To the Editor: The article by Carlos Blanco, M.D., Ph.D., and colleagues (1) drew attention to the lack of a coherent mental health policy in the United States. The results of this study indicated that international medical graduates work more frequently in the public sector and treat a higher proportion of patients with psychotic disorders. Psychiatrists with international medical degrees also treat more African American, Hispanic, and other minority patients. However, a lower percentage of psychiatrists with international medical degrees have board certification. One reason, according to Dr. Blanco et al. (1), might be poorer training. Yet government and organized medicine are trying to decrease the number of international medical graduates in the United States. Thus, the mental health field faces several paradoxes, some of them underscored by the results of Dr. Blanco and colleagues’ report (1).