Selecting international medical graduates (IMGs) for training in US surgical residencies.

Training individuals who completed their medical education outside the United States, the socalled “International Medical Graduates” (IMGs), is an issue of growing importance. IMGs continue to fill vital positions not taken by US medical school graduates. In fact, Whitcomb et al reported that 12% of general surgery residency programs were “IMG dependent.” In the 2005 match, 9% of the 2382 general surgery positions were filled by IMGs (7% of the categorical positions and 12% of the preliminary positions). Many IMGs are talented, knowledgeable, and highly motivated physicians who do very well in US residency programs. From the perspective of the American surgical workforce, 9% of IMG surgery graduates who remain in the United States enter academic practice, a percentage that compares favorably with the 13% of US residents who enter academic practice. For their native country they can represent either a major loss (“brain drain”) when they remain in the US, or a major gain when they return to their country of origin and set up new programs and systems. Graduates who return usually become prominent members of academic or community practices and, because of their advanced surgical education, reach positions of influence within their society. This allows the US to influence health care in developing nations and adds another dimension to the perspectives discussed above: that of continued leadership, relevance, and respect in the world at large.