An Identity Crisis

I was excited when, a few weeks ago, I received an e-mail from a colleague soliciting articles for a journal's special issue on international medical graduates (IMGs). Maybe, I thought, I will ask a junior faculty member and a resident to write about their experiences as IMGs. However, as I contemplated this further, it struck me that I too was one of the IMGs from whom he was soliciting articles. This is despite the fact that I have been here in Illinois for over 30 years and have practiced psychiatry here for the past 25.

I began my residency in the United States at age 26 and have practiced medicine exclusively in the U.S. In the past 25 years, I coauthored two books, published dozens of journal articles, and trained 3,500 medical students and over 200 psychiatry residents. For the past 10 years, I have been a professor and chairperson of a department of psychiatry in a medical school accredited by the Liaison Committee on Medical Education (LCME).

So why am I still called an international medical graduate? Is my experience of being a psychiatrist for 25 years somehow so different from that of my own trainee, who just finished his residency after obtaining his M.D. degree from my own school, that I must be labeled an IMG to differentiate me from him? Is predoctoral training of origin so vital to my identity that no amount of training in the U.S., and no amount of breathing American oxygen, can diminish its importance and require me to maintain my label? To be honest, everything I know now I learned in residency and beyond. I cannot even conduct a psychiatric interview in a language other than English.

Strikingly, this IMG label is restricted to medicine alone. My husband, who has a Ph.D. from the University of Wisconsin, is considered a UW graduate even though his basic engineering degree is from India. Engineering does not have a category of “IEG” (“international engineering graduate”), and neither does the field of law have “ILGs” (“international law graduates”). Most professions have strict rules about who enters their ranks, but once they admit an individual to their profession, they do not create a separate category—only medicine does! I have deliberately not cited articles demonstrating that IMGs are as good as, or even better than, American medical graduates (AMGs) because, at my core, I reject the separation itself. It resembles “separate, but equal” status.

I am told that some orthodox religions will not accept a converted individual as a full-fledged member because, even if you have studied and understood the ancient scriptures, to become a true “member” you have to be born to a mother who belongs to that group by virtue of her birth. It feels like American medicine applies the same principle. With these “international medical graduates” serving in almost all spheres of medicine, one would think it is time to do away with this label. I alone may not be able to make this change, but at least I can let my colleagues know that I find this offensive and very, very disappointing.