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International medical graduates care for Medicare patients with greater healthcare needs

International medical graduates comprise almost one quarter of U.S. practicing physicians, and one third of primary care physicians.

Jeff Lagasse, Associate Editor

Internal medicine physicians who are graduates of medical schools outside the U.S. care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools, a Massachusetts General Hospital research team has found.

The team's report, published online in the Journal of General Internal Medicine, has implications for the potential impact of federal immigration policies on access to care for Medicare patients, and potentially for others as well.

International medical graduates comprise almost one quarter of U.S. practicing physicians, and one third of primary care physicians, the report found.

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Given the current nationwide shortage of primary care physicians and the number of international medical graduates who provide primary care services, the MGH team set out to improve understanding of the needs of the patients they serve.

To do so, they analyzed information from the Center for Medicare and Medicaid Services' Physician Compare database, which includes background information for physicians participating in Medicare. They included physicians listed as practicing internal medicine, excluding subspecialties, and determined whether they were graduates of domestic or international medical schools based on physician profiles on Doximity.

Information on Medicare patients cared for by each physician was based on the CMS risk scores that are calculated for patients based on age, gender and previously documented health problems and reported in the CMS Provider Utilization and Payment Data File.

A risk score of 1.0 would reflect a Medicare beneficiary predicted to have average healthcare costs, while a score of 1.5 would indicate a beneficiary whose costs would be expected to be 50 percent higher.

Among the almost 75,000 internal medicine physicians included in the study, 52 percent were graduates of domestic medical schools, 30 percent were international medical graduates, and the status for the other 18 percent was unknown.

While the average risk score of all Medicare patients was 1.73, among patients of domestic graduates the average score was 1.45, while patients of international medical graduates had an average risk score of 1.94. After adjustment for several characteristics related to physicians and their practices, the average scores for Medicare patients cared for by international medical graduates remained significantly higher.


Many experts are predicting a physician shortage in the coming years, particularly as aging baby boomers put stress on the healthcare system. A 2018 analysis from Mercer shines a light on the issue with a bit more specificity, pinpointing which jobs in healthcare are likely to face shortages by 2025.

Home health aides top the list, according to Mercer's stats, with a predicted shortfall of 446,300 in seven years' time. That's far and away the most of any healthcare job. Nursing assistants came in a distant second at 95,000.


"Our findings add to previous literature by demonstrating that international medical graduates generally care for sicker Medicare beneficiaries," the authors wrote. "Although policies that restrict or discourage international medical graduates from entering and practicing in the U.S. probably would not have an impact on care for several years, there is a real concern about restrictive immigration policies reducing access to primary care for the sickest Americans."

Twitter: @JELagasse

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