How U.S. Policy Lures Physicians from Low-Income Countries to Practice in our own Underserved Communities

A number of country-level and international reports in recent years have quantified the extent of health worker migration from low-income countries to rich countries (US, UK, Canada, Australia, and others). For example, the World Health Organization's 2006 World Health Report pointed out that "countries with the lowest relative need have the highest number of health workers," and that the developing world may need an additional 4 million more health workers. International medical graduates constitute 23 to 28 percent of physicians in the United States, the United Kingdom, Canada, and Australia; Fitzhugh Mullan has calculated "migration factors" for low income countries (N Engl J Med 2005;353:1810-8), noting that reliance on international graduates reduces the supply of physicians in many lower-income countries.

While other rich countries with national health programs can address the international recruitment of health workers in a centralized manner, the US has a patchwork of health policies that are less coherent. The US has about 750,000 doctors (250 per 100,000 population); recent estimates show the physician workforce is growing, but there is still a projected shortfall of 100,000 doctors by 2020.

We trace the origins and manifestations of physician workforce policy in the US, and how various policy decisions at the levels of training institutions, state and national government, and professional organizations continue to create significant incentives for the in-migration of physicians trained abroad. The US has no plans to train the number of physicians sufficient to meet projected demand in the near future. We discuss the implications of these policy decisions for both the US and the source countries from which IMGs migrate.