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Abstract: Physician supply in the U.S. is again on the national health policy agenda. A central issue in this debate is the availability of physicians willing to work in underserved and disadvantaged communities-an issue closely linked to the number of minority and international medical graduate (IMG) physicians working in the U.S. In California, South Asian IMGs, but not South Asian U.S. medical graduates, are more likely to work in underserved communities. Incorporation of strong policy levers aimed at an equitable geographic distribution of physicians will be critical as the U.S. moves toward greater self-sufficiency of physician supply. More specifically, the authors note the continuing central importance to addressing the needs of medically underserved populations of training physicians from under-represented minority groups (African Americans, American Indians, and Hispanic Americans) in U.S. medical schools.
Key words: Physician supply, foreign medical graduates, professional practice location, medically underserved areas, minority groups, Asian Americans, California.
Growing concern about a physician shortage in the U.S. has re-ignited the debate over the consequences of importing physicians trained abroad versus expanding U.S. training programs in order, as it were, to grow our own. Graduates of international medical schools currently fill one-quarter of U.S. residency positions,1 and most of these international medical graduates (IMGs) remain in the U.S. after completing their residency training. Advocates of increasing the number of medical students educated in U.S. schools have argued that achieving greater self-sufficiency in physician production would stem what is generally known as brain drain, which depletes health systems in developing nations of precious human resources, and would provide greater opportunity for qualified U.S. students to pursue careers in medicine.2-4
This workforce debate plays out in the context of a health care system in the U.S. characterized by pronounced inequities in access to care and maldistribution of physicians. While the Health Professional Shortage Area (HPSA) designations are up for revision, under the current system 4,771 communities, populations or facilities are designated by the federal government as HPSAs.5-6 Community health centers, a key component of the safety net in underserved communities, are experiencing difficulties recruiting physicians to fill vacant positions.7
It has been estimated that one out of every five adequately served rural counties would be underserved without IMGs.8 International medical graduates are more likely than...