In this issue of Academic Psychiatry are two Letters to the Editor/commentaries on the subject of International Medical Graduates (IMGs).
Drs. Richard Balon and Michelle Riba describe a study extending previous findings that residency programs in a wide variety of specialties respond differentially to otherwise identical inquiries from potential applicants depending on the "foreignness" of the applicant's name and the location of the medical school. Dr. John Norton describes his own personal experiences with pressures from his department and school to "buy American."
This is a subject about which few are truly objective. My own bias probably comes from the knowledge that, had someone not given my grandfather a break almost 100 years ago, it is not clear where I would be now.
There are many complexities to the arguments. What is the constituency of a given program? What are its service needs? Are the differences in training and preparation among various countries as great as they may have been 20 years ago? Are we developing a two-tiered system of residencies and psychiatrists? How do we measure fairness? How do we fairly compare individuals from vastly differing backgrounds and training? How capable are individuals of achieving comfort and subtle fluency in a new language and culture, etc.?
There still remain a few programs that will not even consider an IMG applicant, but most psychiatry residencies that did not already accept international applications were forced to reconsider because of the dramatic decline in United States graduates entering psychiatry in the late '80s. It appears that most have discovered that there are some gems to be found amid the mass of applications from abroad. These gems are on particular display each March when the American Association of Directors of Psychiatry Residency Training hand out the Wyeth-Ayerst IMG Mentorship Awards.
American psychiatry has long prospered from the immigration of those trained elsewhere. Often, they were escaping difficult situations in their home countries. Names such as Deutsch, Alexander, Fava, Fromm-Reichman, Mezzich, Kohut, Akiskal, and Mahler leap to mind. These days, individuals from India, Pakistan, Eastern Europe, and the former Yugoslavia seem most prominent. Two recent APA presidents have been IMGs.
As I sit here writing this, I notice that two of the last five winners of our program's Outstanding Resident Award were IMGs, that seven IMG graduates of the last few years are now faculty members, that two of our IMG PGY-I's are now struggling, and that one of the stars of our senior class is an IMG who struggled mightily and almost didn't make it for the first 18 months.
This is an issue that will be with us for some time to come. It is worthy of the continuing struggle.