The primary care physician workforce: ethical and policy implications.
OBJECTIVE
We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States.


METHODS
We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States.


RESULTS
Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce.


CONCLUSIONS
The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply.
Starfield
Barbara
B
Johns Hopkins School of Public Health, Baltimore, MD, USA. bstarfie@jhsph.edu
Fryer
George E
GE
D000574:American Medical Association; D003906:Developing Countries; D005260:Female; D005550:Foreign Medical Graduates / Q000600:supply & distribution*; D006291:Health Policy; D006280:Health Workforce; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment; D010560:Personnel Selection / Q000941:ethics* / Q000379:methods / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000600:supply & distribution*; D011050:Policy Making; D011365:Professional Practice Location; D011787:Quality of Health Care; D012042:Registries; D013038:Specialization; D014481:United States; D016526:Workload; D014944:World Health Organization