Separate but Equal? The Sorting of USMDs and Non-USMDs in Internal Medicine Residency Programs

Background The US internal medicine workforce relies on international and osteopathic medical graduates to fill gaps in residency. Little is known about the distribution and impact of IMGs, DOs, and USMDs concentrating in different types of IM programs. Objective Determining the extent to which USMDs, DOs, and IMGs concentrate in different types of IM programs and comparing Board pass rates by program concentration. Design, Settings, and Participants This survey study used data from the AMA’s FREIDA database for 476 non-military IM programs in 2017–2018, and 2016–2018 ABIM exam pass rates for 388 accredited programs. Measurements Outcomes were (1) program concentration based on percentage of residents who were USMDs, IMGs, and DOs in 2017–2018 and (2) 2016–2018 program ABIM pass rates as proxies for program quality. Key independent variables were hospital type (community-based, community-based university-affiliated, or university-based) when program concentration was the outcome, and program concentration when Board pass rates were the outcome. Results Twenty-five percent of programs were “USMD-dominated,” 17% were “DO-dominated,” 42% were “IMG dominated,” and 16% were “integrated.” The chances that a university hospital was USMD-dominated were 32 percentage points higher than that for a community hospital (AME = 0.32, baseline probability = 0.11, 95% CI, 0.17–0.46, P