Are “International” Medical Graduates Second-class Anesthesiologists?

To the Editor:—I read with keen interest the article published in the September 2001 issue of ANESTHESIOLOGY entitled “The Anesthesiologist in Critical Care Medicine,” especially since I am currently enrolled in a critical care fellowship after having completed my anesthesiology residency. I agree for the most part with the positions of the authors, especially regarding the profound difference between the situation in the United States, where anesthesiologists have all but abandoned the field of critical care medicine, and that in Europe, where they are at the forefront of it. However, I was appalled to see that the main criterion used by the authors to evaluate the success of a discipline, such as otorhinolaryngology, is the reduction in the number of “international” medical graduates. This hypocritical denomination aside (what was wrong with “foreign”?), I feel that in a country whose success stems in great part from diversity and in which discrimination is illegal, residency candidates should be evaluated on their abilities and their character, not based on where they attended medical school. Evidence of discrimination in resident recruitment has been found in other specialties. I do not think that the education I received in a French medical school is in any way inferior to the one that students get in this country. If there are any objective data that show that “international” medical graduates are not as good physicians as their American-educated counterparts or that the patients they treat have worse outcomes, more complications, longer lengths of stay, or higher expenditures, I would like to be made aware of it. Until such time, I feel that it is unfairly biased to consider that a specialty fares better or worse based on the number of “international” medical graduates entering residency programs.