Not Just Filling Slots: International Medical Graduates and the Spatial Inequality of Health-Care Capacity

• In Event: International Migration Section Refereed Roundtables
  In Refereed Roundtable (60 minute): 18. Methods and measurement

Abstract

International medical graduates (IMGs) are routinely framed as a policy-relevant workforce reservoir for underserved U.S. communities, and prior research documents their disproportionate presence in shortage areas through designation- and visa-linked channels. By contrast, spatial inequality and health labor-market research emphasizes agglomeration: multiple layers of health-care capacity—physician labor, service infrastructure, and capital-intensive technologies—cluster in high-capacity “thick” markets, generating persistent geographic disparities. This juxtaposition leaves two unresolved questions. First, does IMG allocation merely reweight the physician workforce across places, or does it translate into measurable reductions in broader capacity inequality? Second, even when IMGs increase physician headcounts, do they expand the service and technology capabilities that ultimately define local care feasibility? I address these gaps by distinguishing IMG stock (the share of active patient-care physicians) from IMG flow (annual net change), motivated by a multi-step migration account, and by estimating effects across three dimensions of county health-care capacity: workforce, service feasibility, and technology. Using a county–year panel (2010–2019) linking the AMA Physician Masterfile to AHRF structural conditions and HRSA shortage metrics, I estimate county fixed-effects models of IMG distribution and leverage a Bartik-style instrument to identify within-county IMG supply shocks. Preliminary results indicate a stock–flow divergence: shortage counties exhibit higher IMG stock, but IMG net growth concentrates in advantaged markets, consistent with indirect multi-step migration. Exogenous IMG increases modestly improve labor-constrained services in rural shortage settings, while effects on capital-intensive imaging are weaker. Together, these findings specify when IMG allocation operates as gap-filling versus market-sorting, and which dimensions of health-care capacity it can—and cannot—equalize.

Author

• Xin Zhao, University of North Carolina-Chapel Hill