Mullan F, Politzer R M, Davis C H
Bureau of Health Professions, Department of Health and Human Services, Rockville, MD 20857, USA.
JAMA. 1995 May 17;273(19):1521-7. doi: 10.1001/jama.1995.03520430057039.
Because of the size and growth of the international medical graduate (IMG) contribution to graduate medical education (GME) in the United States, and subsequently to the US physician workforce, it is essential to understand the demographics and patterns of IMG training and practice as well as the routes of entry into the United States.
Published data from the American Medical Association, the American Osteopathic Association, and the Association of American Medical Colleges; tabular runs of county-level data contained on the Bureau of Health Professions' Area Resource File.
The majority of IMGs who participate in GME in the United States ultimately enter US practices. A significant proportion of exchange visitors eventually enter into permanent practice in the United States, contrary to the intent of the J-1 visa-based GME training as an international educational exchange program. International medical graduates gravitate toward initial residency programs in internal medicine and pediatrics, many of which have unfilled positions; however, IMGs subspecialize at a disproportionately high rate, reducing their net contribution to the generalist pool. Patterns of ultimate practice location of IMGs parallel the patterns of US medical graduates (USMGs).
In recent years, participation of IMGs in GME and practice has increased significantly. Most IMGs in GME are not exchange visitors, but are either permanent residents or US citizens. Patterns of specialization and location of IMGs ultimately mirror those of USMGs. National IMG policy must be examined in light of the projected surplus of physicians in the United States. The best option for long-term control of the number of physicians in practice, USMG or IMG, is a system of specifying the number of GME positions nationally.
鉴于国际医学毕业生（IMG）对美国毕业后医学教育（GME）进而对美国医师队伍的规模和增长有重要影响，了解IMG培训与执业的人口统计学特征、模式以及进入美国的途径至关重要。
美国医学协会、美国骨科协会和美国医学院协会发布的数据；卫生专业人员局区域资源文件中包含的县级数据表格。
在美国参加GME的大多数IMG最终进入美国执业。相当一部分交流访问者最终在美国永久执业，这与基于J-1签证的GME培训作为国际教育交流项目的初衷相悖。国际医学毕业生倾向于选择内科和儿科的初始住院医师培训项目，其中许多项目有职位空缺；然而，IMG亚专科化的比例过高，减少了他们对通科医生人才库的净贡献。IMG最终执业地点的模式与美国医学毕业生（USMG）的模式相似。
近年来，IMG参与GME和执业的情况显著增加。参加GME的大多数IMG不是交流访问者，而是永久居民或美国公民。IMG的专科化模式和执业地点最终反映了USMG的模式。鉴于预计美国医生会出现过剩情况，必须审视国家IMG政策。长期控制执业医生数量（无论是USMG还是IMG）的最佳选择是在全国范围内规定GME职位数量的制度。
