The study analyzed records for 249,679 physicians initially certified in internal medicine by the American Board of Internal Medicine between 1990 and 2025. Investigators linked 178,782 of those physicians to Medicare claims, allowing them to examine the patients treated by different groups of doctors. Approximately 36% of the physicians were international medical graduates, or IMGs, who were born outside the United States and attended medical school abroad. Another 11% were born abroad but trained in U.S. medical schools. Together, these groups made up nearly half of the internal medicine workforce represented in the analysis. The researchers used country of birth and medical-school location to distinguish physicians whose professional pathways crossed national borders, rather than treating all IMGs as a single category.

The patient-level analysis revealed a consistent association between non-U.S.-born IMGs and populations that have historically faced greater barriers to healthcare. Among traditional Medicare beneficiaries treated by these physicians, 9.5% were Black, compared with 7% of patients treated by U.S.-born graduates of U.S. MD or DO programs. Latino patients represented 6.6% of the population treated by non-U.S.-born IMGs, compared with 3.9% among patients treated by the U.S.-born physician group. The differences were also evident in measures of economic disadvantage. Nearly 21% of patients cared for by non-U.S.-born IMGs were eligible for both Medicare and Medicaid, a marker often associated with low income and complex healthcare needs, compared with 11.7% of patients cared for by U.S.-born U.S.-trained physicians. Almost 20% lived in ZIP codes with high poverty rates, compared with 15.9% in the comparison group.

These patterns do not mean that a physician’s birthplace determines the kind of patients they treat, nor can an observational study establish that international graduates cause better or worse access to care. Instead, the results indicate that non-U.S.-born IMGs are disproportionately present in the settings where vulnerable patients receive medical services. Factors such as hospital location, specialty choice, employment opportunities, insurance mix and physician recruitment practices may all contribute to the association. Medicare claims also capture only certain aspects of healthcare delivery and do not fully describe patients’ clinical histories, language preferences, transportation limitations or access to physicians outside the traditional Medicare system. Even with those limitations, the scale of the pattern suggests that international physicians are not a peripheral component of American medicine but a structural part of how the system functions.

Their importance was visible across internal medicine subspecialties. Non-U.S.-born IMGs represented at least 27% of physicians in every subspecialty examined by the researchers. In geriatrics, sleep medicine and nephrology, they represented more than half of all physicians. Geriatrics is especially significant because the demand for physicians trained to care for older adults is expected to rise as the population ages. Nephrology faces patients with long-term, resource-intensive conditions such as chronic kidney disease and kidney failure, while sleep medicine addresses disorders linked to cardiovascular disease, metabolic illness, impaired cognition and accidents. A shortage in any of these fields can delay diagnosis, increase reliance on emergency care and complicate the management of chronic disease.

Internal medicine also serves as a major entry point into the American healthcare system. Internists diagnose and manage multiple conditions simultaneously, coordinate care among specialists and often provide continuing treatment for patients whose illnesses become more complicated over time. Physicians who complete internal medicine training may continue into fields including cardiology, medical oncology, rheumatology, infectious diseases, pulmonary medicine and gastroenterology. The study’s workforce estimates therefore extend beyond the image of the general internist: they include doctors whose expertise supports cancer treatment, heart care, immune disorders, respiratory disease and other highly specialized services. In many regions, losing even a small number of these physicians can lengthen wait times and force patients to travel substantial distances for appointments.

The findings also place current immigration policies in a healthcare context. Physicians born in countries affected by U.S. travel restrictions accounted for about 6% of internal medicine doctors in the study. Although restrictions introduced in 2025 and 2026 ultimately exempted physicians, the researchers and physicians involved in the study noted that uncertainty can still have practical consequences. Hospitals may delay recruitment, training or credentialing decisions when visa rules are unclear, and doctors already working in the United States may face administrative disruptions. Reports that some noncitizen physicians from affected countries were placed on administrative leave illustrate how policy uncertainty can reach clinical settings even when formal exemptions exist. At the same time, the National Resident Matching Program reported that the match rate for non-U.S.-citizen IMGs entering U.S. residency programs reached a five-year low in March.

That decline matters because residency training is the principal route through which internationally educated physicians become eligible to practice independently in the United States. After passing required examinations and meeting regulatory standards, IMGs must compete for limited residency positions, often navigating visa requirements, state licensing rules and institutional policies. A reduction in successful matches can therefore produce effects years before a shortage becomes visible in hospital staffing data. The consequences may be particularly pronounced in internal medicine subspecialties that already depend heavily on physicians born abroad. If fewer international graduates enter training, the resulting gap may affect not only the number of available doctors but also the geographic distribution of care, since IMGs have historically helped staff hospitals and clinics serving lower-income and medically underserved populations.

The authors describe their work as evidence for incorporating physician migration and training pathways into national workforce planning. Alicia Fernandez, MD, an ABIM Board director and internist at Zuckerberg San Francisco General Hospital and Trauma Center, said physicians born outside the United States often care for patients with complex conditions and limited access to medical services, providing continuity in communities that may struggle to attract other doctors. Lead author Giacomo Meille, PhD, emphasized that the need is likely to grow as the population ages, especially in geriatrics. The study was conducted by researchers affiliated with ABIM, and several authors disclosed employment or leadership roles with the organization. Those disclosures do not invalidate the analysis, but they are relevant when interpreting research about the workforce of the institution that supported the study.

The central message is both straightforward and consequential: physicians born outside the United States are deeply embedded in American internal medicine, and the patients who rely on them often face greater social and economic vulnerability. In 2024 alone, their care reached tens of millions of Medicare beneficiaries. The data suggest that immigration policy, residency recruitment and specialty workforce planning are not separate from healthcare access; they are mechanisms that help determine who can receive care, where that care is available and whether the system can meet rising demand. As physician shortages intensify, the United States may find that maintaining a stable supply of internists and subspecialists depends not only on educating more doctors at home but also on preserving the international pathways that have long supported American medicine.

Subject of Research: People

Article Title: Non–US–Born Physicians in the US Internal Medicine Workforce

News Publication Date: 12-Aug-2026

Web References: American Board of Internal Medicine: https://www.abim.org/ ; National Resident Matching Program: https://www.nrmp.org/about/news/2026/03/nrmp-releases-results-of-the-2026-main-residency-match-for-more-than-38000-future-residents/ ; U.S. Health Resources and Services Administration physician projections: https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/physicians-projections-factsheet.pdf

References: JAMA, “Non–US–Born Physicians in the US Internal Medicine Workforce,” DOI: 10.1001/jama.2026.13268

Keywords: internal medicine, international medical graduates, physician workforce, Medicare, healthcare access, health disparities, geriatrics, nephrology, sleep medicine, immigration policy, physician shortages

The study begins by addressing the pressing need to understand health service utilization in the context of patients nearing the end of their lives. As populations age and chronic conditions become more prevalent, the demand for healthcare services grows exponentially. The nuances of these healthcare interactions become vital to discussions about end-of-life care. Patients often encounter numerous healthcare settings—emergency rooms, inpatient wards, and palliative care units—each with its associated costs and resources. Understanding these patterns is essential for improving both the quality of care and the allocation of resources.

Duan and colleagues emphasize that while an in-hospital death might suggest comprehensive care, it is also a manifestation of deeper systemic issues. High rates of hospital deaths can signify barriers to effective palliative care, inadequate home support systems, and the challenges faced by healthcare providers in managing complex chronic illnesses. These scenarios prompt the question of whether aggressive treatments in hospitals genuinely align with patients’ preferences and values or if they inadvertently prolong suffering without addressing quality of life.

Moreover, the study showcases the staggering medical costs associated with end-of-life hospitalization. As patients approach death, their healthcare expenses can peak, often leading families into financial distress. The interplay between effective medical treatment and economic burden displays the intricacies facing families and policymakers. The researchers meticulously outline not just monetary figures, but also the emotional toll this financial strain often places on families grappling with loss.

Interestingly, the study sheds light on the role of healthcare policy in shaping end-of-life experiences. The authors discuss how current policy frameworks often prioritize aggressive life-sustaining treatments rather than holistic care approaches geared toward comfort and dignity. This focus may inadvertently deter patients from exploring more compassionate options. By redirecting policies toward supportive care models, healthcare systems can enhance patient satisfaction and reduce unnecessary costs.

As healthcare systems confront the ethical implications of end-of-life care, the findings provoke reflection on societal values around dying. Emotional and psychosocial support for patients and their families is as crucial as medical interventions. The researchers call for increased investment in training healthcare professionals to navigate these conversations with sensitivity. This approach not only accommodates patient autonomy but also fosters more meaningful exchanges around treatment options and palliative care.

Duan et al. also discuss data-driven strategies to improve health service utilization at the end of life. By analyzing electronic health records and other data sources, healthcare institutions can glean insights into patient trajectories and identify patterns that could enhance care delivery. Predictive modeling, for instance, could revolutionize how providers understand the needs of patients as they approach critical transitions, ultimately fostering a more responsive healthcare system.

The ramifications of this research extend beyond individual experiences to influence the broader healthcare landscape. Policymakers need to consider evidence-based reforms that prioritize both cost-effectiveness and patient-centered care. Incorporating the voices of patients and families in dialogue surrounding healthcare reforms is crucial. An inclusive approach ensures that policies resonate with the lived experiences of those most affected by these decisions.

In light of these findings, the research urges stakeholders to reevaluate the status quo. The traditional views on hospital deaths often highlight a perceived failure in healthcare systems, yet this study evokes empathy and understanding. Death is a natural aspect of life, and how we approach it within hospitals reflects broader societal attitudes toward mortality. Encouraging open conversations around death can demystify the experience and empower patients and families to make informed decisions.

The study’s insights lead to a thought-provoking conclusion: reimagining how healthcare services are utilized at the end of life can revolutionize patient care. Emphasizing compassionate practices, improved communication, and resource allocation may bridge the gap between optimal care and rising healthcare costs. Thus, a transformation towards dignity in dying may not only alleviate financial burdens but also align medical practices with the values of compassion and respect.

In summary, the intricate dance between health service utilization, costs, and patient quality of life at the end of life is illuminated by the recent research led by Duan and colleagues. Their findings provide a critical overview of current practices, open the door for necessary policy discussions, and ultimately advocate for a compassionate reimagining of end-of-life care. The conversation around death and dying warrants more than a cursory glance; it requires a holistic approach that centers patients and families at the forefront of their care.

The study concludes with a call to action, urging stakeholders to take heed of these findings and reconsider how healthcare processes function when death approaches. Ethical healthcare must prioritize the dignity of patients, integrating emotional support and empathy into clinical pathways. As studies like this proliferate, they stand to alter how society views death and provides care for individuals at life’s end.

As we grapple with these issues, it’s crucial to remember that behind every statistic is a story, a family, and a lifetime of memories. Shifting the focus from mere healthcare metrics to genuine human experiences can redefine how we view the final stages of life. Reforming healthcare practices to align with dignity, compassion, and patient autonomy is no longer just a noble ideal—it is a pressing necessity for our evolving health system.

In conclusion, Duan, Xie, Yu, and their team’s endeavor is a vital step toward change. They illuminate a path where empathy, thoughtful dialogue, and data-driven improvements converge to create a healthcare ecosystem that honors the dying process, thereby transforming how we understand and manage life’s ultimate transition.

Subject of Research: Health service utilization and medical costs for in-hospital death at the end of life.

Article Title: Health service utilization and medical costs for in-hospital death at the end of life.

Article References:

Duan, S., Xie, L., Yu, H. et al. Health service utilization and medical costs for in-hospital death at the end of life.
BMC Health Serv Res (2025). https://doi.org/10.1186/s12913-025-13791-6

Image Credits: AI Generated

DOI:

Keywords: End-of-life care, health service utilization, medical costs, in-hospital death, palliative care, healthcare policy.

This innovative degree, embedded within the University of Arizona College of Medicine – Tucson, represents a deliberate convergence of diverse disciplines overseeing medical device innovation from concept through commercialization. By fostering collaboration among physicians, biomedical researchers, engineers, entrepreneurial business strategists, and regulatory law experts, the program cultivates graduates who are uniquely capable of navigating the complex landscape of medical device development, regulation, and market deployment.

Growing at an unprecedented rate, the medical device sector currently accounts for over two million jobs nationwide and continues to expand due to demographic shifts such as an aging population and the rising prevalence of chronic conditions like diabetes and hypertension. These evolving healthcare dynamics spur demand for cutting-edge medical technologies designed to facilitate in-home care, improve patient outcomes, and reduce healthcare costs, underpinning the necessity for a workforce fluent in the intersecting sciences and business drivers of this market.

At the heart of the curriculum lies comprehensive foundational training designed to cultivate fluency in the core disciplines essential to medical device innovation. Students embark on their academic journey with medical school-level coursework, including immersive simulation training and instruction in human anatomy, physiology, and specialized medical terminology. This foundational knowledge establishes a firm biomedical context critical for subsequent engineering and design phases.

Building upon their medical expertise, students delve into engineering principles at the University of Arizona’s College of Engineering, where emphasis is placed on device design, materials science, biomechanical systems, and product development protocols. Such education empowers students to engineer medical devices that are not only functionally effective but also compliant with safety and ethical guidelines inherent to healthcare technologies.

The academic experience is further augmented by coursework in business fundamentals offered through the Eller College of Management. This phase emphasizes organizational behavior, accounting, economics, corporate management, and ethical considerations within the healthcare marketplace. Understanding the commercial imperatives and logistical challenges of scaling medical devices from prototypes to mass-market products is vital for graduates who must navigate competitive and regulatory environments.

Recognizing the critical role of legal expertise in medical device approval and commercialization, the program integrates regulatory affairs and healthcare law instruction through the James E. Rogers College of Law. Students explore the intricacies of the U.S. Food and Drug Administration (FDA) approval process, intellectual property rights, compliance with global standards, and risk management, equipping them to anticipate and circumvent potential legal obstacles in the device development pipeline.

A distinctive feature of the program is its strategic partnership with Tech Launch Arizona, the university’s technology commercialization arm. This collaboration exposes students to real-world technology transfer activities, enabling practical understanding of the mechanisms by which innovations transition from academic laboratories to viable healthcare solutions in the marketplace.

Graduates of this ambitious, four-year program will emerge proficient in evaluating disease therapies through a multidisciplinary lens, factoring in biomedical efficacy, market dynamics, regulatory landscapes, and ethical ramifications. They will possess refined skills that transcend traditional academic silos, positioning them for impactful roles in diverse sectors including medical device sales, research and development, governmental regulatory bodies, and private industry innovation labs.

Dr. Michael M.I. Abecassis, the inaugural Humberto and Czarina Lopez endowed dean of the College of Medicine – Tucson, underscores the program’s unique scope: “After four short years, these graduates will be fluent in the languages of medicine, engineering, business, and law as these relate to medical devices. There is nothing quite like this in the country.” His comments highlight both the interdisciplinary nature of the curriculum and the acute alignment with workforce needs projected by labor statistics forecasting a shortage of roughly 10,000 biotech workers annually over the coming decade.

Technological advances further amplify the significance of this degree. The rapid evolution of connected, patient-centric medical devices — utilizing innovations in wireless communication, sensor miniaturization, and data analytics — demands professionals who not only understand device functionality but also the integration of these technologies into the broader healthcare ecosystem. The program’s integration of hands-on simulation and exposure to emerging trends primes students to lead in this transformative era.

Moreover, societal trends such as a shift toward decentralized health care delivery models necessitate devices that support remote monitoring and management of chronic conditions. Graduates trained under this curriculum will be uniquely prepared to innovate solutions that improve quality of life and reduce burdens on traditional healthcare infrastructure.

Enrollment for this cutting-edge program will commence in spring 2026, marking a significant step forward for the University of Arizona and the national landscape of biomedical education. By aligning rigorous academic instruction with industry demand, this degree holds promise to catalyze innovation, fill critical workforce shortages, and ultimately translate medical technology breakthroughs into improved patient care on a global scale.

As healthcare technologies continue evolving rapidly, the Bachelor of Science in Medical Device Development and Application sets a blueprint for interdisciplinary education tailored to the complexities of modern medical device ecosystems, ensuring graduates not only survive but thrive in the high-stakes arena of product development, regulation, and commercialization.

This program serves as a model for integrating cross-sector expertise — from clinical insight and engineering acumen to business strategy and legal frameworks — creating a new generation of leaders equipped to navigate and shape the future of medical device innovation.

Subject of Research: Development and interdisciplinary education of medical device innovation and application
Article Title: University of Arizona Launches Groundbreaking Bachelor’s Program in Medical Device Development
News Publication Date: June 15, 2024
Web References:
– University of Arizona College of Medicine – Tucson (https://medicine.arizona.edu)
– College of Engineering, University of Arizona (https://engineering.arizona.edu)
– Eller College of Management (https://eller.arizona.edu)
– James E. Rogers College of Law (https://law.arizona.edu)
– Tech Launch Arizona (https://techlaunch.arizona.edu)

Keywords: Medical Device Development, Interdisciplinary Education, Biomedical Engineering, Healthcare Innovation, Medical Technology, Regulatory Affairs, Medical Device Commercialization, Biotechnology, Health Care Workforce, Simulation Training