International medical graduates valuable source of primary care

The U.S. increasingly outsourced its primary care because of poor income prospects. Primary-care physicians’ income essentially has stayed the same since the 1990s, while their practice expenses have steadily increased. After accounting for inflation, their average income fell 7 percent from 1995 to 2003. This obviously is an unsustainable business model.

Primary-care physicians’ share of the U.S. health-care dollar is only 7 cents. Even if payers cut reimbursement for physician services by 25 percent – certainly a doomsday scenario for doctors – the average rate of medical inflation would decrease from 6.2 percent to 5.7 percent.

However, primary-care doctors control 80 cents of the health-care dollar by sending their patients to hospitals, referring them to specialists and handing out prescriptions. This is a key paradox: Primary-care physicians arguably are the most powerful players in the health-care system but are underappreciated and comparatively undercompensated. In a 2006 survey, nearly 8 out of 10 characterized themselves as “junior partners” or “second-class citizens” in the health-care galaxy. Medical students, including those who plan to become primary-care physicians, view the work more negatively than that of other physicians.

First-year guaranteed compensation for specialty physicians is $240,000 to $260,000, compared with about $180,000 for primary-care physicians. There is a perception that surgeons endure greater mental challenges and stress than primary-care physicians, which some believe accounts for the income disparity. However, a group of University of Cincinnati scientists used work-intensity measurement tools to determine that the mental burden was similar.

About 1 out of 4 physicians practicing in the U.S. and 10 to 15 percent of those in residency programs are international medical graduates (IMGs).

IMGs play a significant role in treating vulnerable populations. They have an oversized presence in counties with high infant mortality and lower socioeconomic status, and in those designated as rural. They tend to work more in the public sector and labor for longer hours. They are twice as likely to work in medically underserved areas as U.S. medical graduates are. They account for more than 1 out of 3 physicians in shortage areas, and 1 out of 10 U.S. hospitals are highly dependent on them.

The AMA House of Delegates urged the expansion of the J-1 visa waiver program. It allocates 30 positions for international medical school graduates who complete graduate medical education and agree to work in federally designated shortage areas in exchange for waivers from the return-home visa requirement.