Finding robust strategies to meet the growing demand for primary care, especially in underserved areas, is an ongoing public health challenge among policymakers. A new study led by the Harvard Pilgrim Health Care Institute suggests that policy interventions aimed at recruiting physicians to specialize in primary care, especially to practice in underserved areas, should be tailored to the citizenship status of international medical graduates (IMGs).
The findings are published on October 15 in Journal of General Internal Medicine.
IMGs, or those who graduated from a medical school located outside the U.S. and Canada, now represent a quarter of all licensed physicians in the U.S. This population has been shown to specialize in medical care. primary school at a higher rate than U.S. medical graduates, especially in underserved areas across the country. However, their citizenship status, which differently affects their ability to enter and remain in the U.S. after medical school, may affect what specialties they enter and where they ultimately practice medicine.
“IMGs have made significant contributions to the US healthcare system, as they are more likely to work in underserved and high-need areas,” says Tarun Ramesh, lead author of the study and researcher at Harvard Pilgrim Health Care. Institute. “Because several factors threaten their ability or desire to continue their contributions, it is crucial that we understand how their citizenship status affects the specialty and practice location they choose to better help policymakers tailor interventions to incentivize entry into primary care practice, especially in rural and scarcity-faced areas.”
Researchers studied 15,133 new physicians who accepted a job offer between 2010 and 2019 using the New York Resident and Fellow Exit Survey. The study sample included 8,177 American medical graduates; 2,753 IMG of US citizens; 1,057 IMG of permanent residents; and 3,146 non-permanent resident non-citizen IMGs. The study evaluated three different outcomes: whether a new physician chose to practice primary care; whether a new primary care physician chose to work in a rural area; and whether a new primary care physician chose to work in an area with a shortage of health professionals.
The team found that citizenship status has significant effects on IMGs’ choices of specialties and practice sites, confirming that the role played by IMGs in the US healthcare system differs depending on their citizenship status. citizenship. Compared to US medical graduates, the team found that US citizen IMGs were five times more likely to enter primary care, permanent resident IMGs seven times more likely, and non-citizen non-permanent resident IMGs nine times more likely. likely than American medical graduates. They also identified two distinct trends: a decreasing proportion of non-citizen IMGs and non-permanent residents entering primary care and an increasing likelihood of them practicing in rural areas and health professional shortage areas.
“The role IMGs play in bolstering health care options in underserved areas should not be overlooked,” said senior author Hao Yu, an associate professor of population medicine at Harvard Medical School in the Harvard Pilgrim. Health Care Institute. He adds: “While visa incentive programs may encourage non-citizen IMGs and non-permanent residents to practice in these areas, our findings show that more nuanced efforts are needed to make primary care a more attractive specialty.”
The authors suggest that more research is needed to better understand differences in subspecialties, salaries, job satisfaction, and incentives among U.S. citizen, permanent resident, and non-permanent resident noncitizen IMGs, as well as evaluate new state laws that offer provisional licensure pathways for the IMGs. to practice medicine.