International medical graduates now have a room of their own in the house of medicine.

After several years of discussion and debate, and with the consistent support of APA, the House of the Delegates of the American Medical Association approved the creation of a section--an organized representative body with a delegate on the house floor--for international medical graduates (IMG's).

The new section council was approved by the House of Delegates at the organization's December meeting in Atlanta.

Like section councils that represent medical specialties, resident physicians, medical students, and medical schools, the Section Council on IMG's will provide a forum for discussion of issues pertinent to a unique constituency; those concerns can then be brought to the house floor by a voting delegate from the section council. The section council also will be able to bring the perspective of the internationally educated to a host of other issues confronting organized medicine.

Joseph T. English, M.D., chair of the Section Council on Psychiatry, cited the action by the house during his remarks to APA's Board of Trustees in December, noting that the new section council was "fully and loudly supported" by APA.

(For an account of AMA house actions relevant to psychiatry, see story on page 4).

Physicians interviewed by Psychiatric News say the creation of the IMG section council is a victory for international graduates, but one that has been a long time coming.

"IMG's will now get substantial representation in the AMA and respect from their partners in American medicine," commented Richard Balon, M.D., APA Assembly liaison to APA's Committee of International Medical Graduates.

Balon also served on an advisory committee to the AMA Board of Trustees on issues related to IMG's for several years prior to the creation of the section council.

Balon underscored what the house vote and the language of the resolution creating the section council make clear: that international medical graduates are now a significant force in the demographics of American medicine.

The resolution--introduced into the house by delegations from Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont--notes that IMG's now make up 23 percent (154,576) of the U.S. physician population and 24 percent (22,230) of the resident population.

Some 44,683 IMG's were AMA members in 1995. That figure represents 17 percent of the total AMA membership, the resolution states. In addition, approximately 31 percent of the active physician IMG population are AMA members.

Balon noted that the growth of international medical graduates is especially pertinent to psychiatry.

"At present about 50 percent of the first-year residents [are] IMG's," he said. "At the same time, there has been declining interest in psychiatry among American medical students. IMG's are vital to organized medicine and vital to treating the poor and underserved in state mental hospitals and community mental health centers."

Balon added that IMG's are disproportionately overrepresented in lower-paying medical disciplines; yet, he added, the attitude of organized medicine toward IMG's has been "ambivalent at best."

Balon said he believes IMG's have grown "disenchanted" with organized medicine.

"Some IMG's feel they have been abandoned by organized medicine," he said, "and some IMG's have in turn abandoned organized medicine."

Among the primary issues that Balon expects the new section council to address is what he called the "painful issue" of licensing requirements.

Balon explained that licensure requirements differ from state to state, and that some states impose stiffer criteria for IMG's than for graduates of American medical schools.

In some cases, licensing boards require information from educational institutions that may be difficult or impossible for IMG's to obtain.

Child psychiatrist Mark Friedlander, M.D., who has been active in the Pennsylvania State Medical Society and a proponent of IMG issues in the American Medical Association, also hailed the creation of the section council. He noted, however, that opponents of the section council in the past included some IMG's themselves.

These physicians feared that to be identified with a special section council would "label" them and further distance them from mainstream American medicine, Friedlander said. He stressed, however, that the structure of the House of Delegates necessitates an organized representative body with a voting delegate to address sensitive issues.

Friedlander told Psychiatric News that there is a unique "culture" to the AMA and a "style of presenting testimony" that is not easily accessible to individual physicians in a state medical society delegation.

Issues relevant to IMG's can be much more cogently and powerfully addressed by an organized section council than by a single representative in a state medical society, he said.

"Hearing a section council testify provides much greater credibility [to IMG issues], and an official delegate makes it much more powerful," Friedlander said. "It also allows a number of physicians who would likely never come to the AMA meeting to get together in an organized forum."

Friedlander echoed Balon in saying that the issue of licensure requirements is pivotal.

He noted that he and another international medical graduate approached the medical society in Pennsylvania with a grievance about licensing requirements; the grievance was subsequently redressed.

"I'm not sure organized medicine would have taken a look [at the issue] if two IMG's hadn't brought it to their attention," Friedlander said.

At the same time, Friedlander said he believes organized medicine has been "incredibly receptive" to IMG's. He suggested that complaints from a few IMG's about the attitude of organized medicine has "poisoned the water," and that the problem is largely one of public relations.

He encouraged psychiatrists and other physicians who graduated from overseas medical schools to become involved in the AMA.

He said, "It is vital for IMG's of any specialty to be involved in organized medicine." (Psychiatric News, February 7, 1997)