0
May 17, 1995, Vol 273, No. 19 >
ARTICLE | May 17, 1995

Medical Migration and the Physician Workforce: Title and subTitle BreakInternational Medical Graduates and American Medicine FREE

Fitzhugh Mullan, MD; Robert M. Politzer, MS, ScD; C. Howard Davis, PhD
[+] Author Affiliations

The views expressed in this article are strictly those of the authors. No official endorsement by the US Department of Health and Human Services or any of its components is intended or should be inferred.

Reprint requests to Bureau of Health Professions, 5600 Fishers Ln, Parklawn Bldg, Room 8-05, Rockville, MD 20857 (Dr Mullan).


JAMA. 1995;273(19):1521-1527. doi:10.1001/jama.1995.03520430057039
Text Size: A A A
Published online
Article
References

Objective.  —Because of the size and growth of the international medical graduate (IMG) contribution to graduate medical education (GME) in the United States, and subsequently to the US physician workforce, it is essential to understand the demographics and patterns of IMG training and practice as well as the routes of entry into the United States.

Data Sources.  —Published data from the American Medical Association, the American Osteopathic Association, and the Association of American Medical Colleges; tabular runs of county-level data contained on the Bureau of Health Professions' Area Resource File.

Results.  —The majority of IMGs who participate in GME in the United States ultimately enter US practices. A significant proportion of exchange visitors eventually enter into permanent practice in the United States, contrary to the intent of the J-1 visa—based GME training as an international educational exchange program. International medical graduates gravitate toward initial residency programs in internal medicine and pediatrics, many of which have unfilled positions; however, IMGs subspecialize at a disproportionately high rate, reducing their net contribution to the generalist pool. Patterns of ultimate practice location of IMGs parallel the patterns of US medical graduates (USMGs).

Conclusions.  —In recent years, participation of IMGs in GME and practice has increased significantly. Most IMGs in GME are not exchange visitors, but are either permanent residents or US citizens. Patterns of specialization and location of IMGs ultimately mirror those of USMGs. National IMG policy must be examined in light of the projected surplus of physicians in the United States. The best option for long-term control of the number of physicians in practice, USMG or IMG, is a system of specifying the number of GME positions nationally.(JAMA. 1995;273:1521-1527)

REFERENCES

1 +
Politzer R. The Impact of Foreign-Trained Doctors on the Supply of Physicians . Washington, DC: US Dept of Health and Human Services; September 1983;. DHHS publication HRS-P-OD-83-2.
2 +
Gamliel S, Cultice J, Bazell C, et al. Patient Care Physician Supply/Requirements: Testing COGME's Recommendations: Draft Report for the Council on Graduate Medical Education . Rockville, Md: Bureau of Health Professions; September 1994;.
3 +
Graduate Medical Education National Advisory Committee. Summary Report to the Secretary . Washington, DC: Health Resources Administration; 1980;.
4 +
Tarlov A.  HMO enrollment growth and physicians: the third compartment. Health Aff (Millwood) . (Spring) 1986;;23-36.
5 +
Council on Graduate Medical Education. First Report of the Council . Washington, DC: US Dept of Health and Human Services; 1988;:1-2.
6 +
Luft H, Arno P.  Impact of increasing physician supply: a scenario for the future. Health Aff (Millwood) . (Winter) 1986;;31-46.
7 +
Crozier D, Iglehart J.  Trends in health manpower. Health Aff (Millwood) . (Winter) 1984;;122-131.
8 +
Iglehart J.  How many doctors do we need? JAMA . 1985;;254:1785-1788.
9 +
Letsch S.  National health care spending in 1991. Health Aff (Millwood) . (Spring) 1993;;94-110.
10 +
Eisenberg J. Doctors, Decisions, and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press Perspectives; 1986;.
11 +
Grumbach K, Lee P.  How many physicians can we afford? JAMA . 1991;;265:2369-2372.
12 +
Wennberg J.  Outcomes research, cost containment, and the fear of health care rationing. N Engl J Med . 1990;;323:1202-1204.
13 +
Hughes J.  How well has Canada contained the costs of doctoring? JAMA . 1991;;265:2347-2351.
14 +
Ginsberg E.  Physician supply policies and health reform. JAMA . 1992;;268:3115-3118.
15 +
Wennberg J, Goodman D, Nease R, Keller R.  Finding equilibrium in US physician supply. Health Aff (Millwood) . (Summer) 1993;;89-104.
16 +
Weiner J.  Forecasting the effects of health reform on US physician workforce requirements: evidence from HMO staffing patterns. JAMA . 1994;; 272:222-230.
17 +
Gamliel S, Politzer R, Rivo M, Mullan F.  Managed care on the march: will the physician workforce meet the challenge? Health Aff (Millwood) . In press.
18 +
Association of American Medical Colleges. Special tabulations of residents for 1988-89 to 1993-94 and recent graduates from allopathic medical schools . Washington, DC: Association of American Medical Colleges; April 1994;.
19 +
American Osteopathic Association. Special tabulations of osteopathic physicians in osteopathic postgraduate training programs and graduates from osteopathic medical schools . Chicago, Ill:American Osteopathic Association; April 1994;.
20 +
Conrad K.  Nationality and Naturalization Amendments of 1993; Pub L No. 103-416,108 Stat 4319. Congressional Record . (October 6) , 1994;.
21 +
Mick S, Worobey J.  Foreign and US medical graduates in practice: a follow-up. Med Care . 1984;; 22:1014-1025.
22 +
Stevens R, Goodman L, Mick S.  What happens to foreign-trained physicians who come to the United States? Inquiry . 1974;;11:112-124.
23 +
Dublin T. The Changing Role of the Foreign Medical Graduate in the Practice of Medicine in the US: Report for the Educational Commission for Foreign Medical Graduates . Philadelphia, Pa: Educational Commission for Foreign Medical Graduates; May 1980;.
24 +
Stevens R, Goodman L, Mick S. The Alien Doctors . New York, NY: John Wiley & Sons Inc; 1978;.
25 +
Stevens R, Mick S, Darge J, Goodman L.  Physician migration reexamined. Science . 1975;;190:439-442.
26 +
Mick S, Worobey J.  Foreign medical graduates in the 1980s: trends in specialization. Am J Public Health . 1984;;74:698-703.
27 +
Mick S.  The foreign medical graduate. Sci Am . 1975;;232:14-21.
28 +
American Medical Association. Physician Characteristics and Distribution 1992 . Chicago, Ill: American Medical Association; 1992;.
29 +
Politzer R, Yesalis C, Katzoff J.  The hidden future supply of foreign medical graduates. Med Care . 1989;;27:1046-1057.
30 +
Mick S.  Foreign medical graduates and US physician supply: old issues and new questions. Health Policy . 1993;;24:213-225.
31 +
Council on Graduate Medical Education. Third Report: Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century . Rockville, Md: US Dept of Health and Human Services; October 1992;.
32 +
Pew Health Professions Commission. Primary Care Workforce 2000: Federal Health Policy Strategies . San Francisco, Calif: Pew Health Professions Commission; March 1993;.
33 +
Josiah Macy Jr Foundation. Taking Charge of Graduate Medical Education to Meet the Nation's Needs in the 21st Century: Proceedings of the Conference, February 19-22, 1992, Naples, Florida . New York, NY: Josiah Macy Jr Foundation; 1993;.
34 +
Physician Payment Review Commission. Annual Report to Congress, 1993 . Washington, DC: Physician Payment Review Commission; 1993;.
35 +
Rockefeller J. Primary Care Workforce Act of 1993. S 1315.
36 +
Mullan F, Rivo M, Politzer R.  Doctors, dollars, and determination: making physician workforce policy. Health Aff (Millwood) . 1993;;12( (suppl) ):138-151.
37 +
Cooper R.  Seeking a balanced physician workforce for the 21st century. JAMA . 1994;;272:680-687.
38 +
Mick S. The 1987 Career Characteristics of Foreign and U.S. Medical Graduates Who Entered the U.S. Medical System Between 1969 and 1982: Technical Report Prepared for the Educational Commission on Foreign Medical Graduates . Ann Arbor: Department of Health Services Management and Policy, School of Public Health, University of Michigan; February 1992;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Politzer R. The Impact of Foreign-Trained Doctors on the Supply of Physicians . Washington, DC: US Dept of Health and Human Services; September 1983;. DHHS publication HRS-P-OD-83-2.
2 +
Gamliel S, Cultice J, Bazell C, et al. Patient Care Physician Supply/Requirements: Testing COGME's Recommendations: Draft Report for the Council on Graduate Medical Education . Rockville, Md: Bureau of Health Professions; September 1994;.
3 +
Graduate Medical Education National Advisory Committee. Summary Report to the Secretary . Washington, DC: Health Resources Administration; 1980;.
4 +
Tarlov A.  HMO enrollment growth and physicians: the third compartment. Health Aff (Millwood) . (Spring) 1986;;23-36.
5 +
Council on Graduate Medical Education. First Report of the Council . Washington, DC: US Dept of Health and Human Services; 1988;:1-2.
6 +
Luft H, Arno P.  Impact of increasing physician supply: a scenario for the future. Health Aff (Millwood) . (Winter) 1986;;31-46.
7 +
Crozier D, Iglehart J.  Trends in health manpower. Health Aff (Millwood) . (Winter) 1984;;122-131.
8 +
Iglehart J.  How many doctors do we need? JAMA . 1985;;254:1785-1788.
9 +
Letsch S.  National health care spending in 1991. Health Aff (Millwood) . (Spring) 1993;;94-110.
10 +
Eisenberg J. Doctors, Decisions, and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press Perspectives; 1986;.
11 +
Grumbach K, Lee P.  How many physicians can we afford? JAMA . 1991;;265:2369-2372.
12 +
Wennberg J.  Outcomes research, cost containment, and the fear of health care rationing. N Engl J Med . 1990;;323:1202-1204.
13 +
Hughes J.  How well has Canada contained the costs of doctoring? JAMA . 1991;;265:2347-2351.
14 +
Ginsberg E.  Physician supply policies and health reform. JAMA . 1992;;268:3115-3118.
15 +
Wennberg J, Goodman D, Nease R, Keller R.  Finding equilibrium in US physician supply. Health Aff (Millwood) . (Summer) 1993;;89-104.
16 +
Weiner J.  Forecasting the effects of health reform on US physician workforce requirements: evidence from HMO staffing patterns. JAMA . 1994;; 272:222-230.
17 +
Gamliel S, Politzer R, Rivo M, Mullan F.  Managed care on the march: will the physician workforce meet the challenge? Health Aff (Millwood) . In press.
18 +
Association of American Medical Colleges. Special tabulations of residents for 1988-89 to 1993-94 and recent graduates from allopathic medical schools . Washington, DC: Association of American Medical Colleges; April 1994;.
19 +
American Osteopathic Association. Special tabulations of osteopathic physicians in osteopathic postgraduate training programs and graduates from osteopathic medical schools . Chicago, Ill:American Osteopathic Association; April 1994;.
20 +
Conrad K.  Nationality and Naturalization Amendments of 1993; Pub L No. 103-416,108 Stat 4319. Congressional Record . (October 6) , 1994;.
21 +
Mick S, Worobey J.  Foreign and US medical graduates in practice: a follow-up. Med Care . 1984;; 22:1014-1025.
22 +
Stevens R, Goodman L, Mick S.  What happens to foreign-trained physicians who come to the United States? Inquiry . 1974;;11:112-124.
23 +
Dublin T. The Changing Role of the Foreign Medical Graduate in the Practice of Medicine in the US: Report for the Educational Commission for Foreign Medical Graduates . Philadelphia, Pa: Educational Commission for Foreign Medical Graduates; May 1980;.
24 +
Stevens R, Goodman L, Mick S. The Alien Doctors . New York, NY: John Wiley & Sons Inc; 1978;.
25 +
Stevens R, Mick S, Darge J, Goodman L.  Physician migration reexamined. Science . 1975;;190:439-442.
26 +
Mick S, Worobey J.  Foreign medical graduates in the 1980s: trends in specialization. Am J Public Health . 1984;;74:698-703.
27 +
Mick S.  The foreign medical graduate. Sci Am . 1975;;232:14-21.
28 +
American Medical Association. Physician Characteristics and Distribution 1992 . Chicago, Ill: American Medical Association; 1992;.
29 +
Politzer R, Yesalis C, Katzoff J.  The hidden future supply of foreign medical graduates. Med Care . 1989;;27:1046-1057.
30 +
Mick S.  Foreign medical graduates and US physician supply: old issues and new questions. Health Policy . 1993;;24:213-225.
31 +
Council on Graduate Medical Education. Third Report: Improving Access to Health Care Through Physician Workforce Reform: Directions for the 21st Century . Rockville, Md: US Dept of Health and Human Services; October 1992;.
32 +
Pew Health Professions Commission. Primary Care Workforce 2000: Federal Health Policy Strategies . San Francisco, Calif: Pew Health Professions Commission; March 1993;.
33 +
Josiah Macy Jr Foundation. Taking Charge of Graduate Medical Education to Meet the Nation's Needs in the 21st Century: Proceedings of the Conference, February 19-22, 1992, Naples, Florida . New York, NY: Josiah Macy Jr Foundation; 1993;.
34 +
Physician Payment Review Commission. Annual Report to Congress, 1993 . Washington, DC: Physician Payment Review Commission; 1993;.
35 +
Rockefeller J. Primary Care Workforce Act of 1993. S 1315.
36 +
Mullan F, Rivo M, Politzer R.  Doctors, dollars, and determination: making physician workforce policy. Health Aff (Millwood) . 1993;;12( (suppl) ):138-151.
37 +
Cooper R.  Seeking a balanced physician workforce for the 21st century. JAMA . 1994;;272:680-687.
38 +
Mick S. The 1987 Career Characteristics of Foreign and U.S. Medical Graduates Who Entered the U.S. Medical System Between 1969 and 1982: Technical Report Prepared for the Educational Commission on Foreign Medical Graduates . Ann Arbor: Department of Health Services Management and Policy, School of Public Health, University of Michigan; February 1992;.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
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.
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:
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.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

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

Related Content

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

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems