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Initial Practice Locations of International Medical Graduates


  • Daniel Polsky,

  • Philip R. Kletke,

  • Gregory D. Wozniak,

  • José J. Escarce

This research was supported by a grant from the Robert Wood Johnson Foundation under its Health Care Financing and Organization initiative.

Daniel Polsky, Ph.D., University of Pennsylvania, Division of General Internal Medicine, Blockley Hall Rm. 1212, Philadelphia, PA 19104. Dr. Polsky is also with the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Philip R. Kletke, Ph.D., is with the Health Research and Educational Trust, American Hospital Association, Chicago, IL. Gregory D. Wozniak, Ph.D., is with the Center for Health Policy Research, American Medical Association, Chicago, IL. José J. Escarce, M.D., Ph.D., is with the RAND Health Program, Santa Monica, CA.

The views expressed in this paper are the authors’ and do not represent the official position of RAND, the University of Pennsylvania, the American Hospital Association, or the American Medical Association.


Objective. To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs.

Data Sources. The annual Graduate Medical Education (GME) Survey of the American Medical Association (AMA) and the AMA Physician Masterfile.

Study Design. We identified 19,940 IMGs who completed GME in the United States between 1989 and 1994 and who were in patient care practice 4.5 years later. We used conditional logit regression analysis to assess the effect of market area characteristics on the choice of practice location. The key explanatory variables in the regression models were whether the market area was in the state of GME, the years of GME required for state licensure, the proportion of IMGs among established physicians, and the ethnic composition of the market area.

Principal Findings. The IMGs tended to locate in the same state as their GME training. Foreign-born IMGs were less likely to locate in markets with more stringent licensure requirements, and were more likely to locate in markets with higher proportions of established IMG physicians. The IMGs born in Hispanic or Asian countries were more likely to locate in markets with higher proportions of the corresponding ethnic group.

Conclusions. Policymakers may influence the flow of new IMGs into states by changing the availability of GME positions. IMGs tend to favor the same markets over time, suggesting that networks among established IMGs play a role in attracting new IMGs. Further, IMGs choose their practice locations based on ethnic matching.

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