Importing medicine: a look at citizenship and immigration status for graduating residents in New York State from 1998 to 2007.

International medical graduates (IMGs) make up roughly one quarter of the U.S. physician supply and residency training positions. Commentary related to IMGs tends to project a continuing rise in supply over time. This study wanted to challenge these perceptions by disaggregating IMGs by immigration and citizenship status to carefully examine their numerical levels and choices in training specialty and location during a 10-year period. The results demonstrate a shrinking IMG population overall for the state of New York, with noncitizen IMGs shrinking the most markedly. This may bear heavily on New York's physician supply and distribution, particularly for underserved locales. The authors find evidence consistent with some degree of substitution in favor of native-born and naturalized IMGs versus noncitizen IMGs.