Family physicians who graduated from overseas medical schools are more likely to care for Medicaid patients than are their counterparts who graduated from U.S. medical schools. That difference, says a study by AAFP members and health care analysts at the AAFP's Robert Graham Center in Washington, may have implications for the nation's low-income and older patients.
IMGs Fill Important Role
Study Compares International, U.S. Medical Graduates
By News Staff
8/23/2006
Researchers Amanda Morris, M.D., a family physician in West Lafayette, Ind.; Robert Phillips, director of the Robert Graham Center in Washington; and their colleagues compared characteristics of family physicians who were international medical graduates, or IMGs, with those of U.S. medical school graduates, or USMGs. They report their findings in "International Medical Graduates in Family Medicine in the United States of America: An Exploration of Professional Characteristics and Attitudes," in Human Resources for Health, an online journal published by BioMed Central.
Among the study's findings: 49 percent of IMG family physicians were accepting all new Medicaid patients, compared with 40 percent of USMG family physicians. IMG family physicians also derived a greater percentage of their revenue from Medicare and Medicaid than did their USMG counterparts.
Those differences and other study findings "may affect important aspects of the health care system, particularly access to care and health care use and costs," the researchers say in the report, which was funded by the Robert Graham Center.
"This study uses data from a decade ago, at the beginning of a large influx of international medical graduates into family medicine training programs," said Phillips. "This influx and IMGs' greater participation in Medicaid and Medicare may partly explain the incredible reliance of these programs on family medicine. Recent calls to expand training of physicians in the United States could put these programs at risk if expansion only happens in medical schools and not in residency training."
The Association of American Medical Colleges, or AAMC, recently called for a 30 percent increase in medical school enrollment and an end to the current limit on the number of residency slots imposed by the federal government through graduate medical education, or GME, funding restrictions.
"Since all physicians must complete accredited graduate training to become licensed in the U.S., the number of GME positions must also be increased for an expansion in U.S. medical school graduates to lead to an increase in physicians available to care for Americans. … the current Medicare restriction on the number of funded residency positions must be eliminated so that sponsors of graduate medical education can respond to changes in medical school enrollment and other physician workforce market dynamics," said the AAMC physician workforce position statement (PDF file: 9 pages / 54 KB. More about PDFs.).
Phillips agreed. "If you build up the medical school enrollment without a concurrent residency increase, you will push IMGs out" as more USMGs vie for the same number of residency positions, he said.
That would not bode well for low-income patients who rely on Medicaid. An Aug. 17 report from the Center for Studying Health System Change, or HSC, showed fewer physicians are accepting Medicaid patients.
The HSC report, "Medicaid Patients Increasingly Concentrated Among Physicians," found that 20.9 percent of physicians -- up from 19.4 percent in 1996-97 -- were accepting no new Medicaid patients in 2004-05. Between 1996-97 and 2004-05, the number of physicians who derived no income from Medicaid rose from 12.9 percent to 14.6 percent. Equally important: Of all physician groups, family physicians and general internal medicine physicians are most likely to close their practices to new Medicaid patients.
What could all these studies mean? Eliminating IMGs' access to family medicine residency training may decrease the number of future family physicians willing to accept Medicaid patients and, in turn, reduce low-income patients' access to health care, said Phillips.
The Graham Center study also found small but significant differences existed between IMGs and USMGs with regard to referral patterns, although no meaningful trends were identified. Moreover, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs.
Among the study's findings: 49 percent of IMG family physicians were accepting all new Medicaid patients, compared with 40 percent of USMG family physicians. IMG family physicians also derived a greater percentage of their revenue from Medicare and Medicaid than did their USMG counterparts.
Those differences and other study findings "may affect important aspects of the health care system, particularly access to care and health care use and costs," the researchers say in the report, which was funded by the Robert Graham Center.
"This study uses data from a decade ago, at the beginning of a large influx of international medical graduates into family medicine training programs," said Phillips. "This influx and IMGs' greater participation in Medicaid and Medicare may partly explain the incredible reliance of these programs on family medicine. Recent calls to expand training of physicians in the United States could put these programs at risk if expansion only happens in medical schools and not in residency training."
The Association of American Medical Colleges, or AAMC, recently called for a 30 percent increase in medical school enrollment and an end to the current limit on the number of residency slots imposed by the federal government through graduate medical education, or GME, funding restrictions.
"Since all physicians must complete accredited graduate training to become licensed in the U.S., the number of GME positions must also be increased for an expansion in U.S. medical school graduates to lead to an increase in physicians available to care for Americans. … the current Medicare restriction on the number of funded residency positions must be eliminated so that sponsors of graduate medical education can respond to changes in medical school enrollment and other physician workforce market dynamics," said the AAMC physician workforce position statement (PDF file: 9 pages / 54 KB. More about PDFs.).
Phillips agreed. "If you build up the medical school enrollment without a concurrent residency increase, you will push IMGs out" as more USMGs vie for the same number of residency positions, he said.
That would not bode well for low-income patients who rely on Medicaid. An Aug. 17 report from the Center for Studying Health System Change, or HSC, showed fewer physicians are accepting Medicaid patients.
The HSC report, "Medicaid Patients Increasingly Concentrated Among Physicians," found that 20.9 percent of physicians -- up from 19.4 percent in 1996-97 -- were accepting no new Medicaid patients in 2004-05. Between 1996-97 and 2004-05, the number of physicians who derived no income from Medicaid rose from 12.9 percent to 14.6 percent. Equally important: Of all physician groups, family physicians and general internal medicine physicians are most likely to close their practices to new Medicaid patients.
What could all these studies mean? Eliminating IMGs' access to family medicine residency training may decrease the number of future family physicians willing to accept Medicaid patients and, in turn, reduce low-income patients' access to health care, said Phillips.
The Graham Center study also found small but significant differences existed between IMGs and USMGs with regard to referral patterns, although no meaningful trends were identified. Moreover, IMGs were more likely to order tests, refer patients to specialists or require office visits than USMGs.
- 82 percent of IMG family physicians practice in metropolitan areas, compared with 75 percent of USMG family physicians.
- A greater percentage of IMGs own their practices and more often work in solo or two-physician groups.
- 67 percent of IMGs are board-certified, compared with 87 percent of USMGs.
- 73 percent of IMGs reported having adequate time to spend with patients versus 66 percent of USMGs; 83 percent of IMGs said they were able to develop continuing patient relationships, compared with 78 percent of USMGs.
- However, 20 percent of IMGs were dissatisfied with their overall medical careers, compared with only 16 percent of USMGs.
- There were no significant differences between IMGs and USMGs regarding the effects of using computers to obtain patient data and treatment guidelines and the effects of practice profile results.
