Domestic production vs international immigration: Options for the US physician workforce
D. A. Kindig and D. L. Libby
Department of Preventive Medicine, University of Wisconsin Medical School, Madison 53706-1532, USA.
OBJECTIVE: To determine alternate combinations for reductions in US medical
school graduates (USMGs), international medical graduate (IMG) immigration,
and graduate medical education (GME) residencies, based on future physician
supply targets. DESIGN: A demographic projection model of the physician
supply was constructed and calibrated to fit observed American Medical
Association Physician Masterfile data and current supply forecasts. Total
annual input to GME was backcast from given future supply targets,
adjusting for the portion of IMGs in GME who do not enter the US workforce.
MAIN OUTCOME MEASURES: The annual number of new physicians added to supply
from domestic or international sources needed to reach future
physician-to-population ratio targets. RESULTS: Because of the low rate of
attrition from the physician supply, it takes up to 50 years for workforce
policy to effectively stabilize the physician-to-population ratio at a
target level. All target ratios considered here would require immediate
reductions in the total number of GME positions. These reductions must be
followed by gradual annual increases to account for population growth. The
size of USMG and IMG reductions are interrelated and depend critically on
the percentage of IMG trainees who remain to practice in the United States.
CONCLUSIONS: Reductions in future physician supply can come from either the
IMG or USMG component of physician production, or both. The model developed
here allows the estimation of multiple combinations of both GME components.
