Evidence of discrimination against international medical graduates applying to family practice residency programs

The purpose of the study was to test the hypothesis that discrimination exists against international medical graduates (IMGs) applying to US family practice residency programs.

Two sets of letters were sent to 146 family practice residency programs randomly selected from the Directory of Graduate Medical Education Programs. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate." The author of the second set was described as "a fourth-year medical student at the University of Nebraska Medical Center." Replies were monitored for 6 weeks after the second mailing. Response rates to each "candidate" were measured. In addition, responses were evaluated for the presence of a brochure describing the residency program, an application, cover letter, invitation for interview, eligibility criteria, and other material.

A total of 113 programs (79%) responded. Of these, 102 responded to the fourth-year medical student and 57 responded to the IMG. Of the 46 programs replying to both candidates, only 20 provided identical mailings. Nine of the 46 programs required IMGs to meet standards that exceeded requirements set by the Educational Commission for Foreign Medical Graduates for residency training in the United States.

A pattern of dissimilarity exists in the way family practice residency programs respond to requests for application materials, and the differences appear to depend on whether the candidate is a US medical graduate or an IMG. These results raise questions about the fairness of current methods of resident selection.