With the increasing portability of physician credentials, there is a need to better understand the impact of physician migration on the health of societies. Approximately one-quarter of physicians practicing in the United States obtained their medical degrees outside of the country, and it is important to better understand their role in caring for the American public. Relatively little research has been conducted to track the practice patterns of this group of physicians and to quantify their role in providing health care services, especially in underserved areas.

Likewise, some international medical graduates have trained in the United States and then returned to their home countries. Little has been done to determine how many physicians follow this course and whether they remain in their home countries. For those who do stay home, it is important to evaluate the impact of their training on patient outcomes, the local health care delivery system, and the medical education process.

Internationally, where physician migration patterns can be quite complex, it is important to know why some regions remain underserved while others experience a surplus of trained physicians. This requires an understanding of the characteristics of the physicians who migrate, the medical education systems that produce them, and the countries to which they go. The ultimate goal of this work is to inform the development of effective programs to address the problem of physician maldistribution.

The Foundation is actively seeking collaborative opportunities to address these issues. For example, a joint research program is underway with the Robert Graham Center of the American Academy of Family Practice in Washington, D.C. The purpose of this effort is to profile international medical graduates entering Family Practice training, compare them with their counterparts from U.S. medical schools, and seek to determine if there have been changes in the profile over time. Further, it will attempt to determine what roles they fill in the Family Medicine workforce and the nature of their practice.

In addition to addressing issues related to physician migration, the Foundation will seek to understand how differences in the process of medical education relate to health care outcomes. For example, the Foundation has provided funding for a pilot study to evaluate the World Federation for Medical Education's International Standards. These standards are intended as guidelines for use by medical schools worldwide as they engage in institutional self-evaluation, peer review, and the accreditation process. The purpose of this study is to determine whether the standards are universally applicable and whether they can be met by a representative sample of medical schools.

Initiatives like those outlined above hold great promise, and the coming year will be critical for defining FAIMER's research program. By taking a leadership role in focused research, combining efforts with professional partners, and developing outstanding informational resources, we anticipate the creation and sharing of knowledge that have the potential to catalyze new research efforts in the field of medical education.