The increase in international medical graduates in family practice residency programs.

International medical graduates (IMGs) are physicians in residency training and in practice in the United States who have graduated from medical schools in countries other than the United States and Puerto Rico. The influx of IMGs to the United States began with the establishment of the US Information and Educational Exchange Act of 1948. Since then, the number of international graduates in graduate medical education (GME) has steadily increased. Between 1989 and 1996, the number of IMGs in US residency programs in all specialties more than doubled to 26,763. International graduates are a heterogeneous group. Of the 5,134 IMGs entering a first-year residency in 1998, 22.7% were US citizens, 39.0% were permanent US residents, and 32.6% were foreign nationals. The increase in the number of international graduates matching in all specialties has sparked contentious debate among policy makers about the role of foreigntrained physicians in the US health care system. A primary concern is that IMGs may exacerbate a purported nationwide oversupply of physicians. While it is impossible to precisely extrapolate future supply and demand, a number of reports have projected an oversupply of physicians in the 21st century. This predicted surplus of physicians is largely attributed to the increased numbers of physicians entering residency training programs. From 1982 to 2000, the number of residents in all specialties increased from 69,142 to 97,989 and now constitutes more than 140% of the annual number of graduates from US allopathic and osteopathic medical schools. Another concern about IMGs is that many remain in the United States after completing residency training rather than returning to their native countries. A study of IMGs conducted in New York in 1999 showed that, even among those on temporary J-1 visas, 72% of graduating residents were planning to stay in the United States The Increase in International Medical Graduates in Family Practice Residency Programs