Acad Psychiatry 31:171-172, March-April
doi: 10.1176/appi.ap.31.2.171
© 2007 Academic Psychiatry
Research During Psychiatry Residency: A Case for IMGs on Visas
Anjali Varma, M.D., Department of Psychiatry, Carilion Health System, Roanoke, Va. and
Mansoor Malik, M.D., Department of Psychiatry, Catawba Hospital, Catawba, Va.
In the last few years, there has been a growing awareness that the number of psychiatrist-researchers does not seem to be keeping pace with the needs and opportunities that exist in brain and behavioral medicine. Few graduating psychiatry residents take up research as a full-time career. In a study by Pincus et al. (1), only 39.1% of the faculty from academic departments of psychiatry qualified as "researchers." Of the clinical research projects funded by the National Institute of Mental Health (NIMH), only about 36% had physicians as their principal investigators (2).
This problem was highlighted by the Institute of Medicine’s (IOM’s) report on research training in psychiatry residency in 2003 (3). Among the strategies for reform, the IOM recommended focusing on various regulatory, institutional, and personal factors. Among the personal factors, the IOM committee mentioned variables such as motivation, drive, family demands, gender, and race as being important determinants of trainee participation in research (3).
Another factor worth considering in the case of international medical graduates (IMGs) in residency training is their visa status. Generally, a considerable investment of time beyond the core clinical residency is required for successful research training. This is usually done through various research fellowship programs. However, IMGs who are on visas are ineligible for these fellowships.
Data from the 2005 match result shows that out of the total 983 filled first-year psychiatry positions, 224 were filled by IMGs, and among these 157 were on visas (4). Thus, 16% of the total residents matched were on a visa. This is a significant number. Most of these IMGs are on J or H visas and have to wait for several years in order to become permanent residents, and only then can they apply for federally funded research fellowships and grants. This seems unfortunate, as many IMGs have undergone psychiatry training in their home countries and have an interest in pursuing research careers. Kupfer et al. (2) discussed various challenges facing the recruitment and retention of physician-scientists as career mental health researchers and stressed the need to attract a more diverse group of trainees, including research-oriented IMGs, into mental health research.
Norton (5) emphasized the attributes of IMGs from the perspective of a residency program director. He emphasized that many IMGs are outstanding in terms of having varied experience, including research training, rich cultural background, and, at times, better credentials and personal attributes when compared to U.S. medical graduates. All of these attributes may serve as an asset during the pursuit of psychiatric research, especially that which is related to transcultural and minority issues.
Due to federal regulations, federally funded projects cannot be awarded to non-U.S. citizens. The majority of the research fellowships/awards available during residency, including those under the aegis of the American Psychiatric Association (APA), are only for permanent U.S. residents/citizens. There are several research fellowships sponsored by the American Psychiatric Institute for Research and Education (APIRE) in conjunction with various industrial sponsors, as well as APA minority research fellowships, which are exclusively for U.S. citizens/permanent residents. In addition, a number of postgraduate research fellowships also do not consider residents on visas.
On the brighter side, the Office of Academic Affiliations (OAA) of the Veterans Affairs (VA) has recognized the need to involve psychiatry residents on visas in research activities. Despite being a federal agency, in July 2001, OAA started a 2-year post-residency special research fellowship in advanced psychiatry, which is currently available at eight sites throughout the country, for which IMGs with a valid visa are eligible to apply.
Blanco et al. (6) examined the practice patterns of international and U.S. medical graduate psychiatrists and found that IMG psychiatrists served the minority and underserved populations, including the poor and the elderly, to a higher degree than did U.S. medical graduates. Providing IMGs with more research training and opportunities may help boost the much-needed research among these underprivileged sections of the society. In the same vein, in a recent issue of Academic Psychiatry, Kramer (7) points to the need for IMGs to be the subject of interest and attention of psychiatric educators. We emphasize that it may be wise to focus also on IMGs as potential psychiatric researchers.
In conclusion, we argue in favor of equal research opportunities under APA for all psychiatry residents. We believe that visa restrictions for eligibility in APA-sponsored research activities seriously limit IMG residents’ participation, and easing these restrictions could go a long way in encouraging well-trained and motivated IMGs to consider and maintain successful research careers. APA, being the largest national body in pursuit of clinical, academic, and research excellence in psychiatry, is in a unique position to advocate the necessary changes in the regulations regarding visa status for research and academic fellowships.
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REFERENCES
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- Pincus HA, Dial TH, Haviland MG: Research activities of full-time faculty in academic departments of psychiatry. Arch Gen Psychiatry 1993; 50:657–664[Abstract/Free Full Text]
- Kupfer DJ, Hayman SE, Schatzberg AF, et al: Recruiting and retaining future generation of physician scientists in mental health. Arch Gen Psychiatry 2002; 59:657–660[Abstract/Free Full Text]
- Institute of Medicine: Research Training in Psychiatry Residency: Strategies for Reform. Washington, DC, National Academic Press, 2003
- National Resident Match Program: NRMP 2005 match results. Available at http://www.aafp.org/match/table15.htm Table 15
- Norton J: Buy American: choosing psychiatry residents. Acad Psychiatry 2001; 25:181–183[Free Full Text]
- Blanco C, Carvalho C, Olfson M, et al: Practice patterns of international and US medical graduate psychiatrists. Am J Psychiatry 1999; 156:445–450[Abstract/Free Full Text]
- Kramer MN: The educational needs of international medical graduates in psychiatric residencies. Acad Psychiatry 2005; 29:322–324[Free Full Text]
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