The United States Physician Workforce and International Medical Graduates: Trends and Characteristics
International medical graduates (IMGs) have been a valuable resource for the United States physician workforce, and their contribution to the United States workforce is likely to increase.
To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States.
Longitudinal analysis of the American Medical Association Physicians’ Professional Data (AMA-PPD) database using the 1978–2004 files and a comparative analysis of the characteristics of a random sample of 1,000 IMGs and a random sample of 1,000 USMGs using the 2004 file.
Historical trends and characteristics of IMGs in the United States.
Over the last 26 years, the number of IMGs in the United States grew by 4,873 per year reaching a total of 215,576 in 2004, about 2.4 times its size in 1978. The proportion of IMGs increased 0.12% per year, from 22.2% in 1978 to 25.6% in 2004. In 2004, compared with USMGs, IMGs were older, less likely to be board certified [Odds ratio (OR), 0.68; 95% CI, 0.53 to 0.86], less likely to work in group practice (OR, 0.60; 95% CI, 0.37 to 0.98), more likely to have Internal Medicine as practice specialty (OR, 2.10; 95% CI, 1.62 to 2.71) and more likely to be residents (OR, 1.52; 95% CI, 1.07 to 2.16).
Over the last quarter century, the IMGs provided a significant and steady supply for the United States physician workforce that continues to grow. Policymakers should consider the consequences for both the United States and source countries.
Key wordsforeign medical graduates health manpower internship and residency
We thank Dr. Gordon Guyatt and Dr. Peter Tugwell for their comments and suggestions. Research for Health in Erie County, Inc. funded this work and was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Investigators received salary support from institutional sources. This study was presented as a poster during the SGIM 29th annual meeting (Apr 28 2006).
Potential Financial Conflicts of Interest
- 2.Graduate Medical Education National Advisory Committee. Summary report of the Graduate Medical Education National Advisory Committee to the Secretary, Department of Health and Human Services. Washington, D.C. April 1981.Google Scholar
- 3.American Association of Colleges of Osteopathic Medicine, American Medical Association, American Osteopathic Association, Association of Academic Health Centers, Association of American Medical Colleges, National Medical Association. Consensus Statement on Physician Workforce. Washington, DC; 1997.Google Scholar
- 6.Sunshine J. Overview and Analysis of Information Regarding the Shortage. Chicago, IL: American College of Radiology; 2001.Google Scholar
- 9.Boyce ST. The Rochester Community Physician Workforce: Factors Affecting Recruitment and Retention. Rochester, NY: CGR; 2003.Google Scholar
- 11.Zerehi, R. For the Health and Public Policy Committee of the American College of Physicians. Creating a New National Workforce for Internal Medicine. A Position Paper: American College of Physicians; 2006.Google Scholar
- 12.Weiner JP. Prepaid group practice staffing and U.S. physician supply: lessons for workforce policy. Health Aff. 2004;Suppl Web Exclusives:W4-43–59.Google Scholar
- 14.American Medical Association. H-200.953 The Physician Workforce: Recommendations for Policy Implementation. 2003 January 18, Available at: http://web.archive.org/web/20040207002827/http://www.ama-assn.org/ama/pub/article/print/1616-8229.html. Accessed January 23, 2006.
- 15.Association of American Medical Colleges. The physician workforce: position statement. February 2005. Available at: http://www.aamc.org/workforce/12704workforce.pdf. Accessed January 23, 2006.
- 16.Council on Graduate Medical Education. Physician Workforce Policy Guidelines for the United States, 2000–2020. Rockville, MD: Health Resources and Services Administration, 2005.Google Scholar
- 20.American Medical Association. International Medical Graduates. 2005 Available at: http://www.ama-assn.org/ama/pub/category/1550.html. Accessed January 23, 2006.
- 21.American Medical Association. AMA Physicians’ Professional Data. 2004. Available at: http://www.ama-assn.org/ama/pub/category/2673.html. Accessed January 23, 2006.
- 22.U.S. Department of Agriculture. RUCA Codes. Available at: http://www.ers.usda.gov/Briefing/Rurality/RuralUrbanCommutingAreas/. Accessed January 23, 2006.
- 30.Regets MC. Research and Policy Issues in High-skilled International Migration: a Perspective with Data from the United States. Arlington VG: National Science Foundation; 2001. Discussion paper 366.Google Scholar
- 31.Adams O, Kinnon C. A Public Health Perspective. International Trade in Health Services: a Developmental Perspective. Geneva: World Health Organization; 1998.Google Scholar