International Medical Graduates in Anesthesiology and Surgery

International Medical Graduates are physicians who complete their basic medical training outside the United States and Canada. Starting July 1, 2025, Canadian graduates will also be classified in this category. Before they can practice in the U.S., these physicians must pass medical science examinations (USMLE Step 1 and Step 2 CK), demonstrate English proficiency through the Occupational English Test (OET) Medicine, and graduate from an Educational Council for Foreign Medical Graduates (ECFMG) approved four-year program. International medical graduates represent approximately 25% of the U.S. physician workforce, including significant representation in anesthesiology and surgery.

The global shortage of healthcare workers provides important context for the migration of physicians between countries, especially into high-income countries (HICs). In 2006, the World Health Organization estimated a shortage of around 4.3 million healthcare professionals globally, with 75 countries having fewer than 2.5 healthcare workers per 1,000 people—the minimum needed to provide basic services (WHO 2006). That estimate has risen to a shortage of 11 million by 2030 due to chronic under-investment in education and training (WHO 2025). The loss of trained professionals represents not only a reduction in workforce for low- and middle-income countries (LMICs) but also a financial loss, as investments in training shift to the benefit of receiving countries (Gathercole 2003). Kenya, for example, is estimated to lose over $500,000 for every emigrating doctor and $300,000 for each emigrating nurse (Kirigia et al., 2006). According to one study, the U.S. saved an estimated $846 million by recruiting foreign-trained doctors (Mills et al., 2011).

Political stability and national prosperity are associated with better healthcare worker retention (Clemens & Pettersson 2008). Conversely, emigration is driven by factors like political instability, poor working conditions, and limited medical resources (Dywili et al., 2013). Aluttis et al. (2014) noted that many HICs rely heavily on LMIC-trained healthcare professionals, particularly during times of economic uncertainty, potentially intensifying strain on under-resourced countries.

To enter U.S. residency programs, international medical graduates must match through the National Resident Matching Program (NRMP), a competitive process requiring high exam scores, U.S. clinical experience, and research credentials. Match data from 2024 showed a match rate of 61% (14,772 applicants) among this group, compared to 93.5% for U.S. MDs (19,755 applicants) and 92.3% for DOs (8,033 applicants).

U.S.-citizen international doctors filled 8.3% of available residency positions. Family medicine (14.3%), OB/GYN preliminary programs (11.1%), emergency medicine (10.7%), and internal medicine (10.6%) saw the highest percentages of matches. In anesthesiology, the U.S.-citizen international medical graduate match rate was 30% (3.3% of total anesthesiology positions), while in surgery specialties, the match rate was 27.8%, accounting for 2.6% of all surgical training spots.

Non-U.S.-citizen international doctors filled 15.2% of available residency positions. Their strongest representation was in pediatrics (50.8%), pathology (27.2%), radiation oncology (25%), and neurology (23.2%). In anesthesiology, the match rate for non-U.S. international medical graduates was 33% (4.7% of positions), while in surgery specialties, they matched at a rate of 30.2% (5.9% of positions).

During the Supplemental Offer and Acceptance Program (SOAP), international medical graduates represented more than two-thirds (67.6%) of all SOAP-eligible applicants. Collectively, they filled 30% (724 of 2,399) of SOAP positions in 2024.

Despite their countless contributions, these doctors often face challenges in the U.S. healthcare system, including language barriers, visa issues, and limited mentorship. Bias during interviews and credentialing may also impact success. Such physicians are underrepresented in academic leadership, likely due to initial placements in underserved areas with fewer advancement opportunities.

International medical graduates remain essential to the U.S. healthcare system, especially in anesthesiology and surgery where demand is high. Continued policy support and international cooperation are necessary to maintain a balanced and ethical global workforce.

References

 Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context: global shortages and international migration. Glob Health Action. 2014;7:23611. doi:10.3402/gha.v7.23611

 Clemens MA, Pettersson G. New data on African health professionals abroad. Hum Resour Health. 2008;6:1. doi:10.1186/1478-4491-6-1

Dywili S, Bonner A, O’Brien L. Why do nurses migrate? A review of recent literature. J Nurs Manag. 2013;21(3):511–520. doi:10.1111/j.1365-2834.2011.01318.x

Gathercole G. Free movement of professionals: opening up opportunities or perpetuating problems? European Public Health Alliance. 2003;Update No. 62.

Kirigia J, Gbary A, Muthuri L, Nyoni J, Seddoh A. The cost of health professionals’ brain drain in Kenya. BMC Health Serv Res. 2006;6:89. doi:10.1186/1472-6963-6-89

Mills EJ, Kanters S, Hagopian A, et al. The financial cost of doctors emigrating from sub-Saharan Africa: human capital analysis. BMJ. 2011;343:d7031. doi:10.1136/bmj.d7031

National Resident Matching Program. Results and Data: 2024 Main Residency Match. Washington, DC: National Resident Matching Program; June 2024. Accessed May 6, 2025. https://www.nrmp.org/match-data/2024/06/results-and-data-2024-main-residency-match/

World Health Organization. The World Health Report 2006: Working Together for Health. Geneva, Switzerland: World Health Organization; 2006.

World Health Organization. Health workforce. World Health Organization. Accessed May 6, 2025. https://www.who.int/health-topics/health-workforce#tab=tab_1