Domestic Production vs International Immigration

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Abstract
Objective. —To determine alternate combinations for reductions in US medical school graduates (USMGs), international medical graduate (IMG) immigration, and graduate medical education (GME) residencies, based on future physician supply targets. Design. —A demographic projection model of the physician supply was constructed and calibrated to fit observed American Medical Association Physician Masterfile data and current supply forecasts. Total annual input to GME was backcast from given future supply targets, adjusting for the portion of IMGs in GME who do not enter the US workforce. Main Outcome Measures. —The annual number of new physicians added to supply from domestic or international sources needed to reach future physician-to-population ratio targets. Results. —Because of the low rate of attrition from the physician supply, it takes up to 50 years for workforce policy to effectively stabilize the physician-to-population ratio at a target level. All target ratios considered here would require immediate reductions in the total number of GME positions. These reductions must be followed by gradual annual increases to account for population growth. The size of USMG and IMG reductions are interrelated and depend critically on the percentage of IMG trainees who remain to practice in the United States. Conclusions. —Reductions in future physician supply can come from either the IMG or USMG component of physician production, or both. The model developed here allows the estimation of multiple combinations of both GME components.