By CAROLYN BUSSE
Sheps Center for Health Services Research

CHAPEL HILL -- Foreign-trained doctors more often practice in rural, medically underserved areas than U.S. medical graduates and help ease physician shortages, according to a new University of North Carolina at Chapel Hill study.

"Many international medical graduates agree to practice in rural areas in exchange for the opportunity to stay in the United States," said lead author Leonard D. Baer, a medical geographer at UNC-CH's Cecil G. Sheps Center for Health Services Research. Co-authors of a report in the November issue of the journal Medical Care are Drs.Thomas C. Ricketts and Thomas R. Konrad, both of the Sheps Center, and Stephen S. Mick of the University of Michigan.

Researchers analyzed the geographical distribution of primary-care physicians - doctors specializing in family and general practice, internal medicine, obstetrics and gynecology and pediatrics. Physicians who trained outside the United States made up a larger percentage of the primary-care physician work force in rural areas facing doctor shortages than in rural areas without shortages.

The study also revealed sharp differences among states regarding which foreign medical graduates practice in rural areas. Researchers believe individual state policies may help explain the variation.

States with the highest rate of such doctors practicing in rural, underserved areas were Florida and West Virginia (45 percent), North Dakota (40 percent) and Illinois (39 percent). States with more than 20 percent international medical graduates in rural areas were New York, Kansas, Georgia, Kentucky, Louisiana, North Carolina and Texas.

The study has important implications for policy-makers, the researchers said.

"There appears to be a policy consensus that this country has too many physicians and that reducing the number of international medical graduates allowed to practice in the U.S. will ease the problem," said Baer, a National Service Research Award fellow.

International medical graduates in U.S. residency programs more than doubled between the 1988-89 and 1995-96 academic years while the number of U.S. medical graduates stayed relatively stable, he said.

Despite the increase, policy-makers must balance alleviating local physician shortages with concerns about reducing a national oversupply.

"This study suggests that international medical graduates are an important safety net in rural America," said Baer. "Their role in alleviating underservice should not be easily dismissed."

The Federal Office of Rural Health Policy supported the study. Information analyzed came from the American Medical Association and the U.S. Bureau of Health Professions.

Sheps Center Contact: Carolyn Busse, 966-3847
News Services Contact: David Williamson, 962-8596