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. Akl
  • Reem Mustafa
  • Fadi Bdair
  • Holger J. Schünemann
Health Policy

Background

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.

Objective

To describe the historical trends and compare the characteristics of IMGs to United States medical graduates (USMGs) in the United States.

Design

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.

Measurements

Historical trends and characteristics of IMGs in the United States.

Results

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).

Conclusions

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 

References

  1. 1.
    Grumbach K, Lee PR. How many physicians can we afford? JAMA. 1991;265:2369–72.PubMedCrossRefGoogle Scholar
  2. 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. 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
  4. 4.
    Cooper RA. Weighing the evidence for expanding physician supply. Ann Intern Med. 2004;141:705–14.PubMedGoogle Scholar
  5. 5.
    Cooper RA, Stoflet SJ, Wartman SA. Perceptions of medical school deans and state medical society executives about physician supply. JAMA. 2003;290:2992–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Sunshine J. Overview and Analysis of Information Regarding the Shortage. Chicago, IL: American College of Radiology; 2001.Google Scholar
  7. 7.
    Schubert A, Eckhout G, Tremper K. An updated view of national anesthesia personnel shortfall. Anesth Analg. 2003;96:207–14.PubMedCrossRefGoogle Scholar
  8. 8.
    Foot DK, Lewis RP, Pearson TA, Beller GA. Demographics and cardiology, 1950–2050. J Am Coll Cardiol. 2000;35:1067–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Boyce ST. The Rochester Community Physician Workforce: Factors Affecting Recruitment and Retention. Rochester, NY: CGR; 2003.Google Scholar
  10. 10.
    Angus DC, Kelly MA, Schmitz RJ, White A, Popovich J. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population? JAMA. 2000;284:2070–762.CrossRefGoogle Scholar
  11. 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. 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
  13. 13.
    Lurie JD, Goodman DC, Wennberg JE. Benchmarking the future generalist workforce. Eff Clin Pract. 2002; 5:58–66PubMedGoogle Scholar
  14. 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. 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. 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
  17. 17.
    Cooper RA. Medical schools and their applicants—an analysis: if more physicians are required, can medical schools fill the gap? Health Aff. 2003;22:71–84.CrossRefGoogle Scholar
  18. 18.
    Blumenthal D. New steam from an old cauldron—the physician-supply debate. N Engl J Med. 2004;350:1780–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper RA. Impact of trends in primary, secondary, and postsecondary education on applications to medical school. I: Gender considerations. Acad Med 2003;78:855–63.PubMedCrossRefGoogle Scholar
  20. 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. 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. 22.
    U.S. Department of Agriculture. RUCA Codes. Available at: http://www.ers.usda.gov/Briefing/Rurality/RuralUrbanCommutingAreas/. Accessed January 23, 2006.
  23. 23.
    Benson JA, Jr., Meskauskas JA, Grosso LJ. Performance of U.S. citizen–foreign medical graduates on certifying examinations in internal medicine. Am J Med. 1981;71:270–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Norcini JJ, Boulet JR, Whelan GP, McKinley DW. Specialty board certification among U.S. Citizen and non-U.S. Citizen graduates of International Medical Schools. Acad Med. 2005;80:S42–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Freshnock LJ, Goodman LJ. The organization of physician services in solo and group medical practice. Med Care. 1980;18:17–29.PubMedCrossRefGoogle Scholar
  26. 26.
    Mullan F, Politzer RM, Davis CH. Medical migration and the physician workforce. International medical graduates and American medicine. JAMA. 1995;273:1521–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Fink KS, Phillips RL, Jr., Fryer GE, Koehn N. International medical graduates and the primary care workforce for rural underserved areas. Health Aff. 2003;22:255–62.CrossRefGoogle Scholar
  28. 28.
    Mullan F. The metrics of the physician brain drain. N Engl J Med. 2005;353:1810–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Hallock JA, Seeling SS, Norcini JJ. The international medical graduate pipeline. Health Aff. 2003;22:94–6.CrossRefGoogle Scholar
  30. 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. 31.
    Adams O, Kinnon C. A Public Health Perspective. International Trade in Health Services: a Developmental Perspective. Geneva: World Health Organization; 1998.Google Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Elie A. Akl
    • 1
    • 2
  • 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

Personalised recommendations