How Immigration Policy Is Affecting Physician Shortage


The scarcity of physicians practicing in rural and underserved urban areas has reached crisis proportions for many communities across the United States. Primary care and psychiatry are among the most challenging specialties to place, which means that basic, unmet health needs escalate into more complex, costly conditions and poor quality of life for millions of Americans. Read on to see how immigration policy is affecting the physician shortage.

Multiple factors contribute to this challenge, exacerbated by an aging population. At a time when the growing number of older Americans requires greater medical care, the boomer-generation of predominantly white, male physicians are retiring in record numbers.

The Evolving Demographics of Physicians

The new face of medicine in America is increasingly female and more diverse by ethnicity, culture and country of origin. Half of medical residents and fellows today are women, and a significant number attended medical school outside of the United States, Puerto Rico, or Canada. They are most often referred to as International Medical Graduates (IMGs).

According to the latest report by the Association of American Medical Colleges (AAMC), 25% of residents and fellows in 2015 were IMGs. Given that fourth-year students at U.S. medical schools filled only 42% of the residency slots in internal medicine in 2016, the growing number of IMGs will be essential for meeting the demand for primary care physicians.

The IMG designation also includes American-born doctors who graduated from medical school outside the U.S. But, the vast majority of IMGs were born and educated outside the U.S., and are completing their residency and fellowships here under J1-Visas.

The J1-Visa, one of two tracks for IMGs, allows them to come into the U.S. for graduate-level studies as long as they commit to doing a three-year residency in an underserved area. The other track is the H-1B program for foreign workers in a variety of technical or specialty fields, including medicine.

To be eligible for licensure and practice in the United States, all IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG) and complete a residency training program in the United States. Each year, nearly 10,000 IMGs receive certification, which includes assessment of English proficiency and clinical skills, as well as passing three sections of the U.S. Medical Licensing Exam.

Findings from numerous studies suggest that the current rigorous approach for selecting IMGs to practice in the U.S. is effective. In fact, a recent study of more than one million hospital admissions found that key parameters for outcomes or quality did not differ significantly in hospitalized patients who received care from IMGs.

How Immigration Policy is Affecting the Supply of Physicians

The Migration Policy Institute, a Washington think tank, says U.S. patients are being treated by about 230,000 foreign-born doctors. That amounts to about a quarter of the country’s physician workforce.

These statistics clearly demonstrate that our healthcare system depends on a steady flow of IMGs to supplement native-born physicians. But the role of IMGs has recently been at the center of the immigration system reform debate.

Yet, the principal consideration in having IMGs fill our pipeline of trained physicians is the underlying uncertainty in our immigration system. Most prominent is the recent executive order limiting immigration from certain countries.  A study by a team of Harvard and MIT economists found that there are currently 7,000 practicing physicians in the U.S. from the countries impacted by the immigration limitations imposed by the executive order.

Reports on the impact of these restrictions are accompanied by calls from the AAMC, medical societies and health system leaders to maintain welcoming policies for well-qualified medical and scientific professionals. The impact of restrictive policies on IMGs and their families may prove to be short-lived and anecdotal, or significant and measurable. But, policy changes and the rhetoric surrounding them hold the potential to intensify the physician shortage in the years ahead.

What Recruiters Can Do

There is no easy answer in our current political climate. Nevertheless, it is clear is that there is a prominent role for IMGs in our healthcare system. Finding a way to ease their transition to becoming part of the overall solution will increasingly fall to recruitment professionals.

Physician recruiters can play a key role in helping organizations develop an effective recruitment strategy, create attractive practice models, facilitate the visa process, offer effective incentives and find the right fit between new physicians and the communities that need them.

Contact us to learn how we assist our clients in navigating the challenge of recruiting physicians and advanced practice providers to underserved communities.

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