Before we discuss the impact of IMGs, lets face the facts. America is experiencing a shortage of physicians. This situation may even get worse with time. This shortage is responsible for the hiring of international medical graduates (IMGs) by the United States health care system to meet the physician demand for her people.

Who are International medical graduates? Before I let you know who the IMGs are, here are the highlights of this article.

  • International Medical Graduates (IMGs)
  • Certification of IMG to enter United States health workforce.
  • Current situation of Health Care Workforce in the US
  • Impact of IMGs in US health care

International Medical Graduates

An International Medical Graduate is a person who has studied medicine and graduated from a recognized medical school found in any country other than the United States and Canada. These graduates play a key role in the quality of health care in the United States.

a diverse group of doctors meeting president obama

IMGs represent 26% of practicing physicians and 24% of residents in specialty programs. Majority of IMGs (about 80%) are engaged in primary care specialties, and sixteen percent are involved in advancing their academics. A significant number of IMGs move to states like New York, New Jersey, Illinois, Florida, and California. Although many countries offer medical education, Pakistan, India, Mexico, Philippines, and the Dominican Republic are the top five countries that provide best medical training.


Certification of IMGs to Practice in the United States

It is not easy for an IMG physician to practice in the United States. An IMG must meet several requirements and go through a thorough systemic process to ensure that he or she acquires the same level of training needed for practicing medicine in the US.

An IMG must have had undergone a four-year or more medical training in a medical school listed in the International Medical Education Directory (IMED) of the Foundation for Advancement of International Medical Education and Research (FAIMER). The IMG’s readiness is assessed by the Educational Commission for Foreign Medical Graduates (ECFMG) before entering residency or fellowship programs in the US. The Accreditation Council for Graduate Medical Education (ACGME) awards accreditation to these programs

ECMFG Certification is also a requirement for medical licensing. It is one of the conditions needed to take the United States Medical Licensing Examination (USMLE). USMLE is sponsored by the National Board of Medical Examiners (NBME) and the Federation of State Medical Boards (FSMB). The exam consists of three parts: Step 1, Step 2 and Step 3.

The first Step tests the basic knowledge of your medical science, Step 2 checks your clinical knowledge and clinical skills while Step 3 is the final examination that puts more emphasis on how you manage a patient and conduct yourself in the ambulatory setting unsupervised.

The USMLE examination is a must have for both US medical graduates and international medical graduates who wish to practice medicine on the American soil.

Current Situation of Physician Workforce in the US

The United States have an inadequate number of physicians. Furthermore, this shortage may increase in the coming years. American Association of Medical Colleges (AAMC) expects that the U.S. will experience a shortage of up to 120,000 physicians by the year 2030. This shortage if not solved, will have a significant health impact on America’s population, which will continue to grow.

The AAMC’s report indicates that the shortage manifests in 4 broad categories: surgical specialties, medical specialties, primary specialties, and other specialties. Here is a table showing the estimated deficit of physicians by the year 2030. The impact of IMGs on these areas is literally lifesaving.

Specialty Estimated shortage of Physicians by 2030
primary care physicians between 14,800 and 49,300
in non-primary care between 33,800 and 72,700


Why this Gap?

By 2030 the US population will grow by almost 11%. Half of the U.S. population will be over 65 in the next decade. The growing population will lead to an increase in physician’s workforce demand. Also, the aging population will reduce physicians supply. Majority of the physicians will be over 65 by 2030 and planning to retire soon. This will make the impact of IMGs even more obvious.

Another factor that contributes to the physician’s workforce shortage is the changing work habits of new physicians. We will miss an estimated equivalent of 40,000 physicians because of younger physicians wanting to work five fewer hours per week. The decrease in the number of physicians’ workforce will result into an increase in the number of patients especially in two groups of people: previously uninsured individuals who seek care under the Affordable Care Act and with baby boomers retiring in large numbers.

IMGs are necessary for reducing the physicians’ workforce shortage. The United States health care systems must, therefore, rely on them in providing health care services primarily in the following health specialties that are in high demand:

  • Internal medicine
  • Family medicine
  • Pediatrics

Impact of IMGs in US Health Care

One-third of all U.S. physician workforce are IMGs. They are the key to providing primary care in underserved and rural areas. If you were to do away with all the IMGs physicians in primary care, then we would see a 44.4% rise in the shortage of physicians in rural counties.

an african american doctor talking to an asian couple

IMGs are essential in United States Critical access hospitals (CAH). One or more IMGs are part of CAH’s medical staff, and the majority are internists. They also make up more than ½ of the medical staff at 16% of CAHs.

IMGs can help reduce cultural and language barriers in a diverse and multiethnic population. IMGs come from different countries hence are of different race and ethnic makeup which is relative to the U.S population. Generally, IMGs find it comfortable practicing in communities matching their own ethnicity.

A debate about how long should IMGs work in rural and underserved areas exists. However, the majority of IMGs often work for a minimum of 3 years. This is the period they use to complete various requirements for the visa-waiver program.

Even though IMGs Physicians are in such increasing demand, they must go through a strict U.S. training program and a complicated and often confusing immigration/visa process. All IMGs must also complete an accredited residency training program in the U.S. or Canada, a process that takes at least three years.


IMGs are equally skilled as the US doctors. Do you think IMGs physicians should be allowed to provide highly specialized health care services? Let us know in the comment section below.