Discrimination against international medical graduates in the United States residency program selection process

We conducted a Medline search for research on the selection process.Two studies provide strong evidence that psychiatry and family practice programs respond to identical requests for applications at least 80% more often for U.S. medical graduates than for international graduates. In a third study, a survey of surgical program directors, over 70% perceived that there was discrimination against international graduates in the selection process.There is sufficient evidence to support action against discrimination in the selection process. Medical organizations should publish explicit proscriptions of discrimination against international medical graduates (as the American Psychiatric Association has done) and promote them in diversity statements. They should develop uniform and transparent policies for program directors to use to select applicants that minimize the possibility of non-academic discrimination, and the accreditation organization should monitor whether it is occurring. Whether there should be protectionism for U.S. graduates or whether post-graduate medical education should be an unfettered meritocracy needs to be openly discussed by medicine and society.The United States owes a huge debt of gratitude to its physicians who graduated from non-U.S. medical schools [1]. Despite this, medical educators have sometimes seemed to be embarrassed by the presence of these residents in their programs. For example, in a recent article that praises international medical graduates (IMGs) one leader states that his program chooses that IMGs comprise 10 percent of his residents - a quota system that belies his later assertion that "U.S. academic medicine is ... a classic meritocracy" [2].The proportion of IMGs practicing in the U.S. is considerable. About one-quarter of practicing U.S. physicians are IMGs, up from 15 percent in 1967 and 6.3 percent in 1959. In 2004, 28 percent of the residency cohort was represented by IMGs, and more so in some specialties, such as psychiat