Licensure of Foreign Medical Graduates: An Historical Perspective

Although it has been demonstrated elsewhere that the progressive liberalization of immigration policy has attracted large numbers of foreign medical graduates (FMGs) to the U.S. health care system (Stevens and Vermeulen, 1975), the current debate over FMGs has largely neglected the corresponding developments in state licensure policies as they have affected the entry of FMGs into this country's medical profession. It is essential to understand that the fluctuations in the nation's immigration policies and the response of the states through their licensure policies reflect broad historical pressures. These pressures date back to the 1920s, when the world center for medical education shifted from Germany to the United States. At this time, many foreign physicians, despite the restrictive immigration quotas of the period, came to America seeking a higher level of training. These foreign physicians received official support in 1926 from both the Council on Medical Education and the American Medical Association, which opposed restrictions on FMGs desiring graduate medical education in this country. But this receptiveness diminished in the 1930s when the financial hardship of the Depression made American physicians resent the influx of foreign doctors. In 1938 the AMA House of Delegates passed a resolution declaring that U.S. citizenship should be required of all FMGs (Stevens and Vermeulen, 1975), and many state boards adopted this requirement in an attempt to limit the licensing of foreign physicians. In contrast to these restrictive licensure policies of the states, the federal government began, after World War II, to implement a set of immigration policies favorable to foreigners seeking advanced education in this country. Before this time, an FMG who wished to stay in the U.S. for more than a brief visit could enter the country only as immigration quotas permitted. But, in 1948, the Smith-