Healing at the Margins: A Cultural/Historical Perspective on International Medical Graduates in the US Healthcare System

Foreign, or international, medical graduates make up about twenty five percent of current American medical trainees and twenty percent of physicians actively practicing medicine in the United States. In some specialties, particularly in primary care, the percentage of residents who received their medical education abroad nears fifty. Furthermore, international medical graduates or IMGs, known as foreign medical graduates or FMGs before the mid-nineteen-nineties, are far from a novel presence within the American medical center, often credited with disproportionately caring for indigent, urban, institutionalized, and rural Americans. The presence of these physicians, however, has also long been controversial, engendering suspicion from organized medicine and concerns from policy analysts about physician surpluses in the United States and a “brain drain” of needed medical talent from much poorer nations. The past, current, and future role of IMGs is a window into American medicine from its margins. Through a historical and narrative exploration this project re-evaluates the role of medical migrants in the academic medical center and American medical practice since World War Two, arguing that the presence of these physicians has had a material impact on the nature and development of the US healthcare system, masking many of its safety-net shortfalls. Through qualitative analysis, I also delve more deeply into the relationship of migration and professional identity that has evolved within American medicine and global medicine throughout the Twentieth century. The United States has not simply functioned as a passive recipient of immigrant clinicians from across the world but has also been a progenitor of powerful ideologies and policies that have had complex and often unintended effects on clinician migration.