Letters to the Editor  |   October 2009
Do Not Exclude IMGs
Author Affiliations
  • Kenneth J. Steier, DO, MPH, MHA, MGH
    Southampton Pulmonary Associates, New York; Adjunct Clinical Professor, New York College of Osteopathic Medicine of New York Institute of Technology, Old Westbury
Article Information
Medical Education / Graduate Medical Education
Letters to the Editor   |   October 2009
Do Not Exclude IMGs
The Journal of the American Osteopathic Association, October 2009, Vol. 109, 554-555. doi:
The Journal of the American Osteopathic Association, October 2009, Vol. 109, 554-555. doi:
To the Editor:  
In recent years, there has been much discussion within the pages of JAOA—The Journal of the American Osteopathic Association,1-3 as well as other forums in the profession,4 regarding allowing allopathic medical school graduates to enter residency training programs approved by the American Osteopathic Association (AOA). 
Part of this ongoing discussion relates to including vs excluding international medical graduates (IMGs) from consideration by AOA-approved residency training programs.4 I would like to object—in the strongest possible terms—to the suggestion that IMGs be excluded from eligibility. 
First, excluding IMGs from AOA-approved residency training programs may lead to the misconception that the AOA is discriminatory with regard to IMGs—perhaps for reasons of race or ethnicity. 
Second, the osteopathic medical profession is a minority profession within the wider medical community. Excluding IMGs would propagate a type of professional discrimination similar to that we, as osteopathic physicians, have spent our careers fighting against. Such a policy would make us seem self-serving and hypocritical. 
Third, I have observed that many IMGs are hospital house staff who hold prominent positions, such as medical directors, board members, and physician organization leaders, at institutions where large numbers of osteopathic medical students train and where many osteopathic physicians work. Adoption of a policy that might be seen as unfairly discriminatory against IMGs could result in a backlash against these members of the osteopathic medical profession. 
Furthermore, there is no scientific rationale for a policy that singles out IMGs for exclusion from AOA-approved residency training programs, while potentially leaving the door open to US-trained allopathic graduates. Does anyone believe that graduates of Liaison Committee on Medical Education–accredited allopathic programs in the United States are any more “osteopathic” than IMGs? 
There is also no need for such an exclusionary policy in terms of lack of IMG qualifications. Many top allopathic-based hospitals accept IMGs into their residency training programs, and it is well known that many of these IMGs have excellent US Medical Licensing Examination scores. In addition, many of the foreign medical schools that have provided training to these individuals are considered “top notch” in the international medical community. 
My final reason for objecting to any policy that would exclude IMGs from AOA-approved residency training programs is that program directors should have the right to determine which students they will accept into their programs. Program directors should also have the right to decide the schools from which they will consider applicants and how to rank those applicants. 
I have previously had a letter published in the JAOA2 advocating acceptance of allopathic medical school graduates into AOA-approved residency training programs. I propose that allopathic trainees be eligible for any AOA-approved residency position that remains unfilled as of June 1 of each year—for a July 1 start date. In other words, osteopathic medical school graduates would have every opportunity to secure such residency positions before allopathic medical school graduates are accepted. 
Incidentally, as a former director of osteopathic medical education and an AOA-approved internal medicine residency program, all positions in my residency program were filled with DOs through the AOA Intern/Resident Registration Program (ie, AOA “Match”) and the post-Match scramble. 
It should be kept in mind that if any funded positions in AOA-approved residency training programs remain unfilled, those programs may be in jeopardy of losing their accreditation status. Also, as I mentioned previously,2 AOA-approved residency training programs are likely to face increased competition for residency positions from a growing number of allopathic medical school graduates. 
My main rationale for accepting allopathic graduates—including IMGs—into AOA-approved residency training programs is to keep as many of these programs and positions alive as possible. One day in the not-so-distant future, our profession may need these residency positions as increasing numbers of graduates of osteopathic medical schools seek the slots. 
Werrell BH. The “big DO” [letter]. J Am Osteopath Assoc. 2005;105:442-443. Accessed September 23, 2009.
Steier KJ. Time to accept allopathic physicians into AOA-approved residencies [letter]? J Am Osteopath Assoc. 2006;106:250-252. Accessed September 23, 2009.
Tatum WO IV. AOA needs to reach out more [letter]. J Am Osteopath Assoc. 2006;106:442-443. Accessed September 23, 2009.
American Association of Colleges of Osteopathic Medicine, American Osteopathic Association. Study on the impact of admitting MDs into OGME training programs. White paper developed in response to request from Medical Education Summit Progress Task Force; April(2009). ; Chicago, IL.