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. 2021 Aug;36(8):2230-2236.
doi: 10.1007/s11606-020-06519-1. Epub 2021 Feb 11.

Where Do International Medical Graduates Matriculate for Internal Medicine Training? A National Longitudinal Study

Shalini T Reddy  1   2 , Michael Kisielewski  3 , Lisa L Willett  4 , Sandhya Wahi-Gururaj  5 , Vinny M Arora  6 , Furman S McDonald  7   8   9 , Himangi Kaushal  10 , Saima Chaudhry  11
Affiliations

Where Do International Medical Graduates Matriculate for Internal Medicine Training? A National Longitudinal Study

Shalini T Reddy et al. J Gen Intern Med. 2021 Aug.

Abstract

Introduction: In 2020, roughly 25% of applicants who matched into internal medicine (IM) residencies were international medical graduates (IMGs). We examine 12-year trends in distribution of IMGs among IM training programs and explore differences in program perceptions towards IMG recruitment.

Methods: Since 2007, Association of Program Directors in Internal Medicine Annual Surveys have collected data about trainees by medical school graduate type. Sixteen additional questions regarding perceptions of IMGs were included in the 2017 spring survey.

Results: The 2017 survey response rate was 63.3% (236/373) and ranged from 61.9 to 70.2% for the 2007-2019 Annual Surveys. During that 12-year period, 55-70% of community programs' and 22-30% of university programs' PGY1 positions were filled by IMGs. In 2017, 45% of community programs' and 15% of university programs' interview and ranking positions were allocated to IMGs. Departmental pressure (university 45.6% [95% CI 43.7-47.5]; community 28.2% [95% CI 26.6-29.7]; p = 0.007), institutional priority (university 64.0% [95% CI 62.1-66.0]; community 41% [95% CI 36.9-44.6]; p = 0.001), and reputational concerns (university 52.8% [95% CI 50.0-55.6]; community 38.5% [95% CI 36.0-40.9]; p = 0.045) were cited as factors influencing recruitment of IMGs.

Conclusion: Our study was limited to exploring program factors in residency recruitment and did not assess applicant preferences. There is a large, longstanding difference in the recruitment of IMGs to US community-based and university residencies, beginning during the interview and ranking process. Further research in disparities in IMG recruitment is needed, including exploring pressures, preferences, and potential biases associated with the recruitment of IMGs.

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Conflict of interest statement

None of the authors report any relevant conflicts of interest.

Figures

Figure 1
Figure 1
12-year trends in IMG composition of US internal medicine residency programs: Academic year 2008 to academic year 2019. Y axis: % of internal medicine positions filled by IMGs. X axis: academic year. Green arrow indicates when the all-in policy was implemented for the NRMP Main Residency Match.
See this image and copyright information in PMC

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