title: The unkindest cut of all: are international medical school graduates subjected to discrimination by general surgery residency programs?
abstract: OBJECTIVE
  International medical school graduates (IMGs) have been part of the United States residency applicant pool for several years. There has been increasing discussion of an overproduction of doctors in the United States, and mention of limiting IMG quotas. The purpose of this study was to find out if measurable discrimination existed real or perceived, against IMGs.
  
  
  METHODS
  A survey was performed to assess whether program directors of surgery residencies perceive the performance, dedication, and abilities of IMGs as being equal to United States medical school graduates (USMGs), and whether program directors believe that a preference toward USMGs exists. Surveys with 30 tailored questions were mailed to all members of the Association of Program Directors in Surgery. One hundred twenty-five surveys were returned out of 283 mailed, and 112 were included in the data analysis. Besides those relating to demographics, questions on the survey included two series of queries. One set was designed to assess whether the respondent reported that IMGs possessed similar skills and abilities as USMGs, whereas the other addressed whether respondents perceived a tendency in their programs to focus recruitment toward USMGs. Still others were inserted to confirm results of these series, and to assess whether program directors perceived discrimination toward IMGs in general.
  
  
  RESULTS
  Survey results indicate the perception that IMGs are similar in skill and ability to USMGs, regardless of program size. However, a perception existed among program directors that USMGs were favored in the recruitment process, with more than 70% of respondents indicating that they believed IMGs were discriminated against. Furthermore, nearly 20% reported that they had been pressured to rank a less-qualified USMG higher than a more qualified IMG, and 22% reported that they had ranked a USMG higher than an IMG to avoid a reduced compliment of USMGs.
  
  
  CONCLUSIONS
  There is a significant belief and perception that IMGs are indeed discriminated against, despite program directors seeing no clear differences in surgical skills between IMGs and USMGs.
authors.affiliation: Department of Surgery, Conemaugh Memorial Medical Center/Temple University, Johnstown, Pennsylvania, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Moore
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Rhodenbaugh