Meeting the growing demand for primary care, especially in underserved areas, is a challenge for policymakers. A study led by the Harvard Pilgrim Health Care Institute suggests that policy interventions to recruit physicians specializing in primary care should be tailored to the citizenship status of international medical graduates (IMGs). IMGs, who make up a quarter of all licensed physicians in the U.S., tend to specialize in primary care at a higher rate than U.S. medical graduates, particularly in underserved areas. However, their citizenship status can impact the specialties they enter and where they ultimately practice medicine.
The study, published in the Journal of General Internal Medicine, analyzed 15,133 new physicians who accepted job offers from 2010 to 2019. The sample included U.S. medical graduates, U.S. citizen IMGs, permanent resident IMGs, and noncitizen non-permanent resident IMGs. The researchers assessed whether new physicians chose to practice primary care, work in rural areas, or work in health professional shortage areas. They found that citizenship status significantly influenced IMGs’ specialty and practice location choices, highlighting the role played by IMGs in the U.S. healthcare system.
Compared to U.S. medical graduates, U.S. citizen IMGs were five times more likely to enter primary care, permanent resident IMGs were seven times more likely, and noncitizen non-permanent resident IMGs were nine times more likely. The study also identified a declining proportion of noncitizen non-permanent resident IMGs entering primary care, but an increased likelihood of them practicing in rural and health professional shortage areas. The findings suggest that more nuanced efforts are needed to make primary care a more attractive specialty, particularly for noncitizen IMGs.
Senior author Hao Yu, an associate professor at Harvard Medical School, emphasized the important role that IMGs play in providing healthcare in underserved areas. While visa incentive programs may attract non-citizen IMGs to practice in these areas, the study highlights the need for additional strategies to incentivize IMGs to choose primary care. The authors recommend further research to explore differences in subspecialties, salaries, job satisfaction, and incentives among U.S. citizen, permanent resident, and noncitizen IMGs, as well as evaluating new state laws offering provisional licensing pathways for IMGs to practice medicine.
In conclusion, understanding how citizenship status impacts IMGs’ specialty and practice location choices is crucial for policymakers seeking to address the demand for primary care, especially in underserved areas. The study underscores the unique contributions that IMGs make to the U.S. healthcare system and the need for tailored interventions to incentivize primary care practice among IMGs. By exploring differences in specialties, salaries, and job satisfaction among IMGs of different citizenship statuses, policymakers can develop more effective strategies to recruit and retain primary care physicians in areas with healthcare shortages.
