International Medical Graduates’ Burgeoning Role in U.S. Health Care

By Steve Barrett
Saturday, July 1, 2017

Approximately 25 percent of physicians in the United States who are actively engaged in patient care are international medical graduates (IMGs), the AMA Journal of Ethics noted in a 2016 commentary.

However, a breakdown of IMGs by specialty shows they are far from evenly distributed across the medical spectrum. According to the AMA Physician Masterfile, IMGs figure particularly heavily in the following specialties:

  • Geriatric medicine: 50.7 percent
  • Nephrology: 47.2 percent
  • Interventional cardiology: 43.6 percent
  • Critical care medicine: 41 percent
  • Internal medicine: 38.6 percent

The fields in which IMGs make up the smallest proportion of providers are:

  • Dermatology: 4.9 percent
  • Orthopedic surgery: 5.5 percent
  • Emergency medicine: 6.6 percent
  • Otolaryngology: 6.9 percent
  • Ophthalmology: 7.1 percent

In a recent white paper, Dallas-based locum tenens staffing firm Staff Care noted the value of IMGs in the United States.

“IMGs continue to play an important role in healthcare delivery, particularly in light of the ongoing physician shortage,” Staff Care stated.

The firm pointed out a projection by the Association of American Medical Colleges that the U.S. could have a shortage of almost 95,000 physicians by 2025 — “a deficit that would be appreciably larger if not for the presence of IMGs.”

Foreign-trained Physicians: Answer to the Shortage?

Roughly 60,000 physicians who were trained overseas prior to coming to the United States do not have licenses to practice in this country, Boston radio station WBUR reported recently.

Some observers believe remedying that disconnect could help solve the U.S. physician shortage. However, a major barrier to that is the clinicians’ ability to get residencies, WBUR explained.

Factors that can reduce the chance a foreign-trained physician will get a residency include:

  • Repeated attempts to pass licensing exams
  • Long gaps in clinical experience
  • A significant amount of time since the physician graduated from medical school

Approximately 95 percent of U.S.-trained physicians obtain residencies, compared with only 51 percent of those born and trained abroad, according to data from the National Resident Matching Program and the Educational Commission for Foreign Medical Graduates. The disparity also holds true for Americans who go abroad for medical education. Of applicants from this group, only 54 percent got residencies in 2016.

However, some say high utilization of physicians from nations that are desperately short on healthcare providers can pose an ethical dilemma.

“A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical,” a 2013 review published in Swiss Medical Weekly states. “Africa carries 24% of the global burden of disease with only 3% of the world’s health workers (the US carries 10% of the global burden of disease with 37% of the world’s health workers).”