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Physicians: If There Were Fewer IMGs, Who Would Replace Them?
by Carl Shusterman

Over 30% of rural counties in the United States are designated as medically underserved areas by the Federal Government. Fortunately, over 2,000 U.S.-trained physicians who were born abroad, are serving the medical needs of Americans who live in these counties. As I stated in my testimony to the Senate Subcommittee on Immigration on May 22, the program is working well, but needs to be significantly increased in size to enable more people living in rural America to have access to medical care. See

A federal program that is working well, involves the states in making decisions, improves health care, and costs the taxpayers only a minimal amount. It seems too good to be true, doesn't it?

If your primary concern is the health and welfare of the American people, what reason would you have to oppose the expansion of such a program? Then why have the Council on Graduate Medical Education (COGME) and six medical associations called for a reduction in the supply of new International Medical Graduates (IMGs) into medical residency and fellowship program in the U.S.; the termination of the J-1 waiver program for foreign medical graduates; and an increased home residency requirement from two to five years?

They say that these steps are necessary to reduce the national physician oversupply. To me, this is tantamount to calling for an end to the food stamp program in order to reduce obesity in America!

Try telling an American citizen living in one of the 161 counties where there is not a single primary care physician that there is a a national physician oversupply. The problem is that there is a maldistribution of physicians in the U.S. and most U.S. medical graduates prefer to enter a specialty field rather than engage in a less lucrative practice involving primary care. Imagine that you have just completed a medical residency or fellowship in New York or California. How likely is it that you will establish a practice in rural North Dakota or in the South Side of Chicago? The answer is painfully obvious to the residents of such localities.

However, if you are an IMG who has finished a medical residency or fellowship, these locations may be a perfect match to your needs. Why? Because, unless you work in a medically underserved area in the U.S. for a minimum of three to five years, chances are that you will be forced to leave the U.S. and return to your home country for at least two years. This is true even if your spouse and children are U.S. citizens, and yes, even if your medical skills would be useless in your native country. This is why over 2,000 IMGs obtain J waivers by practicing in medically underserved areas. And guess what? A lot of IMGs find that they like working in these areas, and settle their permanently.

Recently, the Federal Office of Rural Health Policy issued a grant to the Cecil G. Sheps Center for Health Service Research at the University of North Carolina to answer the following question:

* If Fewer IMGs Were Allowed In The U.S., Who Might Replace Them In Rural Areas?

The researchers from the Sheps Center interviewed state policy makers, health planners and physician recruiters in four states with high concentrations of IMGs in rural areas (Florida, New York, North Dakota and West Virginia). Their report raises the yellow caution flag to those who are all too eager to end the J waiver program for IMGs. Below are some of the report=s major findings:

* IMGs constitute an important component of the U.S. medical workforce, and their numbers have increased rapidly over the past decade.

* Given the difficulty of expanding ongoing recruitment and retention efforts, many underserved rural areas would likely remain underserved in the event of a cutback in IMGs, and many rural areas that are currently adequately served could face serious problems as well.

* IMGs reduce physician shortages by practicing in rural and inner city areas where U.S. medical graduates are less likely to practice.

You can read the complete text of the study, or the Executive Summary if you wish, by accessing our "Physicians Page" at

and scrolling down to "IMGs And Canadian Physicians" and clicking on "If Fewer IMGs Were Allowed In The U.S., Who Might Replace Them In Rural Areas? (PDF File)."

About The Author

Carl Shusterman is a certified Specialist in Immigration Law, State Bar of California
Former U.S. Immigration & Naturalization Service Attorney (1976-82)
Board of Governors, American Immigration Lawyers Association (1988-97)
Phone: (213) 623-4592 Fax: (213) 623-3720
Law Offices of Carl Shusterman, 624 So. Grand Ave., Suite 1608
Los Angeles, California 90017