In the US, 25% of licensed doctors graduated from non-U.S. based medical schools and belong to a minority group. Most international medical graduates (IMGs) and minority medical graduates work in the domains of psychiatry and nephrology. The number of licensed IMGs has increased 20% since 2010. Similarly, many doctors and medical residents in America have immigrant backgrounds; their parents and/or grandparents have been immigrants. Since America is a country of immigrants, IMGs have added scientific, cultural, and clinical value to U.S. medicine. However, despite the fact that the U.S. owes gratitude to its non-U.S. medical graduates, these professionals are often subjected to both inadvertent and intentional forms of racism. Particularly, in the residency selection process, IMGs face discrimination that includes micro-aggressions and underlying structural racism. Residency can be a challenging time as candidates tirelessly develop skills and prepare for careers to serve the needs of others in healthcare. The existence of racism within residency is the sole reason IMGs and minority medical graduates are thirty percent more likely to withdraw from medical residency programs and are eight times more probably to ask for extended leaves.

Discrimination Against International Medical Students

Lack of diversity in the medical field leads to racial health inequality. According to the results of Medline research, two studies indicate that there is strong evidence that U.S. medical graduates were preferred over IMGs, particularly in the selection process of psychiatry and family practice programs. In the first study, it was concluded that applications of non-U.S. graduates applying for family practice programs were sent a week late as compared to U.S graduates. The letters described IMGs as “foreign medical graduates,” whereas the U.S. medical graduates were formally mentioned with the names of American medical institutes. Similarly, the second study examined the selection procedure of 192 psychiatry residency programs where letters of foreign graduates were sent with a delay of one week. It was revealed that almost 80% of selections for these two program slots were exclusively given to U.S. medical graduates. Moreover, another study claimed that based on the responses of 280+ members of the Association of Program Directors of Surgery, where the program directors were asked if the residency selection committee preferred U.S. Medical graduates over International medical graduates for selection in surgical, 70% of the surgical program directors believes that IMGs were discriminated against in the residency section process.

Racism in Medical Residency Programs and Black Lives Matter Movement

The incidences of police brutality and the support of the Black Lives Matter movement have shined a light on how racism and discrimination continues to have deep roots in the U.S. The medical field is no exception. According to a qualitative study, non-U.S. medical residents confessed that they were subjected to daily bias, substantial stress, and extra burden inflicted by accreditation entities. Like all other public offices and organizations in America, where people of color face perceived and systematic racism, IMGs are exposed to the same level of discrimination which significantly affects their training experience as a physician. It is time to address the inequalities in medical residency programs to ensure the inclusion of diversity and take a further step forward toward a more inclusive medical community. Similar to the vision of the Black Lives Matter movement, which is based on eradicating the underlying structural racism, medical institutes need to reflect on their residency selection programs. We must not forget that the U.S. is a country of immigrants where everyone should be given equal opportunity to prosper and expand his/her career. We need diversity and inclusion more than ever now in order to fight the ongoing global pandemic that is wreaking havoc on the nation’s economy and has caused major social turmoil.

What Can Be Done to Improve the Residency Selection Process?

As mentioned earlier, there is significant evidence of discrimination against IMGs, therefore, it falls upon medical organizations to improve the residency selection process by making it more transparent and inclusive. Medical institutions should implement strict policies against discrimination of IMGs. Some additional possible solutions include implementing anti-racism curriculum and a continued commitment toward diversification. There is a dire need to introduce uniform and transparent policies for selecting directors to reduce the likelihood of non-academic favoritism.

Conclusion

Minority medical graduates and international medical graduates constitute a significant portion of American doctors and they are a true asset to the U.S. It is crucial, now more than ever, that we put an end to the structural racism and underlying forms of discrimination in all forms, including the medical residency programs.