Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles

The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion

PURPOSE

The purpose of this study is to examine the number of Latino physicians in residency training and Latino resident physician trends in the nation's 10 largest medical specialties in the United States and in the 4 states with the largest Latino populations: California, Florida, New York, and Texas.

METHOD

The authors used data from the United States Census Bureau's American Community Survey to determine Latino populations and a special report from the Association of American Medical Colleges to determine rates of Latino resident physicians in the United States and in California, Florida, New York, and Texas from 2001 to 2017. Rates of Latino residents in the nation's 10 specialties with the largest number of residents were also determined.

RESULTS

From 2001 to 2017, the United States had an average of 37 resident physicians per 100,000 population. At the national level, however, Latino residents were underrepresented, with only 14 per 100,000 Latino population. At the state level, California and Texas, the 2 states with the largest Latino populations (39.4% and 39.7% of their population, respectively), had 5 and 9 Latino residents per 100,000 Latino population, respectively. Latino residents in California, Texas, Florida, and New York were also very underrepresented in the primary care specialties examined.

CONCLUSIONS

The findings show a severe shortage of Latino resident physicians. While a similar shortage also exists in primary care specialties, the majority of Latinos in states with large Latino populations are consistently choosing to train in primary care. Investment and greater improvement in the representation of certain population groups in medicine and for combating the inequities existing in the current educational system is needed. The authors offer recommendations to increase the number of Latinos in residency programs and for increasing the number of Spanish-speaking physicians and Latino international medical graduates in residency programs.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review

PURPOSE

The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.

METHOD

In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles.

RESULTS

Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas.

CONCLUSIONS

Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

Monitoring Sub-Saharan African physician migration and recruitment post-adoption of the WHO code of practice: temporal and geographic patterns in the United States

Data monitoring is a key recommendation of the WHO Global Code of Practice on the International Recruitment of Health Personnel, a global framework adopted in May 2010 to address health workforce retention in resource-limited countries and the ethics of international migration. Using data on African-born and African-educated physicians in the 2013 American Medical Association Physician Masterfile (AMA Masterfile), we monitored Sub-Saharan African (SSA) physician recruitment into the physician workforce of the United States (US) post-adoption of the WHO Code of Practice. From the observed data, we projected to 2015 with linear regression, and we mapped migrant physicians' locations using GPS Visualizer and ArcGIS. The 2013 AMA Masterfile identified 11,787 active SSA-origin physicians, representing barely 1.3% (11,787/940,456) of the 2013 US physician workforce, but exceeding the total number of physicians reported by WHO in 34 SSA countries (N = 11,519). We estimated that 15.7% (1,849/11,787) entered the US physician workforce after the Code of Practice was adopted. Compared to pre-Code estimates from 2002 (N = 7,830) and 2010 (N = 9,938), the annual admission rate of SSA émigrés into the US physician workforce is increasing. This increase is due in large part to the growing number of SSA-born physicians attending medical schools outside SSA, representing a trend towards younger migrants. Projection estimates suggest that there will be 12,846 SSA migrant physicians in the US physician workforce in 2015, and over 2,900 of them will be post-Code recruits. Most SSA migrant physicians are locating to large urban US areas where physician densities are already the highest. The Code of Practice has not slowed the SSA-to-US physician migration. To stem the physician "brain drain", it is essential to incentivize professional practice in SSA and diminish the appeal of US migration with bolder interventions targeting primarily early-career (age ≤ 35) SSA physicians.