LETTER
Study of Internal Medicine Manpower: XX
Srinivas S. Vasireddi and
Jayadeva Chowdappa
15 March 1995 | Volume 122 Issue 6 | Pages 477-478
TO THE EDITOR:
Lyttle and Levy [1] prominently highlight the inroads made by international medical graduates (IMGs) into the subspecialties of internal medicine and project them as an indirect cause of a future shortage of primary care physicians. The 110% cap on residencies may not guarantee a solution but will definitely restrict freedom of choice for all residents. We must seek a solution to the maldistribution of physicians that leads to a significant primary care physician shortage [2] and must not restrict IMG residents who deliver health care to the under-served in many inner-city areas shunned by U.S. graduates. The tendency to specialize may stem in part from the lack of opportunities in their home countries, a factor that prompts IMGs to scale greater academic heights in the United States. Many IMGs who come to the United States as exchange visitors specifically to receive subspecialty training at this country's expense often find that their acquired expertise is inappropriate in their home nations because of a lack of facilities and resources. As a world leader, the United States has a role to help other nations, but some IMGs may not feel a debt to their home countries, and some are "world citizens" whose background and upbringing do not allow them to identify with a particular country of origin [3]. Not only will the use of such IMGs as primary care providers, through necessary legislation, help to alleviate the physician shortage, but it will also give them their due recognition as mainstream health care providers in a land of such ethnic diversity [4].
1. Lyttle CS, Levey GS. The National Study of Internal Medicine Manpower: XX. The changing demographics of internal medicine residency training programs. Ann Intern Med. 1994; 121:435-41.
2. Starfield B, Simpson L. Primary care as part of U.S. health care services reform. JAMA. 1993; 269:3136-9.
3. Varki A. Of pride, prejudice, and discrimination: why generalizations can be unfair to the individual. Ann Intern Med. 1992; 116:762-4.
4. Vasireddi SS. Primary care as part of U.S. health care services reform (Letter). JAMA. 1993; 270:2434.
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