The Article in Brief

The Primary Care Physician Workforce: Ethical and Policy Implications

Barbara Starfield, MD, MPH , and colleagues

Background Professionals from other countries make up more than a quarter of the medical and nursing workforces in Australia, Canada, the United Kingdom, and the United States. This study examines the characteristics of countries that export doctors to the United States.

What This Study Found Poor countries with high physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates disproportionately help the United States to maintain its primary care workforce. The most impoverished, underdeveloped African nations are a major source of primary care doctors to the United States, further reducing their own abilities to meet the needs of their citizens.

Implications

• The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its supply of primary care doctors.
• The ethical aspects of depending on foreign medical graduates is an important issue, but it is particularly troubling when it deprives disadvantaged countries of their graduates.
• US policy makers need to create more opportunities and incentives for primary care training and practice to make it an appealing career choice for US graduates.