A. The Situation Today

During the last ten or fifteen years, the common wisdom was that physicians were being produced in numbers far greater than the demand for medical care in the U.S. could support. It was commonly thought that the supply of physicians would greatly exceed the need by the year 2000.

To the contrary, however, recent studies have shown that not only would physician shortages be evident as early as 2007, but that they would become increasingly problematic at least until the year 2020, when the annual shortage could exceed 12,000 physicians.

One key assumption in several studies was that managed care in the future would reduce the demand for physicians. On the contrary, however, later research has actually showed that while managed care reduces the use of hospitals, it actually increases the use of physicians.

In addition, three other factors point to an increasing need for physicians in America. First, the remarkable increase in the number of women entering medicine (50 percent of first year medical students in the 2006 entering class are women) may result in the need for more physicians to satisfy a given demand, in view of a woman's childbearing and family responsibilities, which may require that they work fewer hours in a given year. Second, the physician workforce in the U.S. is aging, with more than 250,000 American physicians over the age of 55. Third, the U.S. population is aging rapidly. In 2020, more than 16.5% of the American population will be over 65, a 30% increase from today. That translates into an over-65 population from about 34 million today to more than 60 million in 2020.

From 1981 to 1999, the numbers of U.S. medical graduates per 100,000 population dropped more than 15%, and expected to drop another 15% by 2020.

In view of the above, the need for foreign physicians in the U.S. will continue to increase.

B. IMG's (International Medical Graduates) in America

For many years, the United States was a closed shop for most foreign-born physicians. Today, however, as many as 30% of all physicians in some specialties are international medical graduates (IMGs) and the majority of these physicians are foreign-born.

Please note the following statistics:

• IMGs make up approximately 23% of the U.S. physician population and 24% of resident physicians.
  
  
• The heaviest concentration of IMGs is in New Jersey (44% of doctors); New York (41%); West Virginia (34.8%); and Illinois (34.3%).
  
  
• Almost half of all IMGs (48%) train in primary care specialties vs. 33% of U.S. graduates.
  
  
• The largest national group is from India (24% of total).
  
  
• Of the 154,576 total IMG population, 130,741 (85%) are in patient care, 7.635 (5%) are in medical teaching, administration or research, and the remainder are not classified, are inactive, or have an unknown address.
  
  
• Of the 22,230 IMGs who are in residency training or are clinical fellows, more than 4,000 are American citizens, 8,200 are immigrants and are permanent residents, and 8,900 are in the U.S. on an exchange visitor visa and plan to return to their country of origin unless the INS grants them a waiver because they are needed to provide care to the American public. Therefore, some 55% of all IMGs in graduate medical education programs are U.S. citizens or lawful immigrants.
  
  
• The total physician population increased by 350,386 between 1970 and 1994 or 104.9% while IMGs accounted for over one-fourth (27.8%) of this increase by gaining 97,359 physicians. In this 24-year period, non-IMGs grew by 91.4% while IMGs increased by 170.2%.
  
  
• In 1980, IMGs accounted for 20.9% of the total physician count of 467,679 while that percent climbed to 23.3% of the total count of 795,000 physicians in 2005.

Where IMGs come from:

India - 24.0% (44,585)

Philippines - 10.6% (19,656)

Mexico - 6.7% (12,448)

Pakistan - 5.7% (10,689)

Dominican Republic - 3.8% (7,147)

Russia - 2.9% (5,343)

Grenada - 2.8% (5,196)

Egypt - 2.6% (4,884)

Italy - 2.5% (4,755)

South Korea - 2.5% (4,676)

China - 2.4% (4,523)

Iran - 2.3% (4,355)

Spain - 2.3% (4,332)

Germany - 2.3% (4,269)

Dominica - 2.1% (4,050)

Syria - 1.8% (3,491)

Israel - 1.6% (3,098)

Colombia 1.6% (3,095)

England- 1.6% (3,071)

Lebanon 1.5% (2,871)

• In terms of specialty, IMG participation is as follows:

  1. Internal Medicine - 20.9% (32,242).

  2. General/Family Practice - 9.8% (15,065).

  3. Pediatrics - 9.3% (14,352).

  4. Psychiatry - 7.0% (10,767).

  5. Anesthesiology - 5.7% (8,826).

  6. General Surgery - 5.2% (7,987).

  7. Obstetrics/Gynecology - 4.6% (7,138).

  8. Pathology - 3.5% (5,439).

  9. Cardiovascular Diseases - 3.3% (5,024)

Total IMG population in United States in 2005 - 23.3% (185,234)

Source: 2005 AMA Membership Fact Book