Evaluating interstate migration among international medical graduates in the United States

Background

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.

Methods

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.

Results

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.

Conclusion

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.