Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle.
Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA. 2024 Aug 13;332(6):490-496. doi: 10.1001/jama.2024.7656.
Physician shortages and the geographic maldistribution of general and specialist physicians impair health care delivery and worsen health inequity in the US. International medical graduates (IMGs) represent a potential solution given their ready supply.
Despite extensive clinical experience, evidence of competence, and willingness to practice in underserved communities, IMGs experience multiple barriers to entry in the US, including the immigration process, the pathways available for certification and licensing, and institutional reluctance to consider non-US-trained candidates. International medical graduates applying to postgraduate training programs compare favorably with US-trained candidates in terms of clinical experience, prior formal postgraduate training, and research, but have higher application withdrawal rates and significantly lower residency and fellowship match rates, a disparity that may be exacerbated by the recent elimination of objective performance metrics, such as the US Medical Licensing Examination Step 1 score. Once legally in the US, IMGs encounter additional obstacles to board eligibility, research funding, and career progression.
International medical graduates offer a viable and available solution to bridge the domestic physician supply gap, while improving workforce diversity and meaningfully addressing the public health implications of geographic maldistribution of general and specialist physicians, without disrupting existing physician stature and salaries. The US remains unable to integrate IMGs until systematic policy changes at the national level are implemented.
美国的医生短缺和普通医生和专科医生的地理分布不均，这两个问题损害了医疗服务的提供，并加剧了健康不平等。国际医学毕业生 (IMG) 是潜在的解决方案，因为他们的供应充足。
尽管有广泛的临床经验、能力证明和愿意在服务不足的社区执业，IMG 在进入美国时仍面临多种障碍，包括移民流程、认证和许可途径，以及机构不愿意考虑非美国培训的候选人。与美国培训的候选人相比，申请研究生培训计划的国际医学毕业生在临床经验、先前的正式研究生培训和研究方面表现出色，但他们的申请撤回率更高，住院医师和研究员匹配率明显更低，这种差距可能因最近取消客观绩效指标（如美国医师执照考试第 1 步成绩）而加剧。一旦在法律上进入美国，IMG 就会遇到额外的障碍，例如获得行医资格、获得研究资金和职业发展。
国际医学毕业生提供了一个可行且可用的解决方案，可以弥合国内医生供应缺口，同时提高劳动力多样性，并切实解决普通医生和专科医生地理分布不均对公共卫生的影响，而不会破坏现有医生的地位和薪资。除非在国家层面实施系统性政策改革，否则美国仍无法整合 IMG。
