Contributions of immigrants to the field of US psychiatry

Abstract

Reports on US immigration policy have been dominating the news, including US President Donald Trump's efforts to restrict travel from several predominantly Muslim countries, proposals for a wall along the USA–Mexico border, and increased deportation of undocumented immigrants. As immigrants and daughters of immigrants employed at major academic medical centres, we are particularly interested in the impact of immigration on the field of psychiatry in the USA. Here, we define an immigrant as a foreign national who now permanently resides in the USA or who has become a naturalised US citizen, and international medical graduates as individuals who have completed medical or doctoral education outside of the USA. Immigrants to the USA have made a considerable contribution to psychiatry in the basic sciences, psychotherapy, and health-care delivery—eg, the Nobel Prize winner Eric Kandel and collaborative care innovator Jürgen Unützer. Additionally, immigrants hold a substantial proportion of chair positions in the psychiatry departments of leading research institutions across the USA, with immigrants chairing four of the top ten departments of psychiatry ranked by U.S. News and World Report (appendix). Furthermore, two of the ten previous American Psychiatric Association presidents were immigrants. Immigrants have contributed greatly to scientific productivity in the USA. In 2016, at least four of the top 20 most highly funded National Institutes of Health investigators in psychiatry were immigrants. According to the Web of Science, 45% of the 20 most-cited articles published in both the American Journal of Psychiatry and JAMA Psychiatry between 2007 and 2017 had a first or senior author who was an immigrant or international medical graduate, and 10% of these publications were from Latin America. Nearly a quarter of the editors from these two leading American psychiatric journals are immigrants or international medical graduates, including one Mexican immigrant. Immigrants are essential to the US psychiatry workforce. Data published in December 2016, reported a deficit of around 3400 psychiatrists in the USA. According to the American Psychiatric Association, international medical graduates contribute to a substantial proportion of this deficit, accounting for about 27% of all practicing psychiatrists in the USA. Notably, international medical graduates fill gaps in community mental health care and rural health-care settings.1Alahdab F Murad MH The US immigration ban: implications for medical education and the physician workforce.Lancet. 2017; 383: 1010Summary Full Text Full Text PDF Scopus (2) Google Scholar, 2Rao NR Kramer M Mehra A The history of international medical graduate physicians in psychiatry and medicine in the United States: a perspective.in: Rao NR Roberts LW International medical graduate physicians. Springer, Basel2016: 245-256Crossref Google Scholar Furthermore, in the USA more psychiatry residency positions are available than there are medical graduates, and international medical graduates help to fill these vacancies. According to National Resident Matching Program statistics,3National Residency Matching ProgramResults and data. 2016 main residency match.http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdfGoogle Scholar almost 10% of the psychiatry residency positions in 2016 were filled by non-US citizens. Through both residency and senior leadership positions, immigrants make considerable contributions to the field of psychiatry in the USA, and restrictive immigration policies might have negative consequences for American psychiatry. The field of psychiatry has a chance to help shape the response of the medical community to non-inclusive policies4Hardeman RR Medina EM Kozhimannil KB Structural racism and supporting black lives—the role of health professionals.N Engl J Med. 2016; 375: 2113-2115Crossref PubMed Scopus (230) Google Scholar, 5Williams DR Medlock MM Health effects of dramatic societal events—ramifications of the recent presidential election.N Engl J Med. 2017; 376: 2295-2299Crossref PubMed Scopus (89) Google Scholar and to highlight the value of immigrants. This opportunity—should we be brave enough to take it—will strengthen leadership, advance scientific creativity, and enhance wellbeing for patients and their families. CM received grants from the National Institutes of Mental Health (K23MH093689), outside the submitted work. CML received grants from the American Psychiatric Association and the Substance Abuse and Mental Health Services Administration (SM060562), outside the submitted work. CR received grants from the National Institutes of Mental Health (K23MH092434 and R01MH105461), the Robert Wood Johnson Foundation, Stanford University Department of Psychiatry and Behavioral Sciences, and the Brain and Behavior Research Foundation; received personal fees from Allergan, Blackthorn Therapeutics, and Rugen Therapeutics; and received a study drug at no cost from Naurex for a study sponsored by the Brain and Behavior Foundation, outside the submitted work. For more on the Health Professional Shortage Area designations see http://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas For more on the Health Professional Shortage Area designations see http://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas Download .pdf (.13 MB) Help with pdf files Supplementary appendix