Online Program

Evaluating interstate migration among international medical graduates in the United States

Monday, November 4, 2013

Samuel Opoku, MBChB, Health Services Research, Administration & Policy, University of Nebraska Medical Center, Omaha, NE
Ge Lin, PhD, College of Public Health, University of Nebraska Medical Center, Omaha, NE
Bettye Apenteng, College of Public Health, Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE
Soumitra S Bhuyan, MBBS, MPH, Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE

The existing literature has devoted little attention to patterns and factors associated with geographic mobility of International Medical Graduates (IMGs) physicians. This study aims to identify the determinants of the decision of foreign-born physicians to move to and from practice locations.


International Medical Graduates were defined as physicians born in foreign countries who weren't U.S citizens by virtue of parents' US citizenship. The 2006-2010 American Community Survey 5-year Public Use Micro data was merged with state-level demographic and socio-economic data for this study. Departure and destination models were run to examine the factors that pushed and pulled physicians out of and into a given state respectively. Multivariate logistic and conditional logit models were used in the analyses.


Age, arrival in the US after 2000 and being African-born were positively associated with departure while naturalized citizenship and marital status were negatively associated with moving. State-level economic, demographic, health care demand & supply factors didn't influence the decision to relocate.

In the choice of destination, states with higher proportion of foreign-born residents, higher poverty rate and higher number of hospitals were attractive, while states with higher number of physicians, higher unemployment rates and higher proportion of Hispanics were unattractive.


Economic considerations and the proportion of foreign-born residents were important factors in the choice of destinations. Workforce research on the extent and determinants of migration patterns of foreign-born physicians in the US holds significant implications for policies concerning the physician recruitment and retention, particularly to underserved areas.

Learning Areas:

Administer health education strategies, interventions and programs
Provision of health care to the public
Public health administration or related administration
Public health or related education
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Identify the "pull" factors attracting physicians who are international medical graduates to a given state. Assess the "push" factors associated with the movement of physicians who are international medical graduates out of a given state.

Keyword(s): Physicians

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an author because I took the lead in the conceptualization and implementation of this research study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.