Addressing geographic disparities in cancer care: An examination of the contributions of international medical graduates (IMGs).

Abstract

1516 Background: IMGs comprise 38% of the US hematology and medical oncology workforce according to the Association of American Medical Colleges. We examined the geographic distribution of oncologists by IMG status to quantify and contextualize the role of IMGs in providing cancer care across the United States, particularly in rural and underserved areas. Methods: We used Medicare Care Compare to identify and locate physicians practicing in the U.S. as hematology and medical oncology specialists. IMG status, defined as graduation from a medical school outside of the US, Puerto Rico, and Canada, was assigned from Care Compare where information was available (51%), then from AMA Masterfile data (43%). For the 6% missing IMG data, Google Gemini was used for imputation. We cross-tabulated oncologist IMG status with whether they practiced in a rural county, a county with high cancer incidence (in top 25% of counties for age-adjusted cancer incidence from the National Cancer Institute), and a primary care Health Provider Shortage Area (HPSA). Across counties, we assessed the distribution of new cancer cases by oncologist availability according to IMG status. Proportions and odds ratios with 95% confidence intervals are reported to demonstrate associations. Results: There were 14,946 oncologists practicing in the US as of March 2025, of which 5,840 (39%) were IMGs. IMG status was associated with locations that are rural, have high cancer incidence, and have provider shortages (Table). In county-level analysis, among 1,395 counties with oncologists, 1,105 (80%) had IMG oncologist presence. In 662 (47%), IMGs comprised ≥50% of the oncology workforce, corresponding to areas where 32% of patients with newly diagnosed cancer live (549K/1.72M). In 250 counties (18%), only IMG oncologists provided care; 191 (76%) of those were rural and/or had high cancer incidence. Conclusions: IMG oncologists play a pivotal role in the geographic availability of cancer care in the United States. They are more likely to practice in rural areas and in areas with increased cancer burden and provider shortages. Any reductions in the IMG oncologist workforce could impede patient access to cancer care on a broad scale and further aggravate shortages in rural and underserved areas. Oncologist practice site characteristics by IMG status. Site Characteristic All Oncologists,N (%) IMG Oncologists,n (%) Non-IMG Oncologists,n (%) Odds Ratio for IMG vs. Non-IMG(95% CI) Overall 14,946 5,840 9,106 Rural 1.34(1.20, 1.50) Yes 1,488 (10) 677 (12) 811 (9) No 13,458 (90) 5,163 (88) 8,295 (91) High Cancer Incidence* 1.54(1.41, 1.68) Yes 2,346 (16) 1,116 (20) 1230 (14) No 12,264 (82) 4,554 (80) 7710 (86) HPSA 1.38(1.29, 1.49) Yes 3,923 (26) 1,760 (30) 2,163 (24) No 11,023 (74) 4,080 (70) 6,943 (76) *County incidence data unavailable for 336 (2%) oncologists.