Is the Need for Foreign Graduates Changing?

International medical graduates (IMGs)—physicians with degrees from foreign medical schools—may be facing some fundamental challenges in their role in the US healthcare system.

For more than half a century, there has been a mutually beneficial relationship between IMGs and the residency training system. Programs have more positions than US graduates, so IMGs are needed to fill in the gap. For their part, IMGs are attracted to a US healthcare system that may often be more advanced than their own. Though many IMGs go back home after training, many others apply for residency positions to get into the US system.

IMGs have been able to count on a relatively abundant number of residency positions that can't be filled by US graduates. In academic year 2014-2015, for example, there were 21.7% more slots than US seniors, according to a November 2015 report[1] published by some top physician-supply experts in the New England Journal of Medicine.

In the future, however, it may be harder for IMGs to get those positions, owing to a huge increase in the number of US medical school graduates, the authors wrote. Since 2002, 16 new allopathic and 15 new osteopathic medical schools have opened in the United States, and many existing schools have expanded class sizes. By the time all of the new US students get through the pipeline, medical school enrollment in the states will have risen by almost 50%, they wrote.

The problem for IMGs is that it's hard to grow the number of residency positions to meet this surge, so that they can have the same number of slots as before. Medicare, the chief funder of residency positions, hasn't increased the number of funded positions since 1997.

However, the situation for IMGs isn't as dire as many people think, the authors reported. Although Medicare lags, other funding sources are stepping up to the plate. For example, a bill passed by Congress in 2014 to reform the Veterans Health Administration will provide 1500 more training slots. As a result, the authors forecasted that the proportion of slots available to non-US graduates would indeed shrink, but is far from disappearing—dropping from 21.7% of positions in 2014-2015 to 13.5% by 2023-2024.

So far, however, the big squeeze on IMGs has yet to materialize. The National Resident Matching Program reported[2] that the 2015 Match offered a record number of positions and was the best ever for IMGs, and the match rate for US-citizen IMGs was the highest since 2005.

But as US schools continue to increase their graduating classes, IMGs are expected to feel the pinch. Furthermore, IMGs from many foreign schools could become completely locked out of the US system in the next decade. The Educational Commission for Foreign Medical Graduates (ECFMG) has announced[3] that in 2023, it will require all applicants to have graduated from schools that have been accredited by standards that are equivalent to those used for US schools. To achieve this standard, the ECFMG will be evaluating accreditors for hundreds of schools around the world.