The hidden future supply of foreign medical graduates

The number of foreign medical graduates (FMGs) as reported by the American Medical Association (AMA) has registered increases in recent years far exceeding the Department of Health and Human Services' (DHHS) published forecasts. The DHHS projections of new entrants have been derived from the number of postgraduate year-one positions filled by FMGs. Apparently, the FMG supply is augmented by physicians who enter by other paths. By using AMA data, this study takes the first step in attempting to shed light on the characteristics of these recent FMG additions. It then uses the DHHS model to forecast FMG supply based on a short-run continuation of the AMA-reported changes. The paper also forecasts FMG supply assuming that no new foreign national FMGs (FNFMGs) will enter the pool. The analysis suggests that some FNFMGs may be entering this country with visas granted to family members of United States citizens or permanent immigrants and then establishing practices without exiting directly from graduate medical education (GME). Further restrictions on GME participation for FMGs likely are not going to severely curtail FMG entrance into the medical care delivery system. Rather, they will likely restrict their entrance by way of the most traditional route.