Globalization, Migration and the U.S. Labor Market for Physicians: The Impact of Immigration on Local Wages

The healthcare labor market has experienced some significant changes in the last half century, including the establishment of Medicare and Medicaid in 1965, the emergence of managed care in the 1980s, and the worldwide mobility of labor encouraged by globalization. Currently, more than 25% of physicians working in the U.S. are foreign-born. The existing body of literature related to the impact of immigration on local wages has to date found conflicting results. The purpose of this research is to evaluate the impact of immigration of foreign physicians on local physician wages. This study employs physician survey data from the AMA Physician Masterfile for the years 1997 through 2007 combined with wage data published by the Bureau of Labor Statistics and data from other government sources. Several econometric models are employed to analyze the wage impacts of immigration, including ordinary least squares, fixed effects, two-stage least squares and a first-difference approach to control for endogenous location choice. The results of this study provide evidence that in the short-run, the impacts of immigration of physicians on area wages is small but positive. In the long run, however, wages adjust and the impact becomes negative and statistically significant, although the magnitude of the impact of a one percentage point increase in the share of immigrant physicians in an area is less than 0.2%. The negative wage effects of immigration tend to be larger for foreign-born physicians educated in the U.S. compared with foreign-born international medical graduates. The study also finds evidence that the negative effects of immigration tend to be offset by outflows of the lowest paid native physicians. Furthermore, physicians tend to locate in areas where wages are already higher, and foreign-born physicians are more likely than their native counterparts to work in larger cities as opposed to rural areas. The research has important policy implications in the presence of current debate over immigration law and healthcare reform and in an era of increasing mobility of labor due to globalization