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@NEJM Ask the Author & Experts: US-Citizen International Medical Graduates

Perspective

U.S.-Citizen International Medical Graduates — A Boon for the Workforce?

A recent report from the Institute of Medicine that called for reform of the financing and governance of U.S. graduate medical education has sparked controversy. Its most contentious aspect is its failure to call for more federal funding and more residency positions. Although the report acknowledges the reliance of the United States on a continuous stream of international medical graduates (IMGs) — who account for 27% of the trainees currently in U.S. residency programs — it includes no substantive discussion of IMGs. This omission appears to derive from ethical concerns about a “brain drain” of physicians from low-income countries. Yet the IMG pool includes a growing proportion of U.S.-citizen graduates of international medical schools, who now represent 38.5% of the IMG applicant pool and 13.7% of overall residency applicants. The number of these graduates achieving certification from the Educational Commission for Foreign Medical Graduates (ECFMG) increased from 527 in 1995 (9% of such certifications) to 2963 in 2013 (30%). More than three quarters of U.S. IMGs certified in 2013 graduated from for-profit, private medical schools located in the Caribbean.