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Once again the residency match is over, and we hear the usual laments regarding the decreasing number of American graduates entering psychiatry (Psychiatric News, April 3). It is time to pause and think about what the goals of an organization like APA are. Is it to provide "good" psychiatrists or "American" psychiatrists to serve the mentally ill?
Despite all the efforts, the number of students choosing psychiatry has not risen. Even if we accept that there are too many psychiatrists, we need at least 800 new psychiatrists a year to meet workforce requirements as expressed by Dr. James Scully in the April 3 issue. This means that international medical graduates (IMG's) will constitute 40 percent to 50 percent of those entering the field. To ensure that quality candidates are selected, APA could develop a test to measure an applicant's knowledge of and aptitude in psychiatry. This test would be administered to all applicants, regardless of whether they are American medical graduates (AMG's) or IMG's.
There is no proof that AMG's fare better in residency or make better psychiatrists than IMG's. In fact, in internal medicine it was shown that in the past three years IMG's fared better than AMG's on in-service examinations.
There is a misperception that programs with a greater number of AMG's are better. Thus, most program directors go out of their way to attract AMG's, even to the extent of sending out "scouts" to Puerto Rico. Whether the "establishment" likes it or not, IMG's constitute a significant minority and will continue to fill residency slots. It is up to the "establishment" to decide its priorities.
Would a program director choose an "average" AMG or a "very well qualified" IMG? I bet everyone knows the answer.
Sanjay S. Chandragiri, M.D.
Middle Island, N.Y.