International Medical Graduates and a Career as a Geriatric Psychiatrist

Abstract

International Medical Graduate (IMG) is a physician who received their basic medical degree or qualification from a medical school located outside the United States and Canada. The location of the medical school and not the citizenship of the physician determines whether the graduate is an IMG. Presently, IMGs represent 23.3% of the total active US physician workforce and 29.2% of the psychiatry workforce. IMGs constitute 52.2 % of the geriatric psychiatry workforce in the US, a number significantly greater than noted in other psychiatry subspecialities, emphasizing the reliance of geriatric psychiatry on IMGs for it's sustainability. Some of the reasons for this are coming from cultures of intergenerational families where older adults play an important role, easier access to geriatric psychiatry fellowships in prestigious universities and access to senior IMG faculty members as mentors in this field.Recently, the number of IMGs being accepted into psychiatry residency has declined, mostly due to increase in interest in psychiatry from American Medical Graduates (AMGs). While more AMGs are matching into psychiatry, their interest in Geriatric psychiatry has remained low, which is reflected in decrease in trainees choosing geriatric psychiatry fellowship. Of all psychiatry subspecialties, Geriatric psychiatry fellowship has seen the biggest drop by 27.59% between 2015-2019 in trainees entering these programs. The decrease in IMGs choosing geriatric psychiatry as a career path not only decreases the overall geriatric psychiatry work force, it also affects the culturally sensitive services that can be offered to increasingly racially diverse US older adult population. IMGs are more likely to work in the public sector and receive a larger proportion of their income from Medicare and Medicaid, often providing services to minorities and socio-economically challenged older adults, which will be compromised from shrinking IMG representation in geriatric psychiatry.Despite the role IMGs play in the field of geriatric psychiatry, they face a lot of challenges unique to them. IMGs in psychiatry are often seen working as full-time hospital staff compared to their US counterparts who are more likely to be working as administrators or medical teachers. They are also less likely to be seen at leadership level, both in institutions and professional organizations. This may be partly due to lack of understanding of the new culture, particularly academic and organizational culture, and hence lack of communication skills to be able to thrive in the new work culture. IMGs often face biases and lack of support and microaggressions, holding them back from their full potential. Additionally, visa issues can serve as barriers in accessing better opportunities. Fortunately, there are ways for IMGs to circumvent some of these hurdles and set themselves up for success.This session focuses on IMGs in geriatric psychiatry, the obstacles they face in choosing geriatric psychiatry as career path, and strategies for success.