What Docs Want From ‘The Pitt’; New Rules for IMGs; Healthcare Workers’ Vax Rates

The following is a transcript of the podcast episode:

Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where MedPage Today reporters share deeper insight into the week’s biggest healthcare stories. I’m your host, Rachael Robertson.

I’m going to kick off today’s episode with how “The Pitt” has handled the pervasive “ortho bro” stereotype and what our audience wants to see from the show next season. Then, Shannon Firth will detail how some states are working to make it easier for foreign-trained doctors to practice in the U.S. To finish the episode, Terry Rudd will break down CDC data on healthcare professionals’ COVID and flu vaccination rates.

Shannon Firth: Season 2 of the hit show “The Pitt” has continued to address the hottest topics in healthcare. A recent episode introduced a character representing a longtime medical stereotype: the ortho bro. Rachael is here in the studio to share what orthopedic surgeons have to say about it.

So Rachael, let’s start with how “The Pitt” introduced the ortho bro plot line.

Robertson: The emergency department in season two has been full of new medical maladies and characters, and in episode 10, we’re introduced to the orthopedic surgeon, Dr. Brendon Park, who everybody refers to as “Park the Shark.” Light spoiler: Park is called down to the emergency department because a patient came in with a severed leg, and the team has to figure out if it’s possible to save it. Park bursts into the trauma room, circling his prey with his curt, confident, and aggressive personality. He makes snarky remarks to his fellow clinicians, and many of them are seemingly stunned and intimidated by his demeanor. Orthopedic surgery is very male-dominated, and the character of Park falls into the pervasive ortho bro image.

Firth: So how are orthopedic surgeons responding to this particular depiction?

Robertson: Responses have been mixed. Orthopedic surgeon Nick Pappas, MD, said in an Instagram post that “We’re not all like ‘the Shark,'” and that the clip “should be used as an example by future ortho and other consultants about how not to behave in the ER.”

On Reddit, some said the depiction was, unfortunately, quite accurate. One user wrote that the shark ratio in ortho was about 50/50. Others said that they had never experienced that type of personality within ortho, and some users pointed out that they’d be okay having a surgeon who was a jerk if they were really, really good at their job.

Firth: That’s wild. Season 2 is still wrapping up, but you wrote about our audience’s suggestions for season 3. What ideas were most popular?

Robertson: Yeah. So our Editor-in-Chief, Jeremy Faust, MD, asked his followers on Threads what they want to see on the next season of “The Pitt.” Believe it or not, the writers are already working on season 3, even though we don’t yet know how season 2 will end, though I’m sure there’s going to be blood and drama.

But for next season, people have some creative suggestions. The night shift characters are quite popular, especially Dr. Abbott and Dr. Ellis. And folks are interested in the night shift getting some more screen time, though not at the expense of the day shift, as people still want to see more of them too.

People are also worried about Dr. Robby, and they want the stressed-out attending to go to therapy. “The world needs to see that men are happier when they deal with their emotions,” one user wrote.

There were several suggestions for how the writers could incorporate regional struggles into the show, which takes place in my hometown of Pittsburgh, Pennsylvania. The city has an abysmally high black maternal mortality rate for one, and the biggest health system in the area halted its youth gender affirming care program last year. Rural areas life-flight people into the city quite often as well. And so people are interested in having some plot lines addressing these issues.

But at the end of the day, people want the core of the show to stay solid. One user put it well: “Stay political. Stay honest about what healthcare workers are facing. Keep introducing people to lesser-known concepts.” Whenever the next season airs, you can count on MedPage Today to cover it.

Firth: Thanks, Rachael.

Robertson: Thank you, Shannon. I’ll take it from here.

International medical graduates, or IMGs, face many challenges to practicing in the United States. But now, many states have either dropped residency requirements for certain IMGs or have introduced legislation to enact such changes, which would open the door to permanent licensure for more foreign-trained doctors. MedPage reporter Shannon Firth is here to break it down for us.

Shannon, in your story, you wrote that Tennessee was the first state to eliminate residency requirements, which was pretty contentious. Can you tell us more?

Firth: That’s right, Rachael. In 2023, Tennessee passed a law allowing IMGs or foreign-trained physicians who never completed a residency in the U.S. or Canada to obtain a license through an alternative pathway. The problem was, even though members of the state’s medical board were required by law to create this pathway, not everyone liked the idea. Some board members argued that the law was forcing them to give licenses to people who might not be safe to practice. One member even threatened to resign.

But according to officials familiar with this pathway, there hasn’t been that same level of friction between boards and state legislatures in the recent past. Having guidance that lays out the guardrails for this process seems to have calmed some nerves.

In early 2025, Tennessee’s new licensure pathway opened for applications. As of last month, 19 more states have passed similar legislation, and another 23 have introduced bills aiming to create one of these pathways for foreign-trained physicians. All together, of the states that passed legislation, at least 10, in addition to Tennessee, are now accepting applications from IMGs.

Robertson: Why are so many states interested in making licensure more flexible for physicians who trained abroad?

Firth: Well Rachael, the simple answer is that, as a nation, we just don’t have enough physicians. I spoke with Jayesh Shah, MD. He’s the president of the Texas Medical Board, and he said that in his state, there are 30 to 40 counties where there are exactly zero physicians. So when Texas passed a bill last May, the idea was to help address those gaps in the workforce.

But they aren’t just handing out licenses to anyone who says they’re a doctor. Shah stressed that the physicians eligible for this pathway have to be well qualified and meet certain stringent requirements. They have to pass the USMLE — that’s the U.S. Medical Licensing Exam — 1 and 2; they need a special certificate from the educational commission for foreign medical graduates; their residency training in their home country has to be similar to training in the U.S.; and they have to have a job offer in hand and a clean license to practice in their home country. Even then, the initial license they’re given here will be a provisional license. They’ll work alongside another physician who will evaluate them for a period of time, 2 to 3 years, and only then can they practice independently.

Robertson: So there is one other challenge — any of the physicians who might be eligible for this new pathway being immigrants also need to have legal status to live and work in the U.S.

Firth: That’s right, Rachael, and obviously that may be a serious obstacle for some, given the current administration’s approach to immigration. In September of last year, President Trump issued an executive order that increased the fee for H-1B visa applications from a few thousand dollars to $100,000. Bills have been introduced that would exempt doctors and other healthcare workers from these fees, arguing that waiving these fees is in the national interest of the country. But as of right now, that legislation is still pending. We’ll be covering the situation as it unfolds.

Robertson: Thank you so much, Shannon.

Firth: Thanks, Rachael.

Robertson: When it comes to vaccines, “do as I say, not as I do,” may be the motto of many healthcare professionals. A new CDC survey reveals which medical staffers got the flu and COVID vaccines last season and which ones skipped their shots. MedPage reporter Terry Rudd is here to tell us about it.

Terry, which healthcare professionals were most likely to get their flu and COVID-19 shots in the 2024 to 2025 season?

Terry Rudd: So let’s start with the good news: flu vaccinations. Overall, three quarters of surveyed U.S. healthcare personnel, at 76%, got a flu shot last season, and that’s up slightly from the year before. Pharmacists were at the top, they led the way — 95% of them got a shot. Physicians were next at 93% and right behind them were 88% of nurse practitioners (NPs). However, a full 15 points behind those leading pharmacists were nurses, and their rate was 80%.

Now to COVID vaccinations. The numbers there were a lot lower. The good news is that a lot more healthcare workers got their COVID shot last season than the year before. The bad news is that the jump was from 31% to just 40%. That means more than half of surveyed healthcare staff didn’t get a COVID shot in the last season. As with flu shots, when it came to COVID shots, physicians and pharmacists led the way: 47% of doctors got theirs, 41% of pharmacists did the same. NPs only reached one out of three — 32%. As for nurses, only about one in four of them, just 27%, got their COVID shot.

Robertson: How did vaccine mandates by healthcare employers affect the numbers?

Rudd: Requiring your workers to get flu and COVID shots definitely drove up vaccination rates. When employers made vaccination mandatory, 97% of workers got their flu shots and 83% got a COVID shot. But if you drop the mandate and you made shots optional, your coverage rates plummet. Among workers whose employers didn’t require vaccinations, only 43% got a flu shot, less than half, and just 19%, that’s fewer than one in five healthcare workers, got a COVID shot.

But mandates weren’t the only way to boost vaccination rates. Even employers who skipped the mandates but offered workplace vaccinations saw better rates; 73% of their workers, three out of every four, who could get on site flu vaccinations got their shots. And almost half, close, 43% of those who were offered workplace COVID vaccinations, got the COVID shot.

Robertson: What about healthcare facilities? Which ones had the highest vaccination rates?

Rudd: So healthcare facilities saw the same steep drop off between the flu rates and the COVID numbers. Flu vaccination rates were highest in hospitals — 88% of workers got the flu shots. They were lowest in long term care settings, only 71% of long term care workers got vaccinated for the flu. Now that ranking flipped with COVID shots. Healthcare workers in long term care and home healthcare had the best COVID vaccination rates, almost half, at 45%. New CMS rules requiring nursing homes to offer staffers a COVID shot were likely what goosed those numbers. Hospitals, they saw 44% of their workers get a COVID shot. And at the rankings bottom, ambulatory care settings saw just 39%, almost down to one out of every three, of their workers get a COVID vaccination.

So the bottom line from the CDC is, if you offer workplace shots and you do more education outreach to your healthcare workers, their vaccination rates will likely go up. And more important, the risk of them passing on flu and COVID to the patients will likely go down.

Robertson: Well, thank you for your reporting on this, Terry, and thanks for making your MedPod debut.

Rudd: Thank you very much.

Robertson: And now for our measles update. There were 98 new cases last week and 87 the week before. Utah alone had 60 cases last week, and 43 the week prior, bringing the state’s total to 567 cases overall. We’ll see how the recent holiday gatherings impact the numbers in a few weeks.

For the second week in a row, though, South Carolina had no new measles cases. States must go 42 days — twice the incubation period of 21 days — without new cases to have an outbreak declared over. So if no new cases are reported, the state’s outbreak will end on April 26, according to Yale.

And as always, if you want to see a more detailed breakdown of where cases are and where the hot spots are, please check out our map linked here.

And that is it for today. If you like what you heard, please leave us a review wherever you listen to podcasts, and hit subscribe if you haven’t already, we’ll see you again soon.

This episode was hosted and produced by me, Rachael Robertson. Sound engineering by Greg Laub. Theme music by Palomar. Our guests were MedPage Today reporters Rachael Robertson, Shannon Firth, and Terry Rudd. Additional reporting by Jennifer Henderson. Links to their stories are in the show notes.

MedPod Today is a production of MedPage Today. For more information about the show, check out medpagetoday.com/podcasts.

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