Mayer M, Konrad TR; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 2053.
University of North Carolina at Chapel Hill, C.G. Sheps Center for Health Services Research, CB #7590, Chapel Hill, NC 27599-7590 Tel. 919-966-7666 Fax 919.966.3811
RESEARCH OBJECTIVE: Previous studies of international medical graduates (IMGs) have debated whether this group exacerbates a physician surplus or ameliorates physician shortages among underserved populations. In addition, this literature has debated the relative tendencies of IMGs and United States medical graduates (USMGs) to specialize. Despite the large literature on IMGs and concerns about their role of the physician workforce in the US, no studies have identified IMG-reliant subspecialties. We explore trends in IMG reliance by physician specialty over the past two decades and identify physician specialties that relied heavily on IMGs in 2001, especially among recent graduates. STUDY DESIGN: For each study year, we included all active physicians. Physicians who graduated from foreign medical schools were considered IMGs. Using date of birth and year of graduation, we classified physicians into three age cohorts: 35 and under, 36 to 50, and 51 or older. For each year, specialty, and age-cohort, we calculated the percentage of physicians who were IMGs. In each year, specialty-specific age-cohorts for which the relative standard error of the percent IMGs exceeded 30 were excluded from further analyses. Specialties were then classified into specialty groups, such as internal medicine subspecialties. To identify trends in IMG reliance, we performed a non-parametric test for trends for each specialty group for all ages and for the youngest cohort. Using the 2001 file, IMG-reliant specialties were identified in two ways by ranking all specialties in descending order by the percent of physicians who were IMGs. This sorting was repeated using only the youngest cohort (<=35). POPULATION STUDIED: All US Physicians in 1981, 1986, 1991, 1996, and 2001.Results PRINCIPAL FINDINGS: When physicians of all ages were included in the analysis, there were significant trends toward increased reliance on IMGs in several specialty groups, including allergy immunology, general internal medicine (IM) and its subspecialties, neurology, and pediatric subspecialties. Among the youngest age cohort, significant trends toward increased reliance on IMGs were noted among IM and its subspecialties, neurology, pathology, pediatric subspecialties, and psychiatry. Trends toward decreased reliance on IMGs in youngest age cohort were noted for emergency medicine, neurosurgery, ENT, OB/GYN, plastic surgery, general surgery, and urology. For all ages, the percent IMGs within specific specialties ranged from 60.4% for selective pathology to 4.7% for sports medicine. Among the youngest physicians, the percent IMGs ranged from 69.9% for pulmonary diseases (IM) to 1.9% for orthopedic surgery. CONCLUSIONS: There are clear trends in IMG reliance across physician specialty groups. General IM and its subspecialties and neurology have become increasingly reliant on IMGs over the past two decades. In contrast, a number of surgical specialties show decreases in IMG reliance, especially among the youngest physicians. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Debates over the role of IMGs in the United States health care system need to consider not only IMGs relative tendency to specialize, but also which specific specialties IMGs populate. While IMG may exacerbate surplus in some physician specialties, they may prevent or ameliorate shortages in other specialties. A more focused discussion is prudent at this time.
Publication Types:
Keywords:
- Child
- Family Practice
- Health Services Needs and Demand
- Humans
- Internal Medicine
- Neurology
- Physicians
- Schools, Medical
- Specialties, Medical
- United States
- hsrmtgs
UI: 103625087
From Meeting Abstracts