While their value to the U.S. health system has gained recognition—particularly for providing care to communities with limited access to health services during the COVID-19 public health emergency—international medical graduates (IMGs) often must overcome regulatory and cultural obstacles before they are able to provide those essential services.
“The progress we have made is monumental, but we have much more work to do to make sure the IMGs have the same support given to them as they give to their patients,” said AMA Board of Trustees Chair Michael Suk, MD, JD, MPH, MBA.
“Unfortunately, most physicians trained abroad seeking work in the United States period face different barriers,” said Dr. Suk, a practicing orthopaedic surgeon and chair of the Musculoskeletal Institute at the Geisinger integrated health system in rural Pennsylvania. “There are difficulties navigating entrance into the U.S. and so many IMGs report discrimination and mistreatment.”
Geisinger is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Supporting access to advancement
Dr. Suk spoke at an AMA Center for Health Equity open forum education session held as part of the 2024 AMA Annual Meeting in Chicago.
“IMGs make up about a quarter of our nation's physician workforce,” Dr. Suk said. “The past four years have seen a year-to-year increase in Match rates among IMGs. This past year saw more than 9,000 IMGs matched to U.S. residencies, compared to about 7,000 in the year 2020.”
Dr. Suk noted that he is sensitive to this issue as his father came to the U.S. as an IMG in 1965 after matching into an orthopaedic residency program, and he listed several ways the AMA is advocating for IMGs.
“Our AMA recognizes substantial interpersonal institutional and policy changes are required to change and create inclusive educational and employment experiences for IMGs in the United States,” Dr. Suk said. “We will continue to support equitable access to career advancement opportunities by IMGs by opposing discriminatory use of filters and GME admissions, improving opportunities for robust mentorship and including IMG voices in our antidiscrimination work with employers.”
AMA advocacy on behalf of IMGs includes supporting “expansion and permanence” of the Conrad State 30 and Physician Access Reauthorization Act (PDF), which would reauthorize the Conrad 30 waiver policy for an additional three years. The Conrad 30 program allows resident physicians working in the U.S. on J-1 visas to remain in the U.S. without having to return to their home country if they agree to practice in an underserved area.
Earlier this year, the AMA was part of a coalition of more than 50 physician and health care organizations that voiced their support (PDF) for the Healthcare Workforce Resilience Act. This legislation would initiate a one-time recapture of up to 40,000 unused employment-based visas—25,000 for foreign-born nurses and 15,000 for foreign-born physicians—so they can strengthen and provide stability to the U.S. health care system.
Dr. Suk also mentioned the IMG physician toolkit developed by AMA that contains resources to help IMGs expand their opportunities in the U.S, including information about residency training, visas, licensure and financial planning.
“Within our AMA, we've seen the growth of IMGs in our council and section leadership positions over the last decade,” he noted. “That being said, representation among delegates and board members have remained flat. Only two members of the AMA board identified as IMGs in the last few decades.”
As part of the 2024–2025 AMA Organizational Strategic Plan to Advance Health Equity, the AMA produced an educational primer on IMGs (PDF). The document centers on IMGs and their expertise, experiences and priorities. It notes that IMGs can ease escalating physician shortages and worsening specialty and geographic maldistribution even as they face daunting challenges entering and operating within U.S. labor markets.
“Despite IMGs having higher U.S. Medical Licensing Examination scores and equivalent surgical outcomes, a two-tiered educational system systematically disadvantages and segregates medical students based on country of medical education,” the primer says.
Imposter syndrome is real
Two physicians who helped develop the IMG toolkit, Natalia Solenkova, MD, PhD, and Ricardo Correa, MD, EdD, participated in a panel discussion and elaborated on the issues raised by Dr. Suk. Also on the panel were George Abraham, MD, MPH, and Tani Malhotra, MD. All are AMA members.
Dr. Solenkova, a critical care specialist in Florida, is the immediate past chair of the AMA International Medical Graduates Section (AMA-IMGS), which is comprised of more than 40,000 IMG physicians and represents the interests of physicians who have obtained their medical school education outside the United States.
She noted that IMGs include anyone who graduated from a medical school outside of the U.S. or Canada, including U.S. citizens who went to medical school abroad.
“We're the driver of health equity to the communities which would not have health care if they didn't have IMG physicians,” Dr. Solenkova said.
She also told of her experience in applying for more than 200 internal medicine residency programs, for which she paid a lot of money only to “get a lot more rejections than interviews.”
Fortunately, she did match on her second attempt, but the experience left her with feelings of self-doubt that many IMGs face.
“Many of us struggle with what has been said here: imposter syndrome, a sense of not belonging, or being not good enough, or always trying to prove that we do belong,” Dr. Solenkova said.
Dr. Abraham, immediate past president of the American College of Physicians and chair-elect of the Federation of State Medical Boards, said his first try for a residency match left him wondering if he had an “overinflated appreciation” of his own merits.
“At that time, I took it quite personally, thinking that there must be something wrong with me,” he said.
A professor of medicine at the University of Massachusetts Medical School, Dr. Abraham said there used to be “reputational pressure” on residency programs to not choose IMG residents.
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“If you're taking an IMG, it meant you didn't get enough U.S. grads and so there must be something wrong with your program,” he said. “To a lesser extent, that still happens today, 30 years later. So there's definitely an inequity that we need to correct—which is the perception that IMGs are sort of a fallback option when you couldn't get plan A or plan B to come to your place.”
Dr. Correa, an endocrinologist who serves on the AMA Council of Medical Education, recalled being laughed at when he accidentally used a Spanish word instead of its English counterpart while presenting his first case as an internal medicine resident in Miami.
“I realized that that was really a microaggression,” he said.
Dr. Malhotra, who chairs the AMA-IMGS Governing Council, noted that “microaggressions are constant.”
She is now a maternal-fetal medicine physician and assistant professor of reproductive biology at the Case Western Reserve University School of Medicine. But a decade ago, she was struggling to find somewhere to train—despite graduating at the top of her class at the American University of Antigua College of Medicine.
“I applied to 142 programs, got seven interviews and didn't match,” Dr. Malhotra said. “It was devastating.”
In addition to her medical training, Dr. Malhotra said she feels as though she has “this additional expertise in immigration law that I never hoped I would have.”
She recalled how she had to leave her husband (and dog) behind in Cleveland and return to Canada in “exile” for three months because the state of Ohio delayed its J-1 waiver review process.
Supporting IMG voices
“It’s time to surface these issues,” Padmini Ranasinghe, MD, MPH, chair-elect of the AMA Council on Science and Public Health, said during the forum’s audience Q&A segment.
Dr. Correa agreed, and he noted how he attended his first AMA meeting as an intern and found the AMA House of Delegates to be like “a huge family that was very supportive” that helped give him a voice as he struggled with feeling like “am not as good as the rest.”
“Many of us suffer the same thing,” he said. “We have to change that because we are equal.”
Learn more about how the AMA supports IMGs by watching this episode of the “AMA Prioritizing Equity” video series.
