Practice Location and Mobility of International Medical Graduates in the U.S. - Evidence from American Communication Survey and AMA Physician Masterfile

Accounting for about one quarter of the total U.S. physician workforce, International Medical Graduates’ (IMGs) role is increasingly important in the light of physician shortage and population aging. Other than the US-IMGs, who are U.S. citizens who obtained their medical degrees from abroad, most of IMGs enter the country for residency under J-1 and H-1B types of visas and their practice location choices may be subjected to restrictions. Using data from the American Community Survey (ACS) and the AMA physician masterfile, we investigate where foreign IMGs practice during various stages of their physician career in the U.S. (likely residency, post-residency and after they likely have fulfilled their immigration obligation or obtain their citizenship) and how their other labor market outcomes, such as work hours and income, compared to the native counterparts (i.e. USMG and US-IMGs).

Results show that in general, IMGs are less likely to reside in rural areas than their native counterparts, and they also tend to reside in more populous cities. While all residents are less likely to be in rural areas because the way residency programs are, foreign IMG residents are less likely than US residents to be located in rural areas. This is not surprising considering the location preference of overall foreign-born population. Among non-resident IMGs, the ones who obtained citizenship are less likely to be in rural areas and tend to reside in more populous cities. Analysis of the AMA physician Masterfile further shows that after likely having fulfilled their immigration obligation, significant proportion of IMGs leave the underserved areas, and this “retaining” ability of the temporary visa programs varies by state, specialty, and country of birth.

This research sits amongst the immigration literature on how temporary visas restrict labor mobility, as well as the literature on evaluating how programs aiming for addressing the physician distribution unevenness work. IMGs are brought into the country through a relatively centralized way - the national residency matching program - although individual residency programs have their autonomy to choose who to admit. Also, the pathway to citizenship for IMGs are deliberately designed towards making IMGs to serve in the MUAs and certain regions that are impoverished. These findings indicate that the visa programs may work in filling the physician shortage in the underserved areas, but the outcome may not last. Research findings on IMGs location choice and job mobility offer unique lessons for the physician labor market planning, as well as for U.S. high-skilled immigration policy-makers.