Journal of General Internal Medicine

, Volume 22, Issue 2, pp 264–268 | Cite as

The United States Physician Workforce and International Medical Graduates: Trends and Characteristics

  • Elie A. AklEmail author
  • Reem Mustafa
  • Fadi Bdair
  • Holger J. Schünemann
Health Policy


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 words

foreign 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

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Elie A. Akl
    • 1
    • 2
    Email author
  • Reem Mustafa
    • 1
    • 2
  • Fadi Bdair
    • 3
  • Holger J. Schünemann
    • 4
  1. 1.Department of Medicine, School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloUSA
  2. 2.Department of Social and Preventive Medicine, School of Public Health and Health ProfessionsUniversity at BuffaloBuffaloUSA
  3. 3.Department of MedicineUnity Health SystemRochesterUSA
  4. 4.INFORMA, Italian National Cancer Institute Regina ElenaRomeItaly

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