International medical graduates’ contributions to psychiatry— a historical review

In high-income countries, international medical graduates (IMGs) constitute 20–31% of medical work force, especially in disciplines like psychiatry. Variations in countries of origin, languages in which they studied medicine, their religious affiliations, gender, sexual orientation, and so on, all tend to play a role in the process of acculturation and adjustment after migration in spite of resilience. IMGs are often placed in subspecialties and geographical locations that are unpopular with local graduates, thereby increasing their isolation. There is evidence to suggest that they tend to work harder and yet are more likely to be reported to the regulators. High-income countries often for their short-term benefits tend to recruit medical workforce from countries that can ill afford to lose them. Using the history of medicine in the USA as an example, this chapter highlights some of the challenges and proposes ways forward. The isolation and difficulties in acculturation may well contribute to poor mental health.