The internal medicine workforce, international medical graduates, and medical school departments of medicine

      The internal medicine workforce in the United States consists of physicians, residents, and fellows, of which a substantial number are international medical graduates who come to the United States to do their residencies and fellowships and then remain for careers in practice, academia, or other areas. How internal medicine departments at medical schools are affected by the diversity of our trainees and faculty has not been reviewed extensively in the published literature, although it is a regular discussion subject among department and residency program leaders and faculty. This is a sensitive topic because discussions of issues pertaining to international graduates may seem to suggest underlying bias and intolerance. Furthermore, the topic may be overlooked because it gets little attention at the more prestigious medical schools that enroll mostly U.S. residents and fellows and have few international graduates on their faculty. In this commentary, I will summarize the demographic characteristics of the internal medicine workforce in the United States, consider how having substantial numbers of international graduates affects our departments, and conclude with a suggestion that the Alliance for Academic Internal Medicine (AAIM) formally address these and other related training and workforce issues.
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