0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
msJAMA |

The Posttraining Plans of International Medical Graduates and US Medical Graduates in New York State FREE

Edward Salsberg, MPA; Joseph Nolan, MS
[+] Author Affiliations

Not Available


Not Available


JAMA. 2000;283(13):1749-1750. doi:10.1001/jama.283.13.1749-JMS0405-5-1.
Text Size: A A A
Published online

The United States' policies regarding international medical graduates (IMGs) have been hotly debated1,2 since the number of IMGs entering training more than doubled from 1988 to 1994.3 In the 1998-1999 academic year, IMGs added an additional 29% (5134) to the 18,000 US medical graduates entering allopathic and osteopathic training programs.4

This influx of IMGs into training programs comes at a time of widespread concern about a potential surplus of physicians and about rising costs of Medicare reimbursement to teaching hospitals for graduate medical education (GME). As a result, some workforce and professional groups have called for restrictions on the numbers of IMGs permitted to enter training and to remain permanently in the United States.5 However, others argue that IMGs have historically filled gaps in the physician workforce by practicing in geographic areas where US medical graduates (USMGs) prefer not to practice and by choosing specialties that USMGs do not wish to enter.6,7

As a major center for GME in the United States, the state of New York provides a useful window into the experiences of newly trained physicians. Although only 7% of the US population resided in New York in 1999, nearly 15% of all allopathic residents and 29% of all IMG residents trained in New York during that year.4 A survey of residents completing training in New York therefore provides a meaningful perspective on the practice patterns and job market experience of both IMGs and USMGs.

Based on data from teaching hospitals and the American Medical Association's (AMA's) GME database, the Center for Health Workforce Studies at the University at Albany determined the number of physicians expected to complete an allopathic or osteopathic residency program in New York state in 1999. Excluding those in preliminary and transitional programs, approximately 4700 residents in 1140 programs were found to be in their last year of training in New York.

A survey with questions addressing the demographic characteristics, educational experiences, postresidency plans, and job market prospects of graduating residents was mailed to all teaching hospitals in New York State. The hospitals distributed the surveys to individual allopathic and osteopathic residency programs, with instructions to distribute them to residents during their last 6 weeks of training. When completed, the surveys were sent back to the Center by the same route.

The Center received completed surveys from more than 3400 residents for a response rate of 73%. The response rate for residents in primary care fields (family practice, general internal medicine, pediatrics, and internal medicine and pediatrics combined) was 77%. Of the respondents, approximately 48% were USMGs; 52% were IMGs.

The demographic characteristics of the survey respondents closely matched those reported in the AMA GME database for residents completing training in New York in 1999. In particular, the percentages of survey respondents who were IMGs versus USMGs were consistent with those documented in the AMA GME database. This led the authors to conclude that the survey respondents were representative of all residents completing training in New York during the year of study.

Four distinct groups of IMGs were distinguished on the basis of citizenship status: naturalized citizens/permanent residents (45% of IMGs); exchange visitor physicians with J visas (41%); physicians with temporary worker H visas (7%); and native-born US citizens who had obtained medical education outside the United States (US-IMGs) (7%). As US-IMGs and IMGs who are naturalized citizens or permanent residents enjoy similar immigration status, they were considered as a single group for data analysis. Physicians with J and H visas, both of which are US temporary immigration visas, were also grouped together for the purpose of analysis.

The results of the survey suggest certain trends in the practice and employment characteristics of graduating New York residents based on their citizenship and visa status. IMGs, particularly those with temporary visas, were more likely to train in primary care specialties, internal medicine subspecialties, and psychiatry than were USMGs. For example, 57% of temporary visa-holding IMGs surveyed were completing training in the primary care fields of family practice, general internal medicine, general pediatrics, or internal medicine and pediatrics combined, compared to 37% of USMGs surveyed (P<.001).

IMGs with temporary visas were more likely to subspecialize than were USMGs. For example, 62% of temporary visa-holding IMGs in internal medicine were planning to subspecialize, compared with 36% of USMGs in internal medicine (P<.001). IMGs who were US citizens or permanent residents subspecialized at a similar rate as USMGs (Figure 1). Of all graduating residents with J visas, 18% were planning to leave the United States immediately following completion of training. Excluding those going on to subspecialize, 28% were planning to leave the United States.

Place holder to copy figure label and caption

USMG indicates US medical graduate; IMG, international medical graduate.

Graphic Jump Location

When the numbers of temporary visa-holding IMGs who were subspecializing or departing from the country were taken into account, the percentage of these IMGs actually entering primary care practice in the United States was approximately equal to that of USMGs (36% vs 38%, P=.409) (Table 1).

Table Graphic Jump LocationTable. Posttraining Plans of Residents Completing Training in New York State in 1999 by Citizenship Status*

Of temporary visa holding IMGs with confirmed plans to practice in the United States, 84% were planning to practice in designated health professional shortage areas (HPSAs), compared with only 11% of USMGs (P<.001) and 6% for other IMGs (P<.001). However, when calculated as a percent of all graduating residents regardless of their plans (including graduates that were subspecializing or leaving the country), the percent of J visa physicians planning to practice in HPSAs dropped to 15%, and the figure for USMGs dropped to 5% (P<.001).

Temporary visa-holding IMGs expressed significantly more difficulty finding a satisfactory practice opportunity than did USMGs or permanent residents/US citizen IMGs. For example, 44% of temporary visa-holding IMGs indicated that they had to change their plans because of limited practice opportunities, compared with only 15% (P<.001) for USMGs and 24% (P<.001) for other IMGs.

The results of this survey indicate that international and US medical graduates in New York State differ significantly in their training and practice characteristics. In addition, significant variations in posttraining plans appear to exist among IMGs, depending on their specific citizenship and visa status.

While it may be that IMGs entering primary care fields are filling a gap created by USMGs, the high percentage of IMGs in certain subspecialties also reflects their willingness to enter specialties that allow them to remain in this country while in training, even if demand for their services is low.

The results of this study indicate that IMGs holding temporary visas are more likely than other IMGs to practice in health profession shortage areas. Given the higher proportion of IMGs with temporary visas who plan to subspecialize or to return to their native country after completing their primary care training, the contribution of IMGs to primary care in underserved areas is not as dramatic as was previously thought.

Although US-IMGs and IMGs who are naturalized citizens or permanent residents are more likely than temporary visa-holding IMGs or USMGs to enter primary care specialties without subspecializing, few of them appear to go on to work in designated medically underserved areas and thus may not contribute to primary care in those areas as may have been thought.

Council on Graduate Medical Education, Eleventh Report: International Medical Graduates, the Physician Workforce, and GME Payment Reform.  Rockville, Md US Dept of Health and Human Services1998;
Institute of Medicine, The Nation's Physician Workforce: Options for Balancing Supply and Requirements.  Washington, DC National Academy Press1996;
Council on Graduate Medical Education, Fourteenth Report: COGME Physician Workforce Policies: Recent Developments and Remaining Challenges in Meeting National Goals.  Rockville, Md US Dept of Health and Human Services1999;
Not Available, Appendix II: Graduate medical education. Tables 3 and 4. JAMA. 1999;282897- 898
The Medicare Payment Advisory Commission, Report to Congress: Medicare Payment Policy.  Washington, DC Medicare Payment Advisory Commission1998;
Politzer  RCultice  JMeltzer  A The geographic distribution of physicians in the United States and the contribution of international medical graduates. Med Care Res Rev. 1998;55141- 150
Link to Article
Baer  LRicketts  TKonrad  TMick  S Do international medical graduates reduce rural physician shortages? Med Care. 1998;361534- 1544
Link to Article

Figures

Place holder to copy figure label and caption

USMG indicates US medical graduate; IMG, international medical graduate.

Graphic Jump Location

Tables

Table Graphic Jump LocationTable. Posttraining Plans of Residents Completing Training in New York State in 1999 by Citizenship Status*

References

Council on Graduate Medical Education, Eleventh Report: International Medical Graduates, the Physician Workforce, and GME Payment Reform.  Rockville, Md US Dept of Health and Human Services1998;
Institute of Medicine, The Nation's Physician Workforce: Options for Balancing Supply and Requirements.  Washington, DC National Academy Press1996;
Council on Graduate Medical Education, Fourteenth Report: COGME Physician Workforce Policies: Recent Developments and Remaining Challenges in Meeting National Goals.  Rockville, Md US Dept of Health and Human Services1999;
Not Available, Appendix II: Graduate medical education. Tables 3 and 4. JAMA. 1999;282897- 898
The Medicare Payment Advisory Commission, Report to Congress: Medicare Payment Policy.  Washington, DC Medicare Payment Advisory Commission1998;
Politzer  RCultice  JMeltzer  A The geographic distribution of physicians in the United States and the contribution of international medical graduates. Med Care Res Rev. 1998;55141- 150
Link to Article
Baer  LRicketts  TKonrad  TMick  S Do international medical graduates reduce rural physician shortages? Med Care. 1998;361534- 1544
Link to Article
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 17

Related Content

Customize your page view by dragging & repositioning the boxes below.