International Medical Graduates (IMGs)/Foreign Medical Graduates (FMGs) Visas

International Medical Graduates' (IMGs) Increased Role in the U.S. Physician Workforce

The size and characteristics of the future health workforce are determined by the complex interaction of the health care operating environment, economic factors, technology, regulatory and legislative actions, epidemiological factors, the health care education system and demographics.

Population Aging

• The aging of the U.S. health workforce.
• The declining proportion of the 18-30 year old population adversely affects attracting sufficient numbers of new health workers.
• The aging population likely will result in rising average patient acuity, requiring higher nurse and physician staffing levels.

Increasing Racial and Ethnic Diversity

• Minorities, who already are underrepresented in the physician and nurse workforce relative to their proportion of the total population, will constitute a larger portion of the population entering the workforce; the U.S. will increasingly rely on minority caregivers.

Geographic Location of the Population

• Many of rural areas are currently designated as physician shortage areas; currently IMG's fill rural and HSA populations.
• Many pockets of urban areas are designated as physician shortage areas. Increasing the supply of health professionals in these areas must deal with economic, cultural and language considerations.

United States Department of Health and Human Services: Health Resources and Services Administration (HRSA) PARM Study: Changing Demographics and the Implications for Physicians, Nurses, and Other Health Workers

Various Scenarios:

• Status Quo forecast: Patterns of health care use, medical insurance coverage, and physician productivity remain constant over time - total requirements for physicians will increase from approximately 781,300 in 2000 to 1,038,200 in 2020 (a 33 percent increase).
• Scenario 2 baseline demographic trends: Physician requirements would increase to 996,400 in 2020 (a 28 percent increase).
• Scenario 3 Universal Coverage: The uninsured population is placed into the insured fee-for-service and health maintenance organization (HMO) settings based on the current proportion of the insured population in each of those two settings - total demand for physicians would have been an estimated 817,600 in 2000, increasing to an estimated 1,092,400 (a 40 percent increase over the 2000 baseline level).
• Scenario 4 universal health care coverage (100 percent of the population enrolled in a HMO - total requirements would have been an estimated 781,900 in 2000, increasing to an estimated 1,059,900 in 2020 (a 36 percent increase over the 2000 baseline level).
• Scenario 5 non-minority rates adjust similar to non-Hispanic whites within each demographic age/sex group - demand have been an estimated 802,400 in 2000, increasing to an estimated 1,072,000 in 2020 (a 37 percent increase over the 2000 baseline level).
• "Non-physician" (as defined in PARM) specialties: physical therapy, podiatry, and optometry - requirements for all three professions are projected to increase, between 2000 and 2020, at rates equal to or slightly greater than the growth in population.

Forecasted Physician Requirements

Allied Health Care Professions

Forecasting Changes on Nurse Requirements - demand-based requirements for FTE registered nurses (RNs), licensed practical nurses (LPNs), nurse aides and home health aides (NAs).

• Under a baseline scenario, which represents the forecasts most likely to occur based on changing demographics and projected trends in other determinants of nurse demand, total requirements for FTE RNs would increase from approximately 2 million in 2000 to 2.8 million in 2020 (a 41 percent increase). Requirements for FTE LPNs would increase from 618,000 in 2000 to 905,000 in 2020 (a 46 percent increase). There would also be an increase in FTE nurse aide and home health aide requirements from 1.5 million in 2000 to 2.3 million in 2020 (a 50 percent increase).
• Under a status quo scenario where patterns of per capita health care use and nurse staffing remain constant over time, the requirement for nurses and nurse aids increases at a slower rate than under the baseline scenario.

Forecasted FTE Nurse Requirements