Latest / Behind The Knife: The Surgery Podcast / Journal Review in Thoracic Surgery: Empowering IMGs in CT Surgery - the Time to Act is Now
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- Preventza_Rakoczy IMGs in CT === Speaker: [00:00:00] Hey, everyone. I'm Kyla Rakoczy, bringing you another Hopkins Thoracic Surgery Subspecialty Team episode. I am so excited to be here today with Irinia Preventza. Dr. Irinia Preventza is a triple board-certified renowned professor of thoracic surgery. She was prior chief of CT surgery at UVA Health, and also spent 15 years as a CT surgeon at Baylor, where she ultimately achieved the distinction of becoming the first female cardiac surgeon to earn tenure as a professor of surgery. Currently, she's maintaining an independent cardiac surgery practice through Cardiac Surgeons of San Antonio, where she is the founder. She's also an MBA holder in healthcare management. Dr. Preventza has been recognized for her outstanding contributions to surgical education and leadership. She's a dedicated mentor, earning a reputation as a fierce advocate for international medical graduates, helping them to succeed in highly competitive American residency programs. She earned her medical [00:01:00] degree from the Medical School University of Athens, and completed her general surgery residency here in the States. Dr. Preventza is an expert in aortic valve and arch surgery, thoracoabdominal operations, and percutaneous heart valve therapy, with special interest in education, health outcomes, policy, and women's cardiovascular health. Dr. Preventza, it is a privilege and honor. Welcome to the show. Thank Speaker 2: you for having me. So I've been listening to several episodes of the Behind the Knife podcast. I'm truly impressed. I want to congratulate you and your colleagues for all the initiatives you have created for trainees. I do believe your work is very impressive, and it's an important contribution to surgical education, and it's clear how much effort and thought has gone into building all these resources for the trainees. So thank you for having me here. Speaker: Oh my gosh, that means a lot coming from you, so thank you. Today, we'll be discussing a couple articles recently published on the [00:02:00] hot topic of IMGs in CT surgery, of which you're an expert. Beyond your clinical success, you've found a niche in mentorship and advocacy for IMGs, and you're gonna serve as our expert guide today, both to trainees and how they can best position themselves for success in the match, but also to faculty, early career to senior surgeon status, and others, advising them how they too can either advocate for themselves or step into the invaluable role of mentor in this space. Dr. Preventza, to start us off, can you tell us a little bit about your origin story? What motivates you in this work, and why IMGs in CT specifically are such a vulnerable group that warrants recognition and safeguarding? Speaker 2: Thank you, Karla. I grew up in Greece. One of the greatest blessings in my life was growing up with parents who deeply valued education. They taught me and my siblings that a good education was worth far more than money [00:03:00] because it open doors, creates opportunities, and builds character. In a way, learning was the greatest investment one could make. My father's favorite saying was, uh, "Knowledge is the only thing that nobody can take away from you." And those words really became more than just a quote for me. They became a principle that has guided me throughout my life and continues to influence both my personal as well as professional journey. Later on, while I was a surgical intern in New York City, my father had open-heart, uh, surgery, and that shaped my decision to become a heart surgeon. The journey of an international medical graduate is deeply personal to me. As somebody who has walked this path, I know the challenges firsthand, and I [00:04:00] also know the incredible potential that lies within its IMGs thriving to contribute to the US healthcare system. But my belief is very simple. By helping one patient, I can save a life, but by guiding and empowering many physicians, I can transform countless lives. So this kind of philosophy has shaped every step of my professional journey And throughout my training, as you may know, I never lost sight of my commitment to giving back. I made a promise to myself that once I succeeded, I could dedicate myself to helping others do the same. So throughout the years, I have mentored many IMGs, as well as US graduates and US medical students, advising them on how to position themselves for success academically and professionally. And while many of them pursued surgical [00:05:00] specialties, I have also helped physicians from a wide variety of disciplines. So what really drives me in this work is not obligation, but is a passion. I see myself in every international medical graduate who refuses to give up on the dream, and I know how much difference the right guidance can make. The principles of success, as Kaila, are universal. But each IMG brings a unique background, and their approach must be tailored accordingly because their path is often marked by uncertainty, and they have to overcome numerous obstacles. And I think this discussion ties directly into the articles that are very important and I believe you are, uh, ready to discuss. Speaker: Oh, perfect. It's really special to hear you talk about y- the impact your dad has had on your life. I know my dad has [00:06:00] played a very significant role, and it's not surprising to me that I was introduced to you through one of my mentors, Dr. Yang, and it's just really special that people of your stature have the, the time and space to give back to trainees. It makes a huge difference in our careers, so we appreciate you. Our first article is titled "International Medical Graduates in Academic Cardiothoracic Surgery." This was published in the Annals of Surgery by Jack Boyd and colleagues in June 2026. This article describes that IMGs currently make up about 25% of licensed doctors in the US, and 24% of academic CT surgeons in the United States. They face a multitude of barriers to practice, one being the requirement to complete residence in the US regardless of prior training or experience. To address known physician shortages, there have been a push by multiple states and work being done in Congress for legislation to modify these strict restrictions. Dr. Provenza, what are some of the barriers you [00:07:00] faced as an IMG and that you would encourage CT IMGs to prepare for during and after their training? Speaker 2: Great question. So early on, I learned a great deal by trial and error. The journey is not linear. It requires much more than just academic excellence. It involves navigating visa issues, cultural adaptation, language barriers, limited opportunities for clinical exposure, and something that we don't talk quite often. This is the psychological toll of uncertainty. The journey of an international medical graduate begins long before the first USMLE examination and continues well beyond residency. Understanding how to become eligible for the USMLE examinations, what is a credential verification [00:08:00] process, how the residency application works, the interviews and the match process All these are very different stages, but each stage presents unique academic, logistical, administrative challenges that require adaptability and access to a reliable guidance, as success does not happen by serendipity. It requires thoughtful preparation before entering the process, adaptability throughout training and resilience, and an ongoing professional development afterward. At every stage, from understanding the pathway to licensure and residency, to building clinical skills, seeking mentorship, and planning for a meaningful [00:09:00] career, IMGs, and not only IMGs, benefit from guidance that helps them make informed decisions. So by helping them and giving them the knowledge and the mentorship and practical resources before, during, and after training, they can not only navigate the system successfully, but also thrive as physicians, and most importantly, and this is why we became doctors, advocate for their patients and communities. But, uh, Kaila, you brought up a very important point of this article, and you mentioned that one of the most pressing concerns of the US healthcare system is the growing shortage of physicians. So the IMGs are not just a solution, but they, um, what I consider untapped source of excellence. They bring a lot of different experiences, strong [00:10:00] work ethic, a deep sense of purpose. We have to move away from viewing IMGs as gap fillers, and instead recognize them as innovators and leaders who can elevate the quality and cultural competency of care in this country. Interestingly, recently, there is a report by the Health Resources and Service Administration where thoracic surgery faces the most acute gap of any specialty. The supply adequacy, that is actually the ratio of available physicians to projected demand, will fall to approximate seventy percent in thoracic surgery by twenty thirty-five, meaning the field will meet less than seventy percent of patient demand In addition, the Society of Thoracic Surgeons estimates [00:11:00] approximately 900 or 1,000 cardiothoracic surgeons will retire by 2035, while, while an overall demand rises 20%. This by itself produces a projected 31% shortfall. Of course, fixing the doctor shortage requires a more comprehensive strategy and in my mind includes innovation in team-based care. The IMGs as gap fillers would not definitely solve the problem, and as you mentioned, it is true that recently state and federal officials tried to alleviate the challenge with at least 15 states introducing novel pathways to practice. These novel pathways use two predominant [00:12:00] strategies to address the physician gap. One is mobilizing domestic physician workforce reservoirs to create pathways toward independent practice, and this may apply to US medical graduates as well as to international medical graduates. And the second strategy is to bypass the traditional graduate educational tracks, allowing IMGs to practice independently without completing GME programs in the United States. But of course, these pathways created recently by legislators at the moment fail to specify this process for verifying skills and knowledge and for people to practice and have a high-quality independent practice. This is a big subject. Thank you for asking [00:13:00] it. Speaker: The article goes on to discuss sexual diversity and suggests that, and I quote, "The under-representation of women IMGs is part of a larger problem in CT surgery, with women having fewer publications per year, lower scholarly impact, and more junior academic positions than men," points you've also echoed in articles you've written like the one with Dr. Backus in Journal of Thoracic Disease in 2021, which we'll link in the show notes. Scholarship programs from organizations like Women in Thoracic Surgery and the Association of Women Surgeons have helped support female IMG surgeons, but there's definitely still room for improvement. You are a prominent leader in a historically male-dominated field. What words of advice do you have specifically for women trainees and surgeons navigating this space? Speaker 2: Thank you, Sarah. This is another subject very dear to my heart. Be confident in your abilities. Let your skills speak louder than stereotypes. [00:14:00] Do not let the lack of representation define your aspirations. Your determination and compassion, and especially your talent, belong in the operating room. You have to choose excellence over acceptance. And remember, respect is there through preparation, honesty, integrity, and consistent performance. There may be moments where you are the only woman in the room. Let that inspire you to lead, not discourage you from believing you belong. And you may also be the only wom- the only person in the room with the courage to speak up, ask difficult questions, or advocate for what is right. Never underestimate the power of your voice. Lead with confidence and integrity and conviction. You have to challenge the barriers with excellence, resilience, [00:15:00] and always remember, every door you open makes it easier for the women who follow. No one gets to the top on their own. We need to help each other, and that's the way we will make progress and, most importantly, help effectively our patients Speaker: Really inspiring words and your career and work have been equally inspiring. So thank you. Our next article is titled The Current Landscape and Challenges Facing International Medical Graduates in Cardiothoracic Surgery Training. This was published in JTCVS and further discusses challenges faced by IMGs and the need to foster a safe and supportive environment for this group. Despite a 12.5% increase over the past 10 years in IMG representation in the physician workforce, CT surgery, as you had mentioned, has had the most [00:16:00] rapid decline in IMG numbers amongst all specialties. Beyond the benefits of improved cultural diversity to match the increasing diversity of our patients, IMGs are also more likely to practice in underserved areas which helps address healthcare disparities. You've been a dedicated mentor and sponsor for IMGs in CT surgery throughout your career. Why do IMGs need sponsors? And what do you say to a trainee looking for one and the experienced clinician who could serve as one? Speaker 2: The reality is that everybody needs a sponsor. As you know, not only an IMG, a sponsor is more than someone who offers advice. Sponsor is a champion, right? You mentioned Dr. Steve Young is one of the greatest champions for trainees. A sponsor is someone who actively advocates for your growth and opens doors to, to opportunities that you may not be able to access on your own. Sponsor is [00:17:00] someone who advocates for your success when you are not in the room. To trainees seeking a sponsor, my advice is focus first on becoming someone others want to sponsor. Demonstrate professionalism, integrity, honesty. Demonstrate strong work ethic. Be prepared. Show initiative. When you identify physician whose career and values you admire, then you maintain the relationship over time. Now, for the experienced clinicians who could be the sponsors, I could say the following: everybody has a story, and everybody has a story of someone who believed in them, opened doors, offered guidance, or [00:18:00] provided an opportunity at a critical moment in their journey. None of us reaches where we are today completely on our own. Along the way, someone somewhere invested their time or gave us a chance. Now is our time to give back. Success is not only the achievements we accomplish ourselves, but is really the people we help rise after us And I believe also, Kyla, one of the things that is within one of these articles and you wanted to bring up is how about a trainee without connections, how they can find a sponsor or resources? And one of the most common misconceptions among trainees is that they don't [00:19:00] have connections. In reality, everyone has connections in one form of another. Many, maybe some more than others. We live in a social environment where we interact with people every day. The difference is not where we have connections, it is where we're intentional about building them. Creating opportunities means seeking opportunities. I say this all the time. Having a proactive mindset and go and get it mentality versus wait and see. Successful relationships rarely happen by chance. Every single interaction is an opportunity to build a relationship that may eventually lead to mentorship, sponsorship, or collaboration Speaker: I couldn't agree more and [00:20:00] it seems like while there's a ton of people available to offer mentorship, I think it does come down to the trainee both showing, as you, you said, mental prowess and individual preparation and being that person that someone wants to invest in and showing initiative and putting themselves out there a little bit to, to make some of those connections. Individual efforts and mentorship that we discussed are very important, but if we're speaking more broadly, what could programs as a whole be doing better to improve access and support for these applicants and early career physicians? What does an ideal support system look like to you? Speaker 2: So first, an ideal support system should provide clear guidance from the beginning. Many trainees struggle not because of a lack of ability, but because the pathway is complex and difficult to navigate without reliable information. [00:21:00] A strong system should offer resources explaining exactly what is the process, what are the expectations and what opportunities are available at each stage of their journey. Second, the system should create structured mentorship and sponsorship opportunities. These relationships should not depend solely on chance encounters. Third, the system should create opportunities for these trainees to demonstrate their abilities, such as access to clinical experiences, research collaborations, leadership opportunities, et cetera. And finally, an effective system should promote the culture of belonging, very important. The goal is not to lower standards, [00:22:00] but to ensure that ability and potential are not overlooked because of a lack of access or guidance. The ideal system that you mentioned, Kaila, does not simply help individuals, but is able to create pathways where more individuals can succeed Speaker: Dr. Proventsa, this has been incredible. You've had such an inspiring career, and getting to talk with you today has been an extreme privilege. Before some take-home points, I'd love to hear, what gives you hope about IMGs in CT surgery? Where are we going from here? Speaker 2: I believe we're moving from a culture of navigating alone to one of shared responsibility, mentorship, and sponsorship, where every talented physician, international medical graduate, or US medical graduate has a chance to [00:23:00] thrive. By investing in people, and I think that's important, I'm going to repeat that, by investing in people, we empower the next generation of physicians to lead, and we move towards a more connected and supportive healthcare community. Speaker: Thank you for your valuable insights, Dr. Proventsa. To wrap up today, international medical graduates are essential to cardiothoracic surgery but face many barriers. Mentorship and sponsorship are critical for success, especially for women and IMGs. Programs and institutions need to be held accountable to create more equitable, supportive environments, improve transparency in their processes, and provide necessary resources to help this important group of providers thrive in CT surgery. To quote our guest today, "Keep moving, do the right thing, and do not let people put you down. Be [00:24:00] honest and humble, and stand on your feet. You can face anything. When there, help others too." That's all for now. This has been the Johns Hopkins Thoracic Surgery Subspecialty Group signing off. Be sure to dominate the day.