The role of international medical graduate psychiatrists in the United States healthcare system.

OBJECTIVE: International medical graduates (IMGs) make up a substantial proportion of the United States physician workforce, including psychiatrists in practice. The purpose of this study was to describe, based on current data, the characteristics and qualities of IMG psychiatrists who provide patient care in the US. METHOD: Physician data from the Educational Commission for Foreign Medical Graduates, American Medical Association, and American Board of Medical Specialties were combined. Descriptive statistics provided an overview of the characteristics and qualities of IMG psychiatrists. The authors contrasted demographic and practice profiles of IMG and U.S. medical graduate (USMG) psychiatrists. RESULTS: International medical graduates make up almost one-third of the practicing psychiatrist workforce. Nearly one-quarter of these individuals attended medical school in India. Compared with USMG psychiatrists, IMG psychiatrists were more likely to be employed in a hospital and less likely to be Board-certified by the American Board of Psychiatry and Neurology. CONCLUSIONS: International medical graduate psychiatrists play an important role in the U.S. healthcare system. Given their numbers and their propensity to practice in settings and areas where USMGs do not, efforts to monitor their practice patterns and qualities, both cross-sectionally and longitudinally, are warranted.

A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness.

BACKGROUND: Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster. METHODS: The EWG conducted a systematic review of peer-reviewed and non-peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process. RESULTS: The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories. CONCLUSIONS: The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time.

Terrorism, our world and our way of life.

In this article, the author touches on a variety of threads relevant to a psychoanalytic approach to terrorism. He begins with a personal September 11 recollection, and then goes on to share some thoughts about terrorism from the vantage point of a citizen who retired from active military duty a little over a year ago. He then speculates about a possible psychoanalytic understanding of terrorists and their motivation, while acknowledging that terrorists too are individuals, and that no hypothesis can apply to an entire group, across the border. To illustrate his points, the author shares some vignettes from literature, biography, and philosophy. He then reflects on our post-September 11 roles as psychoanalysts or psychodynamic psychiatrists, but also as Americans.