Foreign-trained physicians in American medicine: a case study.

The understanding of reliance upon foreign medical graduates (FMGs) in the United States is vague and general. Little is known about the specific roles of FMGs or the populations they serve in relation to United States medical graduates (USMGs). The recent passage of the Health Professions Educational Assistance Act calls for significant reductions in the future influx of FMGs. Hence, there is an immediate need for detailed information upon which to base predictions of legislative outcomes. The American Medical Association's 1974 physician data tape for Maryland was used as the study population. These data were analyzed, using th Gini Index of Concentration and other test stastistics, for FMG/USMG distributional differences for 1) office-based practice and hospital-based practice, 2) catchment areas aggregated by income, 3) primary, secondary, and tertiary case specialty groupings, 4) level of development of country of medical education, and 5) all of the above in relation to population. Office-based and hospital-based catchment areas were developed in order to create a valid consumer-provider relationship between the numerator and denominator of physician/population ratios. The major finding is that regardless of practice setting, FMGs are more evenly distributed relative to population than USMGs. This conclusion is in contrast with the notion that FMGs tend to locate where USMGs locate. A useful methodology has been presented for 1) development of catchment areas, and 2) examination of distributional differences in relation to population which can easily be duplicated.