In 1970,10% of practicing physicians were graduates of foreign medical schools (IMGs). In 1985, 22% of practicing physicians were. In 2019, some 230,000 active physicians graduated from international medical schools, accounting for 25% of the total active physician workforce.
Who controls the flow of MDs from abroad? The AMA effectively influences the flow of foreign-born doctors (very roughly = graduates of IMGs. Over 80% of IMGs are non-U.S. citizens). In contrast, foreign born workers are a quarter of computer science workers but their employers have far less influence over the overseas supply of computer science workers.
Let’s say that the AMA wants to increase the supply of MDs by 10%. How would it make that happen?
Easing International Medical Graduates integration: The Educational Commission for Foreign Medical Graduates (ECFMG) could streamline its certification process for IMGs, making it easier for qualified foreign-trained doctors to practice in the U.S.. This could quickly boost the physician workforce, given as IMGs already constitute about 25% of the U.S. physician workforce. The AMA and ECFMG are separate organizations. But the AMA’s influence as a leading voice in American medicine ensures that its perspectives are considered in shaping ECFMG.
Increase Medical School Enrollment: The AMA could advocate for expanding enrollment in existing medical schools and support the establishment of new medical schools. This would directly increase the number of U.S. medical graduates entering the workforce.
Support for Residency Programs: Lobbying Congress to increase funding for residency programs would be crucial. The AMA has already urged Congress to remove caps on Medicare-funded residency slots. Expanding residency positions is essential, as it’s a bottleneck in physician training.
State-Level Initiatives: Advocating for more states to follow Tennessee’s example of lowering barriers for IMGs could significantly expand the talent pool.
Policy and Regulatory Changes: The medical community could push for the passage of bills like the Resident Physician Shortage Reduction Act, which aims to increase Medicare-supported residency positions.
Promoting the use of telehealth could help extend the reach of existing physicians, effectively increasing the supply of medical services.
In sum, the AMA has far more concentrated and effective influence over the flow of physician immigration then does Silicon Valley over computer science, and manufacturers over engineering immigrants.
Immigrant physicians and other health service staff (nurses, etc.) are more significant in certain communities in the U.S. Immigrant physicians are often the only physicians in rural communities. Some hospitals will actively seek foreign medical school graduates because they have difficulty attacting U.S. medical school graduates. There are valid concerns about the ability to attract foreign trained medical professionals under the incoming Administration at a time when there are projections of a substantial number of physician retirements. This is a quiet concern amongst the hospitals and clinics where I live in central California.