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The Primary Care Physician Workforce: Ethical and Policy Implications

¹ Johns Hopkins School of Public Health, Baltimore, Md
² New York University School of Medicine, New York, NY

CORRESPONDING AUTHOR: Barbara Starfield, MD, MPH, University Distinguished Professor, Johns Hopkins School of Public Health, 624 North Broadway, Room 452, Baltimore, MD 21205, bstarfie{at}jhsph.edu

PURPOSE 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.

CONCLUSION 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.

Key Words: Foreign medical graduates • primary health care • brain drain • US public policy/manpower

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