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

Abstract

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Ahmed AA, Hwang W-T, Thomas CR, Deville C. International medical graduates in the US physician workforce and graduate medical education: current and historical trends. J Grad Med Educ. 2018;10(2):214–8.

    Article  Google Scholar 

  2. 2.

    National Residency Matching Program. Results and Data: 2020 Main Residency Match. 2020. http://www.nrmp.org/main-residency-match-data/. Accessed 4 September 2020.

  3. 3.

    National Residency Matching Program. Results and Data: 2014 Main Residency Match. 2014. https://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf. Accessed 27 Jan 2020.

  4. 4.

    National Residency Matching Program. Results and Data: 2019 Main Residency Match. 2019. http://www.nrmp.org/main-residency-match-data/. Accessed 3 February 2020.

  5. 5.

    American Psychiatric Association. 2018 Resident/Fellow Census 2019. https://www.psychiatry.org/residents-medical-students/medical-students/resident-fellow-census. Accessed 2 February 2020.

  6. 6.

    US Department of Commerce, Economics and Statistics Administration, US Census Bureau. Geographic Areas Reference Manual. 1994. https://www2.census.gov/geo/pdfs/reference/GARM/GARMcont.pdf. Accessed 3 February 2020.

  7. 7.

    US Census Bureau, 2018 American Community Survey. Selected Social Characteristics in the United States. 2020. https://data.census.gov/cedsci/. Accessed 15 September 2020.

  8. 8.

    Bhui K, Warfa N, Edonya P, McKenzie K, Bhugra D. Cultural competence in mental health care: a review of model evaluations. BMC Health Serv Res. 2007;7:15.

    Article  Google Scholar 

  9. 9.

    Blanco C, Carvalho C, Olfson M, Finnerty M, Pincus HA. Practice patterns of international and U.S. medical graduate psychiatrists. Am J Psychiatry. 1999;156(3):445–50.

    CAS  PubMed  Google Scholar 

  10. 10.

    U.S. Citizenship and Immigration Services. Conrad 30 Waiver Program. 2014. https://www.uscis.gov/working-united-states/students-and-exchange-visitors/conrad-30-waiver-program20. Accessed 14 February 2020.

  11. 11.

    Juul D, Colenda CC, Lyness JM, Dunn LB, Hargrave R, Faulkner LR. Subspecialty training and certification in geriatric psychiatry: a 25-year overview. Am J Geriatr Psychiatry. 2017;25(5):445–53.

    Article  Google Scholar 

  12. 12.

    Frierson RL. Examining the past and advocating for the future of forensic psychiatry training. J Am Acad Psychiatry Law. 2020;48(1):16–25.

    PubMed  Google Scholar 

  13. 13.

    Gibson C, Jung K. Historical Census Statistics on the Foreign-Born Population of the United States: 1850-2000. 2006. https://www.census.gov/population/www/documentation/twps0081/twps0081.html. Accessed 14 February 2020.

  14. 14.

    American Association of Medical Colleges. 2019 State Physician Workforce Data Report. 2019. https://store.aamc.org/downloadable/download/sample/sample_id/305/. Accessed 27 Jan 2020.

  15. 15.

    American Association of Medical Colleges. Matriculants to U.S. Medical Schools by Race/Ethnicity and State of Legal Residence 2019-2020. 2020. https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-applicants-and-matriculants-data. Accessed Feb 14 2020.

  16. 16.

    Balon R, Mufti R, Williams M, Riba M. Possible discrimination in recruitment of psychiatry residents? Am J Psychiatry. 1997;154(11):1608–9.

    CAS  Article  Google Scholar 

  17. 17.

    American Association of Colleges of Osteopathic Medicine. 2019-2020 Student Guide to Osteopathic Medical Colleges. 2019. https://www.aacom.org/docs/default-source/presentations/student-guide-for-web-5-28-19.pdf?sfvrsn=4aab3d97_2. Accessed 27 Jan 2020.

  18. 18.

    American Association of Colleges of Osteopathic Medicine. Applications, First-Year Enrollment, Total Enrollment and Graduates by Osteopathic Medical College. 2019. https://www.aacom.org/docs/default-source/data-and-trends/applications-enrollment-and-graduates-by-osteopathic-medical-college-2014-2019.pdf?sfvrsn=a6d83497_7. Accessed 27 Jan 2020.

  19. 19.

    Majeed MH, Ali AA, Sudak DM. International medical graduates and American psychiatry: the past, present, and future. Acad Psychiatry. 2017;41(6):849–51.

    Article  Google Scholar 

  20. 20.

    Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements (Residency). 2020. https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2020.pdf. Accessed 30 Dec 2020.

  21. 21.

    American Association of Medical Colleges. Holistic Review. https://www.aamc.org/services/member-capacity-building/holistic-review. Accessed 28 Sept 2020.

  22. 22.

    Bailey RK, Saldana AM, Mohayed MO, Saldana AM. Ten-year review of the extern program: a solution to an unsuccessful match? Acad Psychiatry. 2020.

    Google Scholar 

Download references

Acknowledgements

Selected portions of the data from this manuscript were presented at the 2020 American Association of Directors of Psychiatric Residency Training Annual Meeting.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sanya Virani.

Ethics declarations

Disclosures

Outside of this work, Dr. Cotes has received research funding from Otsuka, Lundbeck, Alkermes, and Roche. He is a consultant to the American Psychiatric Association and Saladax Biomedical. The remaining authors have nothing to disclose.

Additional information

Selected portions of the data from this manuscript were presented at the 2020 American Association of Directors of Psychiatric Residency Training Annual Meeting.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Virani, S., Mitra, S., Grullón, M.A. et al. International Medical Graduate Resident Physicians in Psychiatry: Decreasing Numbers, Geographic Variation, Community Correlations, and Implications. Acad Psychiatry (2021). https://doi.org/10.1007/s40596-020-01380-0

Download citation

Keywords

  • International Medical Graduates
  • NRMP
  • Psychiatry match