Original Investigation|Articles in Press

International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues

      Rationale and Objectives

      The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them.

      Materials and Methods

      We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered.


      We received responses from 121 of 195 (62.1%) DR programs (121/149 = 81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs’ issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork.


      Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas.

      Summary Sentence

      Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.


      ACGME (Accreditation Council of Graduate Medical Education), DR (diagnostic radiology), ECFMG (Educational Commission for Foreign Medical Graduates), GME (Graduate Medical Education), IR (interventional radiology), NRMP (National Residency Match Program), PD (program director), RSNA (Radiology Society of North America), URiM (under-represented in medicine), USCIS (United States Citizenship and Immigration Services), US DO (United States Doctor of osteopathy graduate), USMLE (United States Medical Licensing Examination), US MD (United States medical school graduate)

      Key Words

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      1. Program NRM. Charting outcomes in the match: international medical graduates characteristics of international medical graduates who matched to their preferred specialty in the 2022 main residency match: NRMP; 4th. Accessed Jan 8, 2023. Available at: 〈〉.

        • Pinsky W.W.
        The importance of international medical graduates in the United States.
        American College of Physicians, 2017: 840-841
        • Boland G.W.
        • Guimaraes A.S.
        • Mueller P.R.
        The radiologist’s conundrum: benefits and costs of increasing CT capacity and utilization.
        Eur Radiol. 2009; 19: 9-11
        • Ahmed A.A.
        • Hwang W.-T.
        • Thomas Jr, C.R.
        • et al.
        International medical graduates in the US physician workforce and graduate medical education: current and historical trends.
        J Grad Med Educ. 2018; 10: 214-218
      2. Association AM. AMA Physician Masterfile: AAMC. Accessed Sep 10, 2022. Available at: 〈〉.

      3. DL L. National Resident Matching Program, Results and Data: 2022 Main Residency Match® The Match: National Resident Matching Program, 2022. Accessed Jan 8, 2023. Available at: 〈〉.

        • Hall T.R.
        • Brown K.
        Diversity in radiology: the right thing to do, the smart thing to do.
        Pediatr Radiol. 2022; 52: 1711-1718
        • Boulet J.R.
        • Duvivier R.J.
        • Pinsky W.W.
        Prevalence of international medical graduates from muslim-majority nations in the US physician workforce from 2009 to 2019.
        JAMA Netw Open. 2020; 3e209418
        • Norcini J.J.
        • van Zanten M.
        • Boulet J.R.
        The contribution of international medical graduates to diversity in the US physician workforce: graduate medical education.
        J Health Care Poor Underserved. 2008; 19: 493-499
        • David Y.N.
        • Issaka R.B.
        Advancing diversity: the role of international medical graduates.
        Lancet Gastroenterol Hepatol. 2021; 6 (PMID: 34774151; PMCID: PMC8813365): 980-981
        • Verma V.
        • Shah C.
        • Lautenschlaeger T.
        • et al.
        International medical graduates in radiation oncology: historical trends and comparison with other medical specialties.
        Int J Radiat Oncol Biol Phys. 2016; 95: 1102-1106
        • Tommee C.G.
        • Nalleballe K.
        • Dandu V.
        • et al.
        Trends in demographics of neurology house staff in the United States.
        Cureus. 2021; 13 (Sep 6, PMID: 34659967; PMCID: PMC8493763): e17754
        • Duvivier R.J.
        • Wiley E.
        • Boulet J.R.
        Supply, distribution and characteristics of international medical graduates in family medicine in the United States: a cross-sectional study.
        BMC Fam Pract. 2019; 20: 1-8
        • Mahmood M.N.
        Diversity in dermatology: international medical graduates and their role in the diversity of a specialty.
        Clin Dermatol. 2022; 40: 549-553
        • Halpern J.A.
        • Al Awamlh B.A.H.
        • Mittal S.
        • et al.
        International medical graduate training in urology: are we missing an opportunity?.
        Urology. 2016; 95: 39-46
        • Al Ashry H.S.
        • Kaul V.
        • Richards J.B.
        The implications of the current visa system for foreign medical graduates during and after graduate medical education training.
        J Gen Intern Med. 2019; 34: 1337-1341
        • Alweis R.
        • Khan M.S.
        • Kuehl S.
        • et al.
        Internal medicine program directors' perceptions of the “all in” match rule: a cross-sectional survey.
        J Grad Med Educ. 2017; 9: 173-177
        • Kahn T.R.
        • Hagopian A.
        • Johnson K.
        Retention of J-1 visa waiver program physicians in Washington State's health professional shortage areas.
        Acad Med. 2010; 85: 614-621
        • Hagopian A.
        • Thompson M.J.
        • Kaltenbach E.
        • et al.
        Health departments’ use of international medical graduates in physician shortage areas.
        Health Aff. 2003; 22: 241-249
        • Abdel-Aziz Y.
        • Khan Z.
        • Barnett W.R.
        • et al.
        H-1B visa sponsorship and physician trainee retention: a single institution experience.
        J Grad Med Educ. 2020; 12: 217-220
        • Pignone M.
        US immigration paths for scientific researchers: part 3.
        MRS Bull. 2020; 45: 598-599
      4. Administration EaT. Permanent Labor Certification. In: LABOR USDO, ed. An official website of the United States government, 2022.

      5. Services USCaI. USCIS Updates Guidance on National Interest Waivers 2022. Accessed Jan 15, 2023. Available at: 〈,and%20thus%20the%20labor%20certification〉.

        • Woods S.E.
        • Harju A.
        • Rao S.
        • et al.
        Perceived biases and prejudices experienced by international medical graduates in the US post-graduate medical education system.
        Med Educ Online. 2006; 11 (PMID: 28253800): 4595
        • Mathews M.
        • Bourgeault I.
        • Ryan D.
        Perceptions of bias in the selection of international medical graduate residency applicants in Canada.
        Can Med Educ J. 2023;
        • Rozenshtein A.
        • Mullins M.E.
        • Marx M.V.
        The USMLE step 1 pass/fail reporting proposal: the APDR position.
        Acad Radiol. 2019; 26: 1400-1402
        • Carmody J.B.
        • Sarkany D.
        • Heitkamp D.E.
        The USMLE step 1 pass/fail reporting proposal: another view.
        Acad Radiol. 2019; 26: 1403-1406
        • Mullan F.
        • Politzer R.M.
        • Davis C.H.
        Medical migration and the physician workforce: international medical graduates and American medicine.
        JAMA. 1995; 273: 1521-1527
        • Wadhwa V.
        • Vilanilam G.K.
        • Chhabra A.
        • et al.
        A 15-year analysis of international medical graduates matching into diagnostic radiology residency programs in the United States.
        Acad Radiol. 2022; 29: 137-143
        • Vilanilam G.K.
        • Wadhwa V.
        • Tomblinson C.M.
        • et al.
        Trends in neuroradiology fellowship match in the United States: analysis of the 13-year National Resident Matching Program Data.
        Curr Probl Diagn Radiol. 2021; 50: 831-834
        • Cannavale A.
        • Santoni M.
        • Mancarella P.
        • et al.
        Malpractice in radiology: what should you worry about?.
        Radiol Res Pract. 2013; 2013: 1-10
        • Studdert D.M.
        • Bismark M.M.
        • Mello M.M.
        • et al.
        Prevalence and characteristics of physicians prone to malpractice claims.
        N Engl J Med. 2016; 374: 354-362
        • England R.W.
        • Lugossy A.-M.
        • Mollura D.J.
        Increasing opportunities for trainees to engage in global health radiology: radiology in training.
        Radiol Soc N Am. 2021; 300: E320-E322
        • Tseng J.R.
        • Kang Y.S.
        • Youm J.
        • et al.
        Radiology resident selection factors predict resident performance.
        Clin Imaging. 2021; 80: 225-228
        • Choi H.H.
        • Clark J.
        • Jay A.K.
        • et al.
        Minimizing barriers in learning for on-call radiology residents—end-to-end web-based resident feedback system.
        J Digit Imaging. 2018; 31: 117-123
        • Huda F.
        • Rozenshtein A.
        • Bedi H.
        The American Board of Radiology's alternate pathway for diagnostic radiology: what the programs and the applicants need to know.
        Acad Radiol. 2022; 29: 465-468
      6. (ACP) ACoP. The role of international medical graduates in the US physician workforce 2008. Accessed Jan 15, 2023. Available at: 〈〉.

        • Johnson T.P.
        • Wislar J.S.
        Response rates and nonresponse errors in surveys.
        JAMA. 2012; 307: 1805-1806
        • Lawn S.D.
        • Brooks S.V.
        • Kranzer K.
        • et al.
        Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the xpert MTB/rif assay: a prospective study.
        PLoS Med. 2011; 8
        • Bennett C.
        • Khangura S.
        • Brehaut J.C.
        • et al.
        Reporting guidelines for survey research: an analysis of published guidance and reporting practices.
        PLoS Med. 2011; 8
      7. SACM. Graduate Medical Education 2020. Accessed Feb 15, 2023. Available at: 〈〉.