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United States Physician Workforce Issues

Recent research suggests that the future supply of physicians in the United States will not be adequate to the country’s health care needs. Though U.S. medical schools have expanded enrollment in an effort to address this shortage, it will take several years for any increases to yield a sufficient number of qualified practitioners. As a result, internationally educated physicians, who currently make up approximately 25% of the practicing physician workforce, will continue to play a role in U.S. health care services for some time, and a great deal of attention continues to be devoted to studying their qualifications and practice patterns.

Since all international medical graduates (IMGs) must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG®) to be eligible to enter accredited U.S. graduate medical education (GME) programs, both their demographic and examination performance data are available to FAIMER dating back 50 years. These data have been analyzed to determine changes in the characteristics of IMGs who have pursued training opportunities in the United States. Because many of these physicians stay in the United States following their graduate training, knowing more about their characteristics, including their intended specializations and likely practice locations, will aid future physician workforce planning. The graphs below illustrate the top 10 countries of citizenship and the top 10 countries of medical school location for IMGs in direct patient care—office-based practice or full-time hospital staff—in the United States as of 2009.

Countries of Citizenship of IMGs in Direct Patient Care in the United States, 2009

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Countries of Citizenship of IMGs in Direct Patient Care in the United States as of 2009
This exhibit reflects the top 10 countries of citizenship for the 187,987 international medical graduates providing patient care in office-based practice or as full-time hospital staff (including residents) in the United States as of 2009. Citizenship is as of the time of entrance into medical school.

Data current as of March 25, 2010.
Sources: ECFMG database and 2009 American Medical Association Physician Masterfile

Countries of Medical School of IMGs in Direct Patient Care in the United States, 2009

[Click image to enlarge.]

This exhibit reflects the top 10 countries of medical school location for the 187,987 international medical graduates providing patient care in office-based practice or as full-time hospital staff (including residents) in the United States as of 2009.

Data current as of March 25, 2010.
Sources: ECFMG database and 2009 American Medical Association Physician Masterfile

Within this group of IMGs, there is particular interest in the characteristics of those who were U.S. citizens at the time they entered medical school. This cohort, which includes many individuals who attended medical schools in the Caribbean, is growing, not only in terms of enrollment, but also with respect to placement in U.S. GME programs and subsequent service in the U.S. health care system. While the expansion of U.S. medical school programs may provide additional educational opportunities for these individuals, many U.S. citizens who attend medical schools outside the United States never applied to U.S. allopathic or osteopathic medical programs. If these U.S. citizens start applying for, and enrolling in, U.S. medical schools, the characteristics and qualities of the IMG physician pool will certainly change. These changes, and their potential impact on both international and U.S. medical school programs, will need to be investigated.

To explore U.S. physician workforce issues in greater detail, FAIMER has partnered with various organizations, including the Association of American Medical Colleges (AAMC), the National Resident Matching Program (NRMP), the National Board of Medical Examiners® (NBME®), the American Medical Association (AMA), the American Association of Colleges of Osteopathic Medicine (AACOM), the American Board of Family Medicine (ABFM), and the American Board of Internal Medicine (ABIM). FAIMER continues to collaborate and pool expertise and data sources to fulfill its research goals related to the U.S. physician workforce.

Selected FAIMER staff publications on this topic are listed below. FAIMER staff members are listed in bold. Click on an article’s title to view its abstract listing in the PubMed database.

Boulet JR, Cooper RA, Seeling SS, Norcini JJ, McKinley DW. U.S. citizens who obtain their medical degrees abroad: an overview, 1992-2006. Health Affairs. 2009;28(1):226-233.

Norcini JJ, van Zanten M, Boulet JR. The contribution of international medical graduates to diversity in the U.S. physician workforce: graduate medical education. Journal of Health Care for the Poor and Underserved. 2008;19(2):493-499.

van Zanten M, Boulet JR. Medical education in the Caribbean: a longitudinal study of United States Medical Licensing Examination performance, 2000-2009. Academic Medicine. 2011;86(2):231-238.

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[last update: June 30, 2011]