Archive for the ‘Physician Shortage’ Category

US must enact measures to support the role of IMGs in US health-care delivery, says ACP

September 16, 2008

(Washington) In a new paper, released today, the American College of Physicians (ACP) says that because of the important place that international medical graduates (IMGs) “have and will continue to have” in the internal medicine workforce, the U.S. needs to enact measures that would support their role. The Role of International Medical Graduates in the U.S. Physician Workforce outlines recommendations that ACP feels would support that role.

IMGs are physicians who have received their medical education outside of the U.S and come to complete their residency or fellowship in the United States. Upon completion of training, IMGs are required return to their home countries for a two-year period unless they qualify for a waiver, typically by agreeing to work in a health professions shortage area. According to ACP’s paper, “the United States has depended on IMGs to fill gaps in care in underserved areas since the 1970s, and will probably continue to do so for some time.”

“The College has long recognized the value of IMGs in the U.S. health care system,” said Jeffery P. Harris, MD, FACP, president of ACP. “They are crucial to our continuing to be able to provide adequate care to the populations they serve.”

IMGs are an important source of primary care physicians in rural and underserved areas. In a paper released by the University of North Carolina, it was estimated that if all IMGs in primary care practice were removed that “one out of every five ‘adequately served’ non-metropolitan counties would become underserved and the percentage of rural counties with physician shortages would rise to 44.4%.” The College strongly supports opportunities for IMGs to train in the United States and supports streamlining the process for those who would like to remain in the U.S. to practice, as long as there are opportunities here.

Because of their contributions to U.S. heath care system, ACP recognizes the importance of IMGs to the U.S. To this end the College released as part of their paper seven recommendations to improve conditions for physicians seeking to train and practice in the U.S. The College:

  • opposes measures that would prevent qualified IMGs from emigrating to the U.S.;
  • supports streamlining the process for IMGs to obtain J-1 and H-1B visas;
  • supports a permanent expansion of J-1 visa waiver programs to help alleviate physician shortages in underserved areas;
  • supports exempting physicians trained in specialties facing a shortage from the annual H-1B visa cap;
  • supports classifying physicians trained in internal medicine and other specialties facing a shortage as Schedule A under the Department of Labor, indicating there is an insufficient number of U.S. workers for that occupation;
  • encourage collaborations between the U.S. and less-developed countries to improve medical education and training in those countries; and,
  • supports the development of a Global Health Corps to provide opportunities for U.S. physicians and providers to serve in less-developed countries.

While ACP strongly advocates for policies to support the role of IMGs in meeting the U.S. health care needs, the College also advocates for policies that would increase the number of U.S. trained physicians in primary care. The College also cautions that IMGs should not be viewed as the solution to physician workforce shortages.

“As noted in our paper, with an increasingly diverse population in the U.S., the physician population must also increase in diversity in order to provide culturally competent care,” concluded Dr. Harris. “This is only one piece of the vital role IMGs play in providing care to our underserved populations.”


The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.


Choice of Specialties

September 16, 2008

15 Sep 2008

Medical school graduates packing an average of $140,000 of debt may need more of an incentive to practice primary care than simply a passion to help mankind.

According to the Journal of the American Medical Association, just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary-care internal medicine. This means the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years.

Among the hectic clinical atmospheres, excessive paperwork and insurance hassles, the shortage may be largely provoked by a single factor – money.

A specialist who performs a procedure in a 30-minute visit can be paid up to three times more than a primary care physician discussing a patient’s diabetes or asthma in that same 30 minutes. In a single year, the typical beneficiary saw a median of 2 primary care physicians and 5 specialists. As doctors are racing to meet demands, reimbursement is coasting toward the quantity of services delivered, rather than the quality.

“Future generations of family physicians are becoming more limited as to what they can do,” said Dr. Kerry Welch, a family physician at American Fork and Timpanogos Hospitals. “Typical procedures for family physicians are going out the window because of fields of expertise.”

But the differences in primary care can differ between rural and urban areas. Dr. Brent Jackson, a general physician in rural Fillmore, said there isn’t much he doesn’t do.

“The lifestyle and details of your work depend a lot on where you practice,” Jackson said. “Sometimes you’re making house calls or getting paid in hair cuts,” he said jokingly.

For Jackson, quality of life and salary do not make for any toss up. He said the unique “small town” doctor-patient relationships alone are rewarding enough for him. However, he said rural areas across the nation won’t suddenly become hot recruiting spots anytime soon. Jackson is the medical director of three hospitals where three family physician positions have gone unfilled for almost a year.

As fields of expertise become more specific, more and more people are opting to skip the family doctor and head straight for the specialist.

“You go to a family physician for a sore throat or some transitory acute illness,” said Susan Lehnhof, a microbiologist at Mountain View Hospital. “Anything bigger, I go to a specialist. I want someone who takes out 5 tonsils a day, not someone who takes out 5 tonsils a year.”

But most family physicians see a lot more than just runny noses and earaches. They’re quick to say they are required to know something about everything under the spectrum of illnesses they see.

“Primary care is a lot of sorting people,” said Ryan Vellinga, president of the BYU Pre-Med Club. “You don’t get to do as much of the cool stuff. … On the upside, as shortage increases, those who are in primary care can become more valuable for the people who do it.”

Vellinga thinks this shortage is a trend now, but that it will take care of itself.

“As long as it is a free market, primary care will not become obsolete,” he said.