Harvard Medical School, Boston, MA, 02115, USA.
Department of Dermatology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Arch Dermatol Res. 2022 Oct;314(8):799-803. doi: 10.1007/s00403-022-02332-4. Epub 2022 Feb 24.
International medical graduates (IMGs) comprise a quarter of the United States (US) physician workforce but are a diminishing minority among dermatologists. Studies on IMGs in other specialties have demonstrated their importance in addressing provider shortage in rural and medically underserved areas (MUAs), but this trend has not been systematically explored within dermatology. This study aims to assess the state-by-state distribution of IMG dermatologists in the US as compared to US medical graduates (USMGs) with focus on provider density in rural settings and MUAs. A national cross-sectional study was performed on actively practicing dermatologists who submitted Medicare claims within 1 year of July 2020; rural and MUA-serving status were determined based on federally designated rural-urban Continuum Codes and Census Bureau data. Nationally, the density of dermatologists has increased from 3.4 per 100,000 persons in 2016 to 3.66 per 100,000 persons in 2020. However, 70% of US states continue to have fewer than 4 dermatologists per 100,000 persons, the estimated minimum necessary to adequately care for a population. Among 12,009 dermatologists, only 576 (4.8%) are IMGs, with disparate distribution across the US: Kansas has the greatest percentage of IMGs with the latter comprising 8.3% of its state dermatology workforce, whereas 8 states have no IMGs. Notably, a significantly greater percentage of IMG dermatologists (43.9%) work in areas designated as MUAs compared to USMGs (37.4%) (P < 0.01). In contrast, a lower percentage of IMG dermatologists (2.8%) work in rural settings compared to USMGs (4.8%) (P = 0.03). Interestingly, no significant difference was observed when rural dermatologists were further stratified by MUA-serving status. These findings corroborate the importance of IMGs in providing greater access to dermatological care in areas with healthcare provider shortage. Further studies on the underlying causes of the decline of IMGs within dermatology are needed.
国际医学毕业生（IMGs）占美国（US）医师劳动力的四分之一，但在皮肤科医生中所占比例逐渐减少。其他专业的 IMG 研究表明，他们在解决农村和医疗服务不足地区（MUA）的医疗服务提供者短缺方面发挥了重要作用，但这一趋势在皮肤科领域尚未得到系统探讨。本研究旨在评估美国各州的 IMG 皮肤科医生的分布情况，与美国医学毕业生（USMGs）进行比较，重点关注农村地区和 MUA 服务提供者的密度。这是一项针对在 2020 年 7 月后的 1 年内提交医疗保险索赔的在职皮肤科医生进行的全国性横断面研究；农村和 MUA 服务地位是根据联邦指定的城乡连续统一体代码和人口普查局数据确定的。从全国范围来看，皮肤科医生的密度从 2016 年的每 10 万人 3.4 人增加到 2020 年的每 10 万人 3.66 人。然而，70%的美国州每 10 万人仍不到 4 名皮肤科医生，这是满足人口需求的最低估计人数。在 12009 名皮肤科医生中，只有 576 名（4.8%）是 IMG，分布在美国各地差异很大：堪萨斯州的 IMG 比例最高，占该州皮肤科医生总数的 8.3%，而 8 个州没有 IMG。值得注意的是，与 USMG 相比，IMG 皮肤科医生（43.9%）在被指定为 MUA 的地区工作的比例显著更高（37.4%）（P<0.01）。相比之下，与 USMG 相比，IMG 皮肤科医生（2.8%）在农村地区工作的比例较低（4.8%）（P=0.03）。有趣的是，当进一步按 MUA 服务地位对农村皮肤科医生进行分层时，没有观察到显著差异。这些发现证实了 IMG 在提供医疗服务提供者短缺地区的皮肤科护理方面的重要性。需要进一步研究 IMG 在皮肤科减少的根本原因。
