Need more primary care physicians? Rethink how international medical grads are handled

As the demand for primary care physicians increases, especially in underserved areas, policymakers must consider how the citizenship status of international medical graduates (IMGs) influences their specialty choices and practice locations, according to a new study from the Harvard Pilgrim Health Care Institute. Published Oct. 15 in the Journal of General Internal Medicine, the study suggests that policy interventions should be customized based on the residency status of IMGs to better address workforce shortages in primary care.

IMGs, who now account for a quarter of all licensed physicians in the U.S., have historically been more likely to specialize in primary care, particularly in underserved areas. However, their ability to practice medicine in the U.S., particularly in these high-need areas, is often shaped by their immigration and residency status.

“IMGs have made significant contributions to the U.S. health care system, as they are more likely to work in high-need, underserved areas,” said lead author Tarun Ramesh, a research fellow at Harvard Pilgrim Health Care Institute, in a statement. “It’s crucial that we understand how their citizenship status impacts which specialty and practice location they choose to better aid policymakers in adapting interventions.”

The study, which analyzed data from over 15,000 new physicians between 2010 and 2019, found that citizenship status has a significant effect on the specialties IMGs pursue and where they choose to practice. Compared to U.S. medical graduates, U.S. citizen IMGs were five times more likely to enter primary care, while permanent resident IMGs were seven times more likely, and noncitizen, non-permanent resident IMGs were nine times more likely. Despite these contributions, the study noted a recent decline in non-permanent resident IMGs entering primary care, though they remain more likely to practice in rural or shortage areas.

“While visa incentive programs may drive non-citizen, non-permanent resident IMGs to practice in these areas, our findings show that more nuanced efforts are needed to make primary care a more attractive specialty,” said senior author Hao Yu, an associate professor at Harvard Medical School, in a statement.

The researchers recommend further studies on factors like subspecialty preferences, salaries, and job satisfaction among different IMG groups. They also highlight the need to evaluate the impact of emerging state laws that provide provisional licensing pathways for IMGs to practice medicine, which could help alleviate primary care shortages.