I think for
• 33:59community programs that aren't looking
• 34:00at people doing postdocs.
• 34:02Correct. Yes. Yeah.
• 34:03Figuring. Yes. So and I
• 34:05will talk about the impact
• 34:06because, yes, places like Yale,
• 34:08because you have there's a
• 34:09whole postdoc problem, etcetera.
• 34:10But community programs,
• 34:12could have a hit.
• 34:14Okay.
• 34:15So the h one b,
• 34:17this one, I think, has
• 34:18literally neutralized
• 34:20h one b visas for
• 34:22this round of enrollment. Right?
• 34:24New I'm sorry. New h
• 34:25one b visas outside of
• 34:27the country. Right? So as
• 34:29we know, it's a hundred
• 34:30grand for a new application
• 34:31outside of the US.
• 34:34And according to Department of
• 34:35Labor, there are about eleven
• 34:37thousand resident physicians
• 34:39at any point in time
• 34:39on h one b. And
• 34:40a lot of them are
• 34:41in the rural areas as
• 34:42well because they got there
• 34:43from the j one.
• 34:45It's important to know that
• 34:47this order does not affect
• 34:48current h one holders in
• 34:50the country,
• 34:51and it does not affect
• 34:52transfers
• 34:53between employees. Right? So
• 34:56there was there had been
• 34:57a big hope that there
• 34:58would be an exemption, but
• 34:59so far there's been no
• 35:00blanket exemptions for h one
• 35:02b cap organizations,
• 35:03research institutions, and health care.
• 35:07So I can it's almost
• 35:09I'm almost certain that there's
• 35:10you can count under your
• 35:11fingers the number of
• 35:13new h one b visas
• 35:14for GME training that has
• 35:16that if there are any
• 35:17at all for this cycle.
• 35:20I I could comment on
• 35:21that too. Yes.
• 35:22We did have a couple
• 35:23of applicants from non travel
• 35:25ban countries who might have
• 35:27been eligible
• 35:28for h one b's in
• 35:29the past, and we have
• 35:31the same account. So Yes.
• 35:32Australia,
• 35:33they think it was somebody
• 35:34from UK,
• 35:36and it was simply because
• 35:37they were outside the country,
• 35:38and we couldn't
• 35:39contemplate a hundred thousand dollars.
• 35:41Yes. Thank you. In case
• 35:42you didn't hear, Mark, it's
• 35:43a very important point. So,
• 35:48all this and so in
• 35:49my training institution, I came
• 35:50on a h one b.
• 35:51H one b's used to
• 35:52be offered. You could
• 35:54get, pre match offers. You
• 35:55could get
• 35:58supposedly
• 35:59more competitive candidates.
• 36:01But now you can
• 36:03still get countries
• 36:04candidates from the non bank
• 36:06countries, but they'll have to
• 36:07accept the j one. And
• 36:08I think almost every institution
• 36:09and, yes, the GME did
• 36:10put out guidance with full
• 36:12transparency to the candidates that
• 36:13if you match here, you're
• 36:15gonna be prepared to accept
• 36:17the j one, visa.
• 36:19On average, what is the
• 36:20loss About a thousand h
• 36:22one b's enter the GME
• 36:24annually,
• 36:26estimatedly.
• 36:27So that's lost.
• 36:29They they will probably join
• 36:30the j one category.
• 36:32So federal cuts, multiple modalities,
• 36:35this is extensive. We've all
• 36:36heard about it. But in
• 36:37terms of GME, it's important
• 36:39to know that some of
• 36:40the proposals,
• 36:41I think they have gone
• 36:42into law. The Medicaid
• 36:44modifications
• 36:45actually will impact indirect funding
• 36:48for medical IME funding. Right?
• 36:51Direct medical education funding was
• 36:53captured in nineteen ninety six,
• 36:55but the indirect funding
• 36:57which,
• 36:59re reimburses teaching hospitals a
• 37:02little more on the assumption
• 37:03that you're kind of slower
• 37:04teaching students,
• 37:06you're less efficient, you're looking
• 37:07at more tests for training
• 37:09purposes, etcetera,
• 37:11that has been,
• 37:13that could be impacted. There's
• 37:15something called the provider tax,
• 37:18which was thought to be
• 37:19a loophole. Like, the state
• 37:20of Connecticut would tax nursing
• 37:22homes and would tax hospitals
• 37:24about one point four percent
• 37:26as an example
• 37:28on paper, but use that
• 37:29to draw down federal funds
• 37:32and thereby put that back
• 37:33to institutions by paying higher
• 37:35Medicaid reimbursements.
• 37:36I think that has been
• 37:37cut off. And that is
• 37:39set to constitute about eighteen
• 37:40percent of Medicaid expenditure.
• 37:44So,
• 37:45just to end, like so
• 37:46what has been the impact
• 37:47on this current match,
• 37:50twenty twenty six?
• 37:52We I mean,
• 37:53congratulations, Mark. You haven't had
• 37:55any impact, but,
• 37:57okay. So for this match,
• 37:59twenty twenty six,
• 38:01I think it's the highest
• 38:02number so far. There
• 38:03were fifty three thousand applicants.
• 38:05There are forty eight active
• 38:07applicants. Those that certified forty
• 38:09eight thousand active applicants.
• 38:11Forty four thousand residency positions
• 38:14offered in over sixty eight
• 38:15hundred programs across the United
• 38:17States. So I have put
• 38:18there the categories of, candidates,
• 38:21the match rate, and the
• 38:22change over last year.
• 38:25For US MDs, there's been
• 38:26no change. The match rate
• 38:27is about ninety four percent.
• 38:29That means that getting into
• 38:31your one of your top,
• 38:32I mean so that means
• 38:33actually getting matching. There's a
• 38:35different rate for getting into
• 38:37your top three.
• 38:38For US DOs, this has
• 38:39been a strong match rate
• 38:41that has actually equaled,
• 38:45the US MD.
• 38:47For the US international medical
• 38:49graduates, that's most of the
• 38:51Caribbean,
• 38:52graduates,
• 38:53significant jump
• 38:55by five absolute points to
• 38:57seventy percent.
• 38:58And why? I think because
• 39:02there's no visa issues.
• 39:03Right?
• 39:04So the loss for the
• 39:07international medical graduates can be
• 39:08covered by the US,
• 39:10international medical graduates.
• 39:12For non US citizen
• 39:14international medical graduates, it's fifty
• 39:16six point two percent.
• 39:19But if you splice it,
• 39:21if you look at the
• 39:22foreign
• 39:23born international medical graduate needing
• 39:25a visa, it's at the
• 39:27lowest ever at fifty four
• 39:29percent,
• 39:30which means
• 39:32practically one in two applicants
• 39:35would not
• 39:36match, you know, and thousands
• 39:38of dollars are spent on
• 39:40this and so on. However,
• 39:41if you're foreign born on
• 39:42a green card, you're almost
• 39:44seventy percent. So you can
• 39:45see that
• 39:46pro it I mean, program
• 39:47directors are just are navigating
• 39:49according to the the external
• 39:51limitations.
• 39:54Now does anyone know the
• 39:56programs with the hundred percent
• 39:58match rate?
• 40:00Not individual programs, specialties. I'm
• 40:02sorry.
• 40:04Actually, I was surprised to
• 40:06I don't know if I
• 40:06was surprised. I was pleasantly
• 40:08surprised to see that med
• 40:09peds is a hundred percent
• 40:10match rate actually. It's in
• 40:11very high demand and it's
• 40:13relevant to our department.
• 40:16What happened this year
• 40:18was as as predicted, there
• 40:20were an ink there was
• 40:21an increase in unfilled positions
• 40:24by about three hundred and
• 40:25ninety from two hundred and
• 40:26twenty five.
• 40:28For our interest, internal medicine
• 40:30fill rate is ninety five
• 40:31percent. That drops for two
• 40:33percent from twenty twenty five.
• 40:36Peds fill rate is ninety
• 40:37four percent.
• 40:38That dropped as well.
• 40:40But family medicine fill rate
• 40:42is actually
• 40:43there's a big challenge there
• 40:44at, eighty four percent. EM
• 40:46has improved,
• 40:48and psychiatry is doing very
• 40:49well, and med ped is
• 40:51actually at hundred percent.
• 40:53So
• 40:56with all of this, since
• 40:57I have a role,
• 40:58one as a as a
• 41:00as a as a person
• 41:01of color, as a minority,
• 41:03a person of minority of
• 41:05as a person of color
• 41:06and an underrepresented,
• 41:09belonging to an underrepresented,
• 41:11category.
• 41:12So what has been my
• 41:13personal experience and reflection during
• 41:14this period? So
• 41:16I would describe my intermittent
• 41:18emotions, feelings, and state of
• 41:19mind. Not permanent, intermittent.
• 41:22So
• 41:23and see if you notice
• 41:24a trend.
• 41:26Days, darkness, derailed, deflated, depression,
• 41:28deprioritized,
• 41:29despair, desperation, despondency, devastated, devalued,
• 41:32disgusted, disconfabulated,
• 41:34discontent,
• 41:35disappointed, disheartened, disillusioned, disoriented, dissuaded,
• 41:39dissatisfaction,
• 41:40distraught, doom.
• 41:42What strikes you?
• 41:45What is the common thread
• 41:47across all of them?
• 41:49D.
• 41:50I never knew d. It
• 41:51was such a devastating and
• 41:53depressing and deflating letter.
• 41:55So what I did is
• 41:56I took I I sat
• 41:57down and said I just
• 41:58tried to articulate
• 42:00various
• 42:01states of mind, and I
• 42:01thought I took it all
• 42:03into
• 42:04uncle chat,
• 42:05and I said, take all
• 42:07of these words
• 42:09and create a picture
• 42:11so that I could mirror
• 42:11and look back on myself,
• 42:14intermittently.
• 42:15And this is what he
• 42:17did. Quite, impressive, I thought.
• 42:21And okay.
• 42:23Nonetheless, the struggle must continue
• 42:25because it will. And so
• 42:27it however you define the
• 42:28struggle, it will continue.
• 42:31And none of this will
• 42:31be easy, and it falls
• 42:33on all of us, and
• 42:34it does not seem fair,
• 42:35but we must know that
• 42:37no one is coming, and
• 42:38it has never been fair
• 42:39or just. And to paraphrase,
• 42:41John Lewis
• 42:43who paraphrased,
• 42:47someone else who paraphrased someone
• 42:48else. I tried to get
• 42:49to the bottom of this,
• 42:50but I think it was
• 42:50actually
• 42:52a
• 42:53Hebrew scholar
• 42:54many, many centuries ago that
• 42:56said, if not us, then
• 42:58who? If not now, then
• 42:59when?
• 43:01So what does the future
• 43:02hold?
• 43:03Institutional and political support is
• 43:05crucial. Departmental
• 43:06division section leadership is crucial.
• 43:08Program leadership is crucial.
• 43:10Funding is crucial. Advocacy by
• 43:12local and political leaders, advocacy
• 43:14by our organizations,
• 43:16and perhaps, eventually, some advocacy
• 43:18and pushback by ag accreditation
• 43:20organizations.
• 43:21For individuals in the in
• 43:23in caught up in all
• 43:24of this, sometime a self
• 43:26care is essential. Sometimes you
• 43:28simply have to step back.
• 43:29I take a news fast
• 43:30intermittently,
• 43:32try to cultivate determination,
• 43:35hope, courage, fortitude,
• 43:37doggedness,
• 43:38persistence,
• 43:39steadfastness.
• 43:40And I love this word,
• 43:42indefatigability.
• 43:45I just it just came
• 43:47across. I just liked it.
• 43:48And innovation and creative strategies
• 43:50will be crucial. And so
• 43:53the way forward, I took
• 43:54this
• 43:55these
• 43:56same words back to uncle
• 43:58chat,
• 43:59and I said, uncle
• 44:01Chad, look at this and
• 44:02tell me what this look
• 44:03like. And this is what
• 44:04he came up with.
• 44:07Hope in defragability
• 44:08and resilience.
• 44:09And I think, ultimately,
• 44:11everywhere in society,
• 44:13nationally, globally, really,
• 44:16the only way out is
• 44:17to find common ground.
• 44:19Right? Our human values, things
• 44:21we share together, and kind
• 44:22of a a march to
• 44:23the middle to meet to
• 44:24meet ourselves.
• 44:26What should GME still strive
• 44:28for?
• 44:30Currently, how do we define
• 44:32success for GME training programs?
• 44:34These are all very valid
• 44:35metrics.
• 44:36So excellent board pass rates,
• 44:38of course, fellowship match rates,
• 44:40top three choices,
• 44:42academic jobs, large scholarly footprint,
• 44:45prior achievements, superstars,
• 44:47policymakers,
• 44:49contribution to patient safety, equitable
• 44:51health outcomes in the community.
• 44:53So these are all excellent
• 44:55parameters.
• 44:58But I wanna go zoom
• 44:59out and the ultimate health
• 45:01care goal of GME,
• 45:02ultimately,
• 45:03if you break it down,
• 45:04we're simply here to produce
• 45:06future generations of physicians and
• 45:08scientists
• 45:08who will ensure the best
• 45:10possible health care for the
• 45:11entire US population.
• 45:13And to attain this goal,
• 45:14it's essential to train highly
• 45:16competent physicians who reflect population's
• 45:19diversity in all its forms.
• 45:21And also,
• 45:23such members, it's important that
• 45:25clinical research and basic research
• 45:27should represent diversity of the
• 45:29country in all its forms.
• 45:31And as leaders,
• 45:33we all acknowledge talent is
• 45:34universal.
• 45:35We should strive for excellence
• 45:37driven by different perspectives. It's
• 45:39up to us to foster
• 45:40a learning and collaborative environment
• 45:42where everyone is respected,
• 45:44feel psychologically safe, and can
• 45:45give their highest value.
• 45:47We want excellence driven by
• 45:49diversity
• 45:50to create a sum greater
• 45:51than its components.
• 45:53We should consider recruiting and
• 45:54retaining faculty who can contribute
• 45:57to this environment.
• 45:58And I'd like to end
• 45:59with this in October. It
• 46:00came out just in time,
• 46:02but can be used for
• 46:03the next cycle.
• 46:04The WMC came up with
• 46:05this mission aligned selection and
• 46:07retention
• 46:08guideline.
• 46:10And mission aligned selection is
• 46:11a flexible evidence informed approach
• 46:13to recruiting
• 46:14and assessing an individual's competency
• 46:17competencies by considering their
• 46:20experiences, attributes, and metrics.
• 46:22In order to select an
• 46:23individual that is best suited
• 46:25for your own program's
• 46:27environment.
• 46:29In other words, they recommend
• 46:30establishing a program's mission
• 46:33as the foundation for defining
• 46:35merit
• 46:36and identifying competencies,
• 46:38attributes, and experiences that would
• 46:40align with programmatic goals and
• 46:42definitions.
• 46:43So they recommend creating
• 46:45proactively having,
• 46:47your mission, institution, or program
• 46:49as a foundation for defining
• 46:51merit.
• 46:53The core principles are your
• 46:55selection criteria is aligned with
• 46:56your program's curriculum, health needs
• 46:58of your community,
• 47:00and the needs of the
• 47:01physician workforce.
• 47:03Make it transparent,
• 47:04equally apply equitably applied,
• 47:07and aligned with what support
• 47:09you can provide.
• 47:10And then consider the contact
• 47:11of each individual's unique educational
• 47:14opportunities,
• 47:14financial resources,
• 47:16experiences, motivations,
• 47:17how they can contribute to
• 47:18your program and the practice
• 47:20of medicine.
• 47:21Then review, interview, and interview
• 47:23candidates to select a rank
• 47:25list cohort of learners.
• 47:27And then at the conclusion
• 47:28of each
• 47:29cycle program,
• 47:31review, evaluate, and refine the
• 47:32process.
• 47:34So this is the new
• 47:35EA EAMC model
• 47:37that they came up with.
• 47:38At the core of it
• 47:39is your program's,
• 47:41priorities
• 47:42and the competencies that you
• 47:43seek.
• 47:45So your program
• 47:46is specific mission,
• 47:48then you look at the
• 47:49knowledge, skills, and abilities of
• 47:50the applicants that can support
• 47:52that defined success.
• 47:54Look at the experience. What
• 47:56do they bring hands on?
• 47:57Are they community,
• 47:58workers? Are they volunteered in
• 48:00the community? Do they have,
• 48:02scientific
• 48:03experience in the lab, etcetera?
• 48:06Then the attributes,
• 48:07resilience,
• 48:08growth mindset,
• 48:09self motivation, self drive.
• 48:12Of course, academics are always
• 48:13part of it. But also
• 48:15to look finally look at
• 48:16the family background, financial status,
• 48:18education, and personal challenges faced.
• 48:21And,
• 48:23so with that, before I
• 48:24stop, I wanted to mention
• 48:26that for the first time,
• 48:26the NRMP is recording the
• 48:28MENA category,
• 48:30Middle Eastern and North, African.
• 48:32And it was in the
• 48:33graph, but it's it's,
• 48:35six percent,
• 48:37six percent of the
• 48:39of the match
• 48:41where MENA categories. Now in
• 48:43terms of in the population
• 48:44generally, it's about the MENA
• 48:46population in the United States
• 48:47based on the census is
• 48:48about one percent.
• 48:51So that just to put
• 48:52that in context. And thank
• 48:53you. I'll stop now.
• 49:06Yes. Yeah. I appreciated your
• 49:08closing
• 49:09the double AMC,
• 49:11mission driven.
• 49:13Yes. Looking at applicants, and
• 49:15I I hadn't seen that
• 49:16before.
• 49:17But it it strikes me
• 49:19that it's it's actually a
• 49:20different,
• 49:22framing than
• 49:24a lot of the factors
• 49:25that drove the concerns over
• 49:27the past year.
• 49:28Yes. I I feel like
• 49:30the a lot of the
• 49:31edicts that
• 49:32were handed down had to
• 49:34do more with, like, the
• 49:35opportunity
• 49:37for the applicant, the notion
• 49:38that somehow it's all zero
• 49:40sum game.
• 49:41If one applicant,
• 49:43position in a residency, then
• 49:45another applicant can't. And and
• 49:47that's that's one way of
• 49:48looking at it. But I
• 49:49actually think as a program
• 49:50director,
• 49:51we've always been focused on
• 49:53the mission. I'm just glad
• 49:55to see it
• 49:56stated explicitly. So, for example,
• 49:58what will this person contribute
• 50:00to our patients and our
• 50:01community and our
• 50:03academic
• 50:04mission? And and that's always
• 50:05stated priority, but I think
• 50:07I think it's important to
• 50:08reassert this because to me,
• 50:11a mission driven
• 50:13approach by definition has to
• 50:15be diverse.
• 50:16Correct. Yes. Yeah. Much of
• 50:18our mission
• 50:19is diverse. Is diverse.
• 50:22Example, looking outside
• 50:23a more narrow pool of
• 50:25athletes. Like, sometimes there are
• 50:26people who come from different
• 50:28backgrounds who are more suited.
• 50:29So one one simple example
• 50:32for us is we have
• 50:33a a very large clinic
• 50:35that serves a predominantly Spanish
• 50:36speaking
• 50:37population.
• 50:38So that we is very
• 50:40important for me
• 50:41to look at applicants who
• 50:43are are fluent or native
• 50:45Spanish speakers.
• 50:46And and culturally competent. So
• 50:49and that is what,
• 50:51like, for us at Chicago,
• 50:53we have big Spanish. So
• 50:54that's what a lot of
• 50:55people
• 50:56but I think this is
• 50:58in the era or in
• 50:59the current era. I think
• 51:00the WMC is trying to
• 51:02help people
• 51:04articulate
• 51:04what it is that they
• 51:05were looking for and aligning
• 51:07with your mission. And I
• 51:08think aligning with your mission
• 51:10is also
• 51:12can is I think has
• 51:13a
• 51:14a legal umbrella
• 51:17just to to to be
• 51:17blunt. It's aligning to that.
• 51:20So there are a couple
• 51:21Yeah. Comments or questions in
• 51:22the chat.
• 51:24Will Robert, wanna hop on
• 51:26and ask your question?
• 51:30Yeah. Hi there. Can you
• 51:31hear me?
• 51:32Yes. Yes. Yeah. Hi. Thank
• 51:34you, for this, you know,
• 51:35amazing talk. I was wondering,
• 51:37like, you know, as, somebody
• 51:38in your position, how do
• 51:39you signal to trainees the
• 51:41importance of diversity in this
• 51:43environment,
• 51:43particularly, like, if sometimes the
• 51:45mission statements, like, take diversity
• 51:46out of that, things like
• 51:47that? Like, how
• 51:49do you conceptualize that?
• 51:51Yeah. So I think it's,
• 51:54luckily, our our mission statement
• 51:56here
• 51:57has not taken that out.
• 51:58But I think
• 51:59when you talk to medical
• 52:01students, GME trainees,
• 52:03at our end goal, ultimately,
• 52:05everything that we're we're trying
• 52:06to achieve
• 52:08in a way boils down
• 52:09to health equity.
• 52:10Right? The United States population
• 52:13that we need to look
• 52:14after is very diverse. It's
• 52:15expanding by twenty twenty
• 52:18By twenty
• 52:22forty, the estimated that the
• 52:23white population will be forty
• 52:25nine point six percent. So
• 52:26it so we're going to
• 52:27we diversity is increasing, and
• 52:29I think,
• 52:31when you
• 52:32dealing with health care,
• 52:35you I you the need
• 52:36for diversity just can't end,
• 52:39right, because it's a very
• 52:40heterogeneous population. So I think
• 52:41in terms of,
• 52:43institutions
• 52:45may change their their verbiage,
• 52:46but, ultimately,
• 52:48health care, health equity,
• 52:50safe,
• 52:51high quality care,
• 52:53everyone in America,
• 52:55respects that and wants that.
• 52:57And I think that's one
• 52:58way to
• 52:59to keep pushing. And and
• 53:00then we our outreach and
• 53:01recruitment continues,
• 53:04unabated
• 53:05because
• 53:07it's really aligned with Yale's
• 53:08mission, which is
• 53:11excellence driven by diversity, enriched
• 53:13curiosity, and enriched by diversity.
• 53:18Magic hour is upon us,
• 53:19but Wendy Barr. Comment. Wendy,
• 53:21you wanna hop out with
• 53:25yeah. So I was just,
• 53:27putting a comment. First of
• 53:28all, thank you so much.
• 53:29I think at the end,
• 53:30centering why this is so
• 53:32important in our outcomes and
• 53:33and what are we trying
• 53:34to do,
• 53:36when we're doing GME.
• 53:38And it's really about serving
• 53:40patients, community, and health and
• 53:43doing that equitably.
• 53:44The NASEM, the National Academy
• 53:46of Science in, Medicine met
• 53:48this week actually to talk
• 53:49about that. And So I
• 53:50just put in the chat,
• 53:52the link to that work
• 53:53the workshop materials, which I
• 53:55think is helpful to think
• 53:56about,
• 53:57policy things that we can
• 53:58think about how to support
• 53:59this moving forward.
• 54:02Oh, absolutely.
• 54:05You mean
• 54:07creating and, deploying policy to
• 54:09support
• 54:11health equity?
• 54:12To support health equity. And
• 54:14and the way they define
• 54:15it as a lot you
• 54:16mentioned a lot about rural
• 54:17health, making sure we're putting
• 54:19phys we're training physicians so
• 54:21that they work in the
• 54:22places where we don't have
• 54:24enough physicians,
• 54:25for populations
• 54:26that have not been served
• 54:28well in the past,
• 54:29you know,
• 54:31culturally sensitive care, culturally appropriate
• 54:33care.
• 54:34All of that ends up,
• 54:36I think, really falling in
• 54:37with each other, and all
• 54:38of this ends up working
• 54:39with each other. But I
• 54:40thought what what's interesting is
• 54:42they really look at,
• 54:44a lot around state based.
• 54:47How do we, on state
• 54:48based level, be able to
• 54:49work to advocate for this?
• 54:51So maybe if you think
• 54:52instead of the maps you
• 54:53showed. Yeah. Absolutely. And if
• 54:55you think about it, I
• 54:56mean, the GME industry, we
• 54:58are gonna look after we
• 54:59I mean, this this is
• 55:01we produce
• 55:03whoever is gonna look after
• 55:04whoever in the future. Right?
• 55:06And and I think a
• 55:07lot of the policies currently,
• 55:09we're shooting ourselves in the
• 55:10foot, especially when it comes
• 55:11to rural rural health care.
• 55:14Yeah. Absolutely.
• 55:16Okay. Some thanks from, other
• 55:18folks, including Andy Asness and
• 55:20Shali Gupta and others.
• 55:22And, Ben, thank you for
• 55:24me and No.
• 55:25For a wonderful presentation.
• 55:27Thank you.