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Michael E. Whitcomb, MD; Rebecca S. Miller, MS

JAMA. 1996;276(9):700-703.

Abstract
Objective.
—To provide insight into the dynamics that determine the pattern of participation of international medical graduates (IMGs) in graduate medical education (GME).

Design.
—Data on IMG-dependent programs (ie, those having at least 50% of first-year positions filled by IMGs) and non—IMG-dependent programs in 6 core specialties (internal medicine, family practice, obstetrics and gynecology, surgery, pediatrics, and psychiatry) were matched with application data from the 1989 and 1995 National Resident Matching Program (NRMP).

Main Outcome Measures.
—Participation of IMG-dependent and non—IMG-dependent programs in the 1995 NRMP and the pattern of US medical graduate (USMG) and IMG applications to these programs in 1989 and 1995.

Results.
—Of the 1634 programs in the 6 specialties, 93.5% participated in the 1995 NRMP. The 1165 non—IMG-dependent programs were significantly more likely to participate in the NRMP and were slightly more likely to fill their offered positions than were the 469 IMG-dependent programs. Specifically, IMGs constituted 76% of applicants to IMG-dependent programs and only 14% of applicants to non— IMG-dependent programs. Changes in NRMP data between 1989 and 1995 indicated that the number of IMG applications to IMG-dependent programs increased 88.7%, as did the number of applicants ranked.

Conclusions.
—Persistent differences exist in the mix of USMGs and IMGs applying through the NRMP to IMG-dependent and non-IMG-dependent programs. Over time, programs that enroll large numbers of IMGs are likely to experience an increase in the number and proportion of applications from IMGs and a decrease in the number and proportion of applications from USMGs. If policies are adopted to limit IMG access to GME, IMG-dependent programs may be unable to recruit USMGs unless the total number of GME programs or the quality of existing programs fundamentally changes.

Author Affiliations
From the Division of Medical Education, Association of American Medical Colleges, Washington, DC (Dr Whitcomb), and the Department of Research and Data Analysis, Division of Graduate Medical Education, American Medical Association, Chicago, III (Ms Miller).

Footnotes
Reprints: Rebecca S. Miller, MS, Department of Research and Data Analysis, American Medical Association, 515 N State St, Chicago, IL 60610.

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