International medical graduates in general surgery: increasing needs, decreasing numbers.

BACKGROUND The current residency training system in the United States (US) has inherent dependence on the international medical graduate (IMG). This article discusses the physician workforce shortage, especially related to general surgery, and examines the distribution of IMGs in general surgery ranks. STUDY DESIGN We performed a cross-sectional study using the American Medical Association Masterfile database of physicians licensed to practice in at least 1 state and determined the number and location of general surgeons in practice. We then stratified the distribution of these practicing surgeons, both IMGs and non-IMGs, according to rural urban commuting areas into small rural, large rural, or urban areas. RESULTS There were 17,727 general surgeons. IMGs were older (52 +/- 8 years versus 47 +/- 8 years; p < 0.001), more likely to be male (93% versus 82%; p < 0.001), and more likely to be further out of training (46% versus 28% > or =20 years out of training; p < 0.001). There were 2,216 IMGs in urban cores, constituting 15% of general surgeons in these areas. Large rural areas contained 223 IMGs (12% of general surgeons in these cores) and small rural areas contained 163 IMG general surgeons (16% of total general surgeons in these cores). CONCLUSIONS General surgeons are in high demand, and until now have remained inherently dependent on IMGs to reinforce their ranks. Current numbers of IMGs in practice are declining. This decline, coupled with inadequate numbers of trainees in domestic general surgery programs, creates a crisis of urgency.