The US Distribution of Physicians from Lower Income Countries

INTRODUCTION: Since the 1960 s, the number of international medical graduates (IMGs) in the United States has increased significantly. Given concerns regarding the effects of this loss to their countries of origin, the authors undertook a study of IMGs from lower income countries currently practicing in the United States. METHODS: The AMA Physician Masterfile was accessed to identify all 265,851 IMGs in active practice in the United States. These were divided by state of practice and country of origin. World Bank income classification was used to identify lower income countries. RESULTS: 128,729 IMGs were identified from 53 lower income countries, constituting 15 percent of the US active physician workforce. As a percentage of the workforce, West Virginia (29%), New Jersey (27%), and Michigan (26%) had the most IMGs from lower income countries, and Montana, Idaho, and Alaska (all less than 2%), the least. The countries with the greatest loss of physicians to the United States per 100,000 population were the Philippines, Syria, Jordan, and Haiti. DISCUSSION: The reliance of US medicine on physicians from lower income countries is beneficial to the United States both clinically and economically. However, it results in a loss of the lower income country's investment in the IMG's education. We discuss possible mechanisms to compensate the lower income countries for the medical education costs of their physicians who immigrate to the US.