International Medical Graduates and American Psychiatry: The Past, Present, and Future

International Medical Graduates in the United States Psychiatry Workforce

OBJECTIVE

This study describes the supply, distribution, and characteristics of international medical graduate (IMG) psychiatrists who provide services in the USA.

METHODS

Cross-sectional study design, using descriptive statistics based on combined data from the American Medical Association (2020 Physician Masterfile) and the Educational Commission for Foreign Medical Graduates.

RESULTS

International medical graduates continue to make significant contributions to the US physician workforce. As a group, they represent 29% of active psychiatrists in the USA, compared to 23% in all other medical specialties. Many IMG psychiatrists were US citizens who obtained their medical degrees outside the USA or Canada, often in the Caribbean. In some states (i.e., Florida, New Jersey), over 40% of active psychiatrists are IMGs. Over 30% of IMG psychiatrists graduated from medical schools in India and Pakistan.

CONCLUSIONS

This study provides an overview of the psychiatric workforce in the USA, quantifying the specific contribution of IMGs. Several factors, including immigration policies, continued expansion of US medical schools, and the number of available residency positions, could impact the flow of IMGs to the US. Longitudinal studies are needed to better understand the implications for workforce composition and distribution, and their potential impact on the care of psychiatric patients.

Foreign medical graduates and American psychiatry

Graduates from foreign medical schools (FMGs) began to staff US state psychiatric hospitals after World War II, and became increasingly associated with the poor quality of those institutions. Public and professional commentary on FMGs criticized their skills and suitability for the US healthcare system in the 1970s, at the same time that state hospitals were under increasing attack. By the 1980s and 1990s, the association between international medical graduates (as they became known) and underserved populations became an argument in favour of easing restrictions on these graduates. The role of foreign-trained psychiatrists in the US public sector became a way for American psychiatry leaders to manage the problems of the seriously mentally ill, first with blame and then with neglect.

International Medical Graduate Resident Physicians in Psychiatry: Decreasing Numbers, Geographic Variation, Community Correlations, and Implications

OBJECTIVES

The number of International Medical Graduate (IMG) physicians matching into categorical psychiatry decreased steadily over the past decade. The authors sought to understand if this trend was occurring in other specialties, if US IMG physicians and non-US IMG physicians were equally affected, and if certain regions of the USA were more affected by this decrease than others. Finally, the authors compared the proportion of foreign-born individuals within a US census region to the proportion of non-US IMG physicians within that region.

METHODS

The authors analyzed data from the National Resident Matching Program from the years 2014-2020. Statewide data was aggregated into nine geographic regions, as per the US Census Bureau. The number of foreign-born individuals within each US census region was calculated from the 2018 American Community Survey data.

RESULTS

In comparison to eight other specialties, psychiatry saw the greatest decrease (46.3%) in IMG physicians matching into PGY-1 positions. Both US IMG physicians and non-US IMG physicians were equally affected. The percentage of IMG physicians decreased in each of the nine US census regions. In six out of nine geographic regions, non-US IMG physicians were under-represented when comparing their proportion to the number of foreign-born people that lived within that region.

CONCLUSIONS

Decreasing numbers of IMG physicians in psychiatry training may have long-term implications for cultural competency, serving underserved populations, and fellowship recruitment. We advocate for program directors to recognize IMG physicians as an important source of diversity and to recruit residents that reflect the communities they serve.