Abstract
Objective: This study examines trends in the supply, distribution, and demographics of psychiatry residents during the 1990s. It evaluates the extent to which the predicted downsizing of psychiatry residency training programs actually occurred and how it affected training programs of different sizes and locations. Method: Data for this study were obtained from the American Medical Association’s (AMA) Annual Survey of Graduate Medical Education (GME) Programs, the AMA GME directory, and the APA Graduate Medical Census. The study compares the roles played by international medical graduates (IMGs) in contrast to U.S. medical graduates (USMGs) in these trends. Results: There was a significant decline in the number of residents during the years studied. The median training program size also decreased. International medical graduates found broad acceptance in training programs of all locations and sizes, including medical school based programs. Implications of the findings are discussed regarding the impact of current graduate medical education (GME) and immigration policies on future workforce patterns. Conclusion: The field will have to decide whether it can afford anymore residency downsizing in light of emerging evidence of a shortage of psychiatrists.
Similar content being viewed by others
References
Lyttle CS, Levey GS: The National Study of Internal Medicine Manpower: XX. The changing demographics of internal medicine residency training programs. Ann Int Med 1994; 121(6): 435–441
Kwakwa F, Jonasson O: The longitudinal study of surgical residents, 1994 to 1996. J Am Coll Surg 1999; 188(6): 575–585
Kwakwa F, Jonasson O: The general surgery workforce. Am J Surg 1997; 173: 59–62
Kwakwa F, Jonasson O: The longitudinal study of surgical residents, 1993 to 1994. J Am Coll Surg 1996; 183: 425–433
Kahn NB Jr, Schmittling GT, Graham R: Entry of US medical school graduates into family practice residencies: 1998–1999 and 3-year summary. Fam Med 1999; 31(8): 542–550
American Academy of Pediatrics Committee on Pediatric Workforce: “Pediatric workforce statement”. Pediatrics 1998; 102: 418–427
O’Neil JA Jr, Gautam S, Geiger JD, et al: “Longitudinal Study of the Pediatric Surgeon Workforce”. Ann Surg 2000; 232: 442–453
Ringel SP: Future neurology workforce: the right kind and number of neurologists. Neuro 1996; 46: 897–900
Hogan PF, Dobson A, Haynie B, et al: Physical Medicine and Rehabilitation Workforce Study, The Supply and Demand for Psychiatrists. Arch Phys Med Rehabil 1996; 77: 95–99
Vance RP, Hartman WH, Prichard RW: Pathology trainee manpower: historical perspectives. Arch Pathol Lab Med 1992; 116: 574–577
Olfsen M, Marcus SC, Pincus HA: Trends in office-based psychiatric practice. Am J Psychiatry 1999; 156: 451–457
Zarin DA, Pincus HA, et al: Characterizing psychiatry with findings from the 1996 National Survey of Psychiatric Practice. Am J Psychiatry 1998; 155: 397–404
Dorwart RA, Chartock LR, et al: A national study of psychiatrists’ professional activities. Am J Psychiatry 1992; 149: 1499–1505
McClendon BJ, Politzer RM, Christian E, et al: Downsizing the physician workforce. Public Health Report 1997 May–Jun; 112(3): 231–9, Bureau of Health Professions, Health Resources and Services Administration, Rockville, MD
Yager J, Burt V, Mohl P: Downsizing Psychiatric Residency Programs: A Pilot Study. Acad Psychiatry 1998; 22: 127–134
American Medical Association. Directory of Graduate Medical Education Programs, Chicago, 1992–2000
American Psychiatric Association: Office of Education. Resident Census. Washington, DC APA, 1972–2001
American Medical Association. Graduate Medical Education. Appendix. Various Issues of Journal of American Medical Association, September 1982–2001
Graduate Medical Education National Advisory Committee. Report of the Graduate Medical Education Advisory Committee to the Secretary, Department of Health and Human Services, Volume 1, Washington, DC, Office of Graduate Medical Education. Health Resources Administration, Public Health Service, US Dept of HHS; 1980
Council on Graduate Medical Education. The Third Report of the Council Washington, DC U.S. Dept of Health and Human Services, Public Health Service, Bureau of Health Professions, 1992.
Council on Graduate Medical Education. Eleventh report: International medical graduates, the physician workforce and GME payment reform. Rockville, Md, U.S. Dept of Health and Human Services; 1998
Lohr K, Venselow N, Detmer D (ed): The Nation’s Physician’s Workforce: Options for Balancing Supply and Requirements, Washington, DC, National Academy press, 1996
Pew Health Professions Commission Staff. Primary Care Workforce 2000. Federal Health Policy Strategies. San Francisco, Pew Health Professions Commission, March 1993
Josiah Macy, Jr, Foundation. Annual Report. New York, NY: Josiah Macy, Jr, Foundation; 1992
Young JQ, Coffman JM: Overview of graduate medical education: funding streams, policy problems, and options for reform. West J Med 1998; 168(5): 428–436
Cunningham R: New York demo proving effective at cutting residencies. Med Health, 1998; 52: 1
Zuvekas SH, Regier DA, Rae DS, et al: The impacts of mental health parity and managed care in one large employer group. Health Aff (Millwood) 2002 21(3): 148–159
Goldman W, McCulloch J, Sturm R: Costs and use of mental health services before and after managed care. Health Aff (Millwood) 1998; 7(2): 40–52
Nyapati, Rao: International medical graduates, in Handbook of Psychiatric Education and Faculty Development. Edited by Kay J, Silberman E, Pessar L. Washington, DC, American Psychiatric Press Inc, 1999
Balon R, Franchini GR, Freeman PS, et al: Medical students’ attitudes and views of psychiatry: 15 years later. Acad Psychiatry 1999; 23: 30–36
Nielsen AC, Eaton JS: Medical students’ attitudes about psychiatry. Implicatioins for psychiatric recruitment. Arch Gen Psychiatry 1981; 38: 1144–1154
Sierles FS, Taylor MA: Decline of U.S. medical student career choice of psychiatry and what to do about it. Am J Psychiatry 1995; 152: 1416–1426
Fiefel D, Moutier CY, Swerlow NR: Attitudes toward psychiatry as prospective career among students entering medical school. Am J Psychiatry 1999; 156: 1397–1402
Mick SS, Pfahler MN: Review and Synthesis of the literature on Foreign Medical Graduates/International Medical Graduates, 1980–1994. Report to the Bureau of Health Professions, Health Resources and Services Administration, United States Department of Health and Human Services. 1995; 94–961
Rao NR, Meinzer AE, Manley M, et al: International medical students’ career choice, attitudes toward psychiatry, and emigration to the United States: examples from India and Zimbabwe. Acad Psychiatry 1998; 22: 117–126
Whalen G: High stakes medical performance testing: the clinical skills assessment program. JAMA, 2000; 283: 1748
Whelan G, Gary N, Kostis J, et al: The changing pool of international medical graduates seeking certification training in U.S. graduate medical education programs. JAMA 2002; 288: 1079–1084
Gary NE, Sabo MM, Sharfron ML, et al: Graduates of foreign medical schools: progression to certification by the educational commission for foreign medical graduates. Acad Med 1997; 72: 17–22
The ECFMG Reporter June 8, 2001
Whitcomb ME, Miller RS: Participation of international medical graduates in graduate medical education and hospital care for the poor. JAMA 1995; 274: 696–699
Blanco C, Carvalho C, Olfson M, et al: Practice patterns of International and U.S. medical graduate psychiatrists. Am J Psychiatry 1999; 156: 445–450
Foreign physicians. Exchange Visitor Program becoming major route to practicing in US underserved area (Letter report 12/30/96. GAO/HEHS-97-26)
Cooper RA: There’s a shortage of specialists: is anyone listening? Acad Med 2002 77: 761–766
Greene J: Now forecast is for shortage of physicians. AM News Jan 2002
Goldman W: Economic grand rounds: is there a shortage of psychiatrists? Psychiatr Serv 2001; 52: 1587–1589
Ivey SL, Scheffler R, Zazzali JL: Supply dynamics of the mental health workforce: implications for health policy. The Mil-bank Q 1998; 76: 25–58
Author information
Authors and Affiliations
Corresponding author
Additional information
The author thanks Joel Yager, M.D. and Larry Faulkner, M.D. for reading the paper and making suggestions and Arthur Meinzer, Ph.D. for his statistical analysis.
Rights and permissions
About this article
Cite this article
Rao, N.R. Recent Trends in Psychiatry Residency Workforce With Special Reference to International Medical Graduates. Acad Psychiatry 27, 269–276 (2003). https://doi.org/10.1176/appi.ap.27.4.269
Published:
Issue Date:
DOI: https://doi.org/10.1176/appi.ap.27.4.269