The changing geography of Americans graduating from foreign medical schools.

Purpose: To study U.S.-born international medical graduates in order to analyze changes in their numbers and countries of training from the 1960s and before until the early 2000s.

Method: This study was conducted from 2003-2004 at the Center for Health Workforce Studies, University of Washington. The analysis was based on data from March 2002 from the American Medical Association (AMA) for active physicians. AMA data were supplemented with data from several other sources. Descriptive statistics were produced on country of birth, country of medical school training, and year of training for all foreign-trained, patient-care physicians whose birth country was known.

Results: At least 17,000 of the foreign-trained physicians practicing in the United States are known to have been born in the United States. American physicians have graduated from foreign medical schools in increasing numbers since the 1960s. The number of U.S.-born physicians who graduated from a foreign medical school peaked in the early 1980s, but the phenomenon endures today. However, the countries in which these physicians chose to attend medical schools have changed significantly from the 1950s to the early 2000s.

Conclusions: Over time, U.S.-born physicians have become much less likely to train in Europe and much more likely to train in certain Caribbean countries. U.S.-born physicians who graduate from medical schools abroad tend to train in just a handful of countries and attend a limited number of medical schools.